The current sociocultural background of eating disorders.

Eating disorders (EDs) are complex phenomena that are partly influenced by sociocultural factors. The thin body ideal of Western civilization, disseminated by mass media and reinforced by the fashion industry, plays a significant role. In this cultural environment, the social perception of the human body has undergone a change.

[The role of dietitians in the care of patients with eating disorder].

Dietitians play an important role in the care of patients with eating disorders. However, the precise conditions are not yet defined. This limits the clarity of the role of the dietitian within the dietetic profession as well as in a broader sense among the health care providers. In Hungary, there is no comprehensive guideline on it yet, so the aim of the present paper is to clarify the role, tasks, and competence boundaries of the dietitians. First, we provide guidance for the recognition of eating disorders by overviewing the symptoms, the diagnostic criteria, and the most important aspects of biopsychosocial assessment. Second, we take stock of the tasks of the dietitian, as a member of the therapeutic team in the treatment of eating disorders in outpatient and inpatient settings.

Concurrent and Prospective Associations of Reward Response with Affective and Alcohol Problems: ADHD-Related Differential Vulnerability.

Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder. Data on the role of transdiagnostic, intermediate phenotypes in ADHD-relevant characteristics and outcomes are needed to advance conceptual understanding and approaches to precision psychiatry. Specifically, the extent to which the association between neural response to reward and ADHD-associated affective, externalizing, internalizing, and substance use problems differ depending on ADHD status is unknown. Aims were to examine, in 129 adolescents, whether concurrent and prospective associations of fMRI-measured initial response to reward attainment (relative to loss) with affectivity and externalizing, internalizing, and alcohol use problems differs between youth at-risk for (i.e., subclinical) (n = 50) and not at-risk for ADHD. Adolescents were, on average, 15.29 years old (SD = 1.00; 38% female), 50 were at-risk for (Mage = 15.18 years, SD = 1.04; 22% female) and 79 not at-risk for (Mage = 15.37 years, SD = 0.98; 48.1% female) ADHD. Both concurrent and prospective relations differed given ADHD risk: across analyses, in at-risk youth, greater superior frontal gyrus response was associated with lower concurrent depressive problems but in not at-risk youth, these characteristics were not related. Controlling for baseline use, in at-risk youth, greater putamen response was associated with greater 18-month hazardous alcohol use, whereas in not at-risk youth, greater putamen response was associated with lower use. Where in brain and for which outcomes modulate (direction of) observed relations: superior frontal gyrus response is relevant for depressive problems whereas putamen response is relevant for alcohol problems and greater neural responsivity is linked to less depressive but to more alcohol problems in adolescents at-risk for ADHD and less alcohol problems in adolescents not at-risk. Differences in neural response to reward differentially confer vulnerability for adolescent depressive and alcohol problems depending on ADHD risk.

Adolescent ADHD and electrophysiological reward responsiveness: A machine learning approach to evaluate classification accuracy and prognosis.

We evaluated event-related potential (ERP) indices of reinforcement sensitivity as ADHD biomarkers by examining, in N=306 adolescents (Mage=15.78, SD=1.08), the extent to which ERP amplitude and latency variables measuring reward anticipation and response (1) differentiate, in age- and sex-matched subsamples, (i) youth with vs. without ADHD, (ii) youth at-risk for vs. not at-risk for ADHD, and, in the with ADHD subsample, (iii) youth with the inattentive vs. the hyperactive/impulsive (H/I) and combined presentations. We further examined the extent to which ERP variables (2) predict, in the ADHD subsample, substance use (i) concurrently and (ii) prospectively at 18-month follow-up. Linear support vector machine analyses indicated ERPs weakly differentiate youth with/without (65%) - and at-risk for/not at-risk for (63%) - ADHD but better differentiate ADHD presentations (78%). Regression analyses showed in adolescents with ADHD, ERPs explain a considerable proportion of variance (50%) in concurrent alcohol use and, controlling for concurrent marijuana and tobacco use, explain a considerable proportion of variance (87 and 87%) in, and predict later marijuana and tobacco use. Findings are consistent with the dual-pathway model of ADHD. Results also highlight limitations of a dichotomous, syndromic classification and indicate differences in neural reinforcement sensitivity are a promising ADHD prognostic biomarker.

[Sexual development in childhood and adolescence].

Sex and gender are essential, inalienable characteristics of the human being permeating the biological, psychological, interpersonal, social, transcendental aspects of our existence. Human sexual development takes place in the context of physical, emotional, cognitive, and social development, beginning at conception and continuing throughout life. It is influenced by biological maturation and complex interactions of psychological, interpersonal, cultural factors and (physical) environmental conditions. Using a developmental-psychopathology approach, we summarise our under standing of the life course-specific features of sexual development, placing them in the broader context of development. We will address gender differences, the development of gender-related concepts, sexual orientation, gender identity, and the development of sexual behaviour at different stages of life. In the field of sexual development and gender, science is often pushed to its limits. It is important that professionals express their opinions and make their decisions with due caution and objectivity.

Frequency of disordered eating habits among fashion models.

OBJECTIVE: Sociocultural influences, including an increasing pressure for fashion models to maintain a thin body frame may be crucial in the development of eating disorders. The present study aimed to establish whether fashion models are more likely than non-models to develop eating disorders. METHODS: Female fashion models were selected by snowball sampling (n = 179, mean age: 25.9 SD = 4.70 years). They were compared with an age adjusted control group (n = 261, mean age: 25.0 SD = 4.97 years). Participants completed an online questionnaire containing the Eating Disorder Inventory. RESULTS: The average BMI of the fashion models was in the underweight range (mean BMI = 18.1 SD = 1.68). The BMI of the control group was significantly higher (mean = 22.1 SD = 4.23, p < 0.001). The frequency of simulated anorexia nervosa was 3.9% among the fashion models and 1.1% in the control group (p = 0.057). 14.6% of the models showed subclinical anorexia nervosa symptoms versus 2.7% in the control group (p < 0.001). The ratio of bulimia nervosa and subclinical bulimia nervosa showed no significant difference between the two groups. CONCLUSION: Female fashion models showed no significant difference from the control group in the frequency of anorexia nervosa and bulimia nervosa but had a significantly higher frequency of the subclinical form of anorexia nervosa.

Reliability of reward ERPs in middle-late adolescents using a custom and a standardized preprocessing pipeline.

Despite advantage of neuroimaging measures in translational research frameworks, less is known about the psychometric properties thereof, especially in middle-late adolescents. Earlier, we examined evidence of convergent and incremental validity of reward anticipation and response event-related potentials (ERPs) and here we examined, in the same sample of 43 adolescents (Mage  = 15.67 years; SD = 1.01; range: 14-18; 32.6% boys), data quality (signal-to-noise ratio [SNR]), stability (mean amplitude across trials), and internal consistency (Cronbach's α and split-half reliability) of the same ERPs. Further, because observed time course and peak amplitude of ERP grand averages and thus findings on SNR, stability, and internal consistency may depend on preprocessing method, we employed a custom and a standardized preprocessing pipeline and compared findings across those. Using our custom pipeline, reward anticipation components were stable by the 40th trial, achieved acceptable internal consistency by the 19th, and all (but the stimulus-preceding negativity [SPN]) achieved acceptable SNR by the 41st trial. Initial response to reward components were stable by the 20th trial and achieved acceptable internal consistency by the 11th and acceptable SNR by the 45th trial. Difference scores had worse psychometric properties than parent measures. Time course and peak amplitudes of ERPs and thus results on SNR, stability, and internal consistency were comparable across preprocessing pipelines. In case of reward anticipation ERPs examined here, 41 trials (+4 artifacted and removed) and, in case of reward response ERPs, 45 trials (+5 artifacted) yielded stable and internally consistent estimates with acceptable SNR. Results are robust across preprocessing methods.

Starving for independence. Anorexia nervosa in an adolescent with type 1 diabetes / Önállóságra éhezve. Az 1-es típusú diabetes mellitus és az anorexia nervosa együttes elofordulása egy serdülo leányban.

Összefoglaló. Az 1-es típusú diabetes mellitus (T1DM-) betegek körében az evészavarok elofordulása az átlagpopulációhoz képest körülbelül kétszeresre teheto. Ez a komorbiditás különösen veszélyes mind a magas mortalitási rizikó, mind a súlyos szövodmények lehetosége miatt. Az evészavarban szenvedo, T1DM-mel élo gyermekek és fiatalok hatékony kezelése a diabetológusok, pszichiáterek, pszichológusok, novérek és dietetikusok összehangolt munkájával valósítható meg. Közleményünkben egy 14,5 éves, T1DM-mel élo, anorexia nervosával diagnosztizált páciensünk multidiszciplináris terápiáját mutatjuk be, kiemelve a különbözo szakemberek együttmuködésének fobb metszéspontjait. A szoros diabetológiai gondozással párhuzamosan az anorexia nervosa terápiájában a protokollok ajánlásaival megegyezoen családterápiát és kognitív viselkedésterápiás elemekkel bovített egyéni terápiát alkalmaztunk. A terápiás folyamat összesen 18 hónapig tartott. Esetünk korábban le nem írt diabetológiai érdekessége, hogy a számottevo súlycsökkenéssel párhuzamosan betegünk inzulinigénye a töredékére csökkent, ami jelentos mértékben érintette a bazálisinzulin-szükségletet is. Orv Hetil. 2021; 162(33): 1341-1346. Summary. The incidence of eating disorders is approximately twice as high in type 1 diabetes mellitus (T1DM) compared to the general population. Comorbidity is related to potentially severe organ complications and consequently higher mortality risk. The effective treatment of eating disorders in T1DM is provided by the teamwork of diabetologists, psychiatrists, psychologists, nurses and dietitians. The purpose of this paper is to present the multidisciplinary treatment of a 14.5-year-old adolescent with T1DM and diagnosed with anorexia nervosa, focusing on the cooperation of the professionals. In line with the current guidelines, both family therapy and cognitive behavioral therapy-informed individual psychotherapy were applied beside the strict diabetes control. Her therapy process lasted 18 months. The unusual diabetological aspect of our case is that the significant weight loss was associated with highly decreased insulin requirement affecting also the basal insulin requirements. Orv Hetil. 2021; 162(33): 1341-1346.

Health protective regulation of the fashion industry / A divatipar egészségvédelmi szabályozása.

Összefoglaló. A divatiparra vonatkozó egészségvédelmi szabályozások hiányosak. A karcsúság elérését célzó szociokulturális nyomás a divatiparon belül fokozott, a divatmodelleket gyakran késztetik kórosan alacsony testsúly elérésére, ami pszichológiai abúzusnak felel meg. Ezért a modellek közt az evészavarok prevalenciája magasabb az átlagpopulációhoz képest. A divatvilág veszélyei között ezeken túl a szexuális abúzus, a financiális visszaélések, illetve a fiatalkorúak foglalkoztatásával kapcsolatos szabályozatlanság említendo. A kockázatok csökkentése érdekében fontos volna nemzetközi szabályozásokat bevezetni a divatszakmában. Az erre irányuló kezdeményezések eloször 2006-ban jelentek meg Spanyolországban: a modellek foglalkoztatásának feltétele volt az egészséges tápláltsági állapot alsó határától minimálisan elmaradó testtömegindex (18,0) elérése. Késobb Franciaországban az evészavarok gyakoriságának mérséklésére törvénybe foglalták a modellek kötelezo egészségügyi vizsgálatát, illetve az utólagosan módosított divatfotók megjelölését. E szabályozások azonban könnyen kijátszhatók. A törvényhozás mellett különbözo szervezetek alkottak olyan irányelveket, amelyek a modellek egészségvédelmét szolgálták. Ezek az iránymutatások elsosorban a biztonságos munkavégzésre, a fiatalkorúak foglalkoztatásának korlátozására és az emberi méltóság megtartására irányulnak. A divatszakmában eloforduló feszültségek vezettek továbbá olyan nonprofit szervezetek megalakulásához, amelyek a modellek érdekvédelméért dolgoznak. A divatmodellek egészségvédelmét célzó jogi szabályozás a mai kultúrában domináns karcsúságideál megváltoztatását is szolgálná, mert a szociális tanulás révén a divatot követo átlagnépesség utánozza a modelleket. A divatmodellek egészségének védelme tehát népegészségügyi vonatkozással is bír. Orv Hetil. 2021; 162(23): 905-910. Summary. The fashion industry is lacking sufficient health protective regulations. There is an increased sociocultural pressure to be thin. Fashion models are often forced to reach abnormally low body weight, which can be regarded as psychological abuse. This leads to a higher prevalence of eating disorders among models compared with the general population. Some of the other dangers associated with the fashion industry are sexual harassment, financial exploitation, and unregulated minor labour force. To reduce these risks, it is crucial to introduce international regulations in the fashion industry. The first initiative for such regulations took place in Spain in 2006 when the condition for models' employment was for their body mass index (BMI) not to drop below 18.0, which is close to the low end of healthy BMI. Later in France, to decrease the prevalence of eating disorders, a legislation on compulsory medical examination for models was made. Also, retouching of photos had to be disclosed. Regulations like these, however, can easily be eluded. Different organisations implemented guidelines, such as establishing safe working conditions, limiting underage labour force, and maintaining dignity to protect models' health. Tension within the fashion industry led to the formation of non-profit organisations seeking the protection of models' interest. Regulations protecting models' health in the fashion industry would encourage society to adjust its predominant ideal for thinness. Just as the general population tends to follow fashion trends portrayed by fashion models, so would they likely imitate the new look of models. Hence, the protection of models' health goes beyond the fashion industry. It has public health implications as well. Orv Hetil. 2021; 162(23): 905-910.

Investigation of possible causes of increase in Hungarian infant mortality in 2019 / A hazai csecsemohalandóságban 2019-ben tapasztalt emelkedés lehetséges okainak vizsgálata.

Összefoglaló. Bevezetés: Magyarországon a csecsemohalandóság 2014 óta folyamatosan javult, azonban 2019-ben az elozo évi adathoz képest 11%-kal magasabb érték mutatkozott. Célkituzés: A vizsgálat célja a 2019. évi kedvezotlenebb csecsemohalálozási mutató lehetséges összetevoinek feltárása. Módszer: A 2018. és 2019. évi csecsemohalálozási adatokat hasonlítottuk össze a csecsemo kora, a halál oka és a gyógyintézeti, illetve nem gyógyintézeti elhalálozás szerint. A vizsgálathoz a Központi Statisztikai Hivatal adatait használtuk. A trendvizsgálatnál 2010-tol elemeztük az adatokat. A nem gyógyintézeti haláleseteket 10 évre összevonva járásonként térképesen ábrázoltuk. Eredmények: 2018-ban 304, 2019-ben 335 csecsemo halt meg Magyarországon, a csecsemohalálozási arányszám 3,4 ezrelékrol 3,8 ezrelékre emelkedett. A 2019. évi érték az elozo évtizedek trendjére illesztett görbe alapján megfelelt a várható értéknek. 2019-ben a 0-27 napos csecsemohalálozás alig változott a 2018. évihez képest, a 28-364 napos korban bekövetkezett halálesetek száma viszont növekedett. A vizsgált évben 59%-kal emelkedett a nem gyógyintézeti csecsemohalálozás. A 2019. évi csecsemohalálozás növekedéséért 74%-ban a nem gyógyintézeti esetek voltak felelosek. A nem gyógyintézeti halálozás dönto többsége késoi csecsemokorban következett be. A járásonkénti, 10 évre összevont, nem intézményben elhunyt csecsemok számában és 1000 élve születésre vonatkozó arányában ötszörös területi különbségek mutatkoztak. A halálokok közül a perinatalis szakban keletkezo bizonyos állapotok miatt meghalt csecsemok száma emelkedett a leginkább, a nem gyógyintézeti halálozás esetében pedig a hirtelen csecsemohalál szindrómában meghaltaké. Következtetés: 2019-ben kiugróan magas volt a nem gyógyintézeti, késoi csecsemohalálozás száma és részaránya, ezen esetek feltuno regionális halmozódást mutattak. A csecsemohalandóság csökkentésének hatásos eszköze lehetne a jövoben minden egyes csecsemohalál részletes szakmai értékelése. Orv Hetil. 2021; 162(1): 830-838. INTRODUCTION: In Hungary, infant mortality has been steadily declining since 2014, but in 2019 it increased by 11% compared to 2018. OBJECTIVE: The aim of our study is to explore the possible components of the above increase. METHOD: Ten-year trends of infant mortality were analized and compared by age, cause, place of deaths (hospital or non-hospital environment) and location, using Central Statistical Office data. RESULTS: There were 304 infant deaths in Hungary in 2018 and 335 in 2019. Infant mortality rate rose from 3.4‰ to 3.8‰, however, it was in line with the expected value based on the curve fitted to the trend of previous decades. In 2019, 0-27-day infant mortality basically did not change compared to 2018, while the number of deaths at 28-364 days of age increased. Non-hospital infant mortality increased by 59% in 2019 and these cases accounted for 74% of the total increase in infant mortality; the vast majority of these deaths occurred in late infancy. There were fivefold regional differences in the number of non-hospital infant deaths. Among the causes of death, the conditions related to the perinatal period and sudden infant death syndrome increased the most. CONCLUSION: In Hungary, the number and proportion of non-hospital infant mortality was remarkably high in 2019 compared to previous years. These cases showed a striking regional accumulation. An effective tool for reducing infant mortality could be an appropriate professional assessment of each infant death in the future. Orv Hetil. 2021; 162(21): 830-838.

Impact of COVID-19 Lockdown in Eating Disorders: A Multicentre Collaborative International Study.

BACKGROUND: The COVID-19 lockdown has had a significant impact on mental health. Patients with eating disorders (ED) have been particularly vulnerable. AIMS: (1) To explore changes in eating-related symptoms and general psychopathology during lockdown in patients with an ED from various European and Asian countries; and (2) to assess differences related to diagnostic ED subtypes, age, and geography. METHODS: The sample comprised 829 participants, diagnosed with an ED according to DSM-5 criteria from specialized ED units in Europe and Asia. Participants were assessed using the COVID-19 Isolation Scale (CIES). RESULTS: Patients with binge eating disorder (BED) experienced the highest impact on weight and ED symptoms in comparison with other ED subtypes during lockdown, whereas individuals with other specified feeding and eating disorders (OFSED) had greater deterioration in general psychological functioning than subjects with other ED subtypes. Finally, Asian and younger individuals appeared to be more resilient. CONCLUSIONS: The psychopathological changes in ED patients during the COVID-19 lockdown varied by cultural context and individual variation in age and ED diagnosis. Clinical services may need to target preventive measures and adapt therapeutic approaches for the most vulnerable patients.

Neural and self-reported reward responsiveness are associated with dispositional affectivity and emotion dysregulation in adolescents with evidence for convergent and incremental validity.

Adolescence is a developmental period characterized by heightened reward sensitivity which, in turn, confers risk for pertinent negative outcomes, underscoring the need to better understand biological bases and behavioral correlates of reward responsiveness during this developmental phase. Our goals in the current study were to examine, in a sample of 43 typically developing adolescents (Mage  = 15.67 years; SD = 1.01; 32.6% boys), (1) evidence of convergent validity between neural and self-report reward responsiveness, (2) associations between neural reward responsiveness and self-report dispositional affectivity and emotion dysregulation (ED) and (3) evidence of incremental validity of self-report beyond neural reward responsiveness in predicting affectivity and ED. During electroencephalography (EEG), adolescents completed two experimental paradigms probing event-related potential (ERP) indices of reward anticipation and initial responsiveness to reward attainment. Following EEG, they completed self-report measures of reward responsiveness, affectivity, and ED. Findings indicated some evidence of convergent validity between enhanced ERP indices of reward anticipation and initial response to reward and greater reinforcement sensitivity; that ERP indices of both reward responsiveness aspects predicted lower negative affectivity and less ED; and evidence of incremental validity of self-report beyond neural reward responsiveness in predicting outcomes. Results underscore the utility of a multi-method framework in assessing adolescent reward responsiveness and support the relevance of reward responsiveness in explaining individual differences in dispositional affectivity and ED.

The association between reinforcement sensitivity and substance use is mediated by individual differences in dispositional affectivity in adolescents.

BACKGROUND: Adolescence marks the onset of substance use experimentation and adolescents are particularly vulnerable to certain negative effects of substances. Some evidence indicates reinforcement sensitivity is associated with substance use, though little is known about mechanisms underlying such association. AIMS: in the current study were to examine, (1) associations between behavioral activation (BAS) and behavioral inhibition (BIS) system sensitivity, positive (PA) and negative affectivity (NA), and alcohol use and alcohol problems as well as tobacco, and marijuana use, and whether (2) associations are mediated by PA or NA. METHODS: Participants were a community sample of N = 125 adolescents (Mage = 15.67 years; SD = 0.93; 52% boys) who completed self-report measures. RESULTS: evinced associations, generally as expected, across variables (all ps < 0.05). In mediation analyses, an association emerged between BIS sensitivity and alcohol use, mediated by NA (95%CIs [0.034; 0.390]); greater BIS sensitivity was associated with greater NA and greater NA was associated with greater alcohol use. These findings were replicated with alcohol problems. An association also emerged between BAS sensitivity and marijuana use, mediated by PA (95%CIs [-0.296; -0.027]); greater BAS sensitivity was associated with greater PA and greater PA was associated with lower marijuana use. Finally, BIS sensitivity was associated with tobacco use through NA (95%CIs [0.023; 0.325]) and PA (95%CIs [0.004; 0.116]), with NA linked to greater, but PA linked to lower tobacco use. BAS sensitivity was also associated with tobacco use through PA (95%CIs [-0.395; -0.049]), with PA linked again to lower tobacco use. CONCLUSIONS: There are unique and shared effects of domains of reinforcement sensitivity on adolescent substance use and these vary with index of dispositional affectivity and type of substance considered.

COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study.

Confinement during the COVID-19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational-theoretical structure of the CIES. Adequate goodness-of-fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face-to-face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.

[Guidelines and recommendations in the treatment of eating disorders].

The importance of eating disorders is increasing in the psychiatric practice, underlined by the epidemiological data and the severity of these disorders. In the treatment several approaches can be found, and some of these are controversial. Following the rules of evidence-based medicine an increasing number of guidelines were published. Eating disorders are prevalent and often show a serious course, the guidelines summarizing the recent knowledge in the literature are very useful for the therapists. The present guideline aims to help the everyday practice. It overviews the principles of the treatment of eating disordered patients, the steps of diagnostics, and the therapeutical methods. Many basic and practical techniques are also presented. It discusses the skills which are necessary for the treatment of eating disorders, and the therapeutical traps as well.

[Pathogenesis of anorexia nervosa. Neurobiological risk factors and possible endophenotypes]. / Az anorexia nervosa kóreredetének újabb megközelítése. Neurobiológiai tényezok és lehetséges endofenotípusok a kutatási eredmények tükrében.

Anorexia nervosa is a serious, chronical state of illness which often starts in childhood or adolescence and has serious consequences on the quality of life. This review focuses on the heterogenity of the disease with emphasis on special diagnostic implications in case of childhood onset. Research findings of the last decade showed that genetic and neurobiological vulnerabilities are at least as potent risk factors as psychological, family constellations and sociocultural preferences. The heritability of eating disorders levels those of diseases predominantly influenced by biological factors. The authors give a summary of the most investigated neurobiologic and neurocognitive factors which could be the fundaments of a biological vulnerablilty. To date, no common risk factor could be identified, but some existing adversities can clearly be related to distinct subgroups with the disorder. The concept of endo- and subphenotypes leads to more specific and more efficient methods of therapy in other somatic and psychiatric diseases.

[Impaired theory of mind in anorexia nervosa]. / Tudatelméleti deficit anorexia nervosában.

Anorexia nervosa (AN) is a severe mental illness, which is characterized by a continuously growing occurrence in the population and by the shift of the onset for earlier ages. The understanding of factors playing role in AN and the importance of effective prevention is an essential issue in science as well as in the society. AN also affects the social domain of life, patients with AN may exhibit impaired social interaction, social isolation, difficulties in emotion recognition and egocentric thinking in cognitive processing. Therefore, the aim of present study was to investigate the theory of mind (ToM) deficits is anorexia nervosa. Although previous studies have reported ToM deficits in autism and in schizophrenia, the number of studies investigating ToM functioning in eating disorders are particularly low. Even though ToM difficulties, such as the affective ToM impairments were found in AN, however, the evidence of cognitive ToM deficits in anorexia patients is still lacking. Twenty anorexia nervosa patients and 20 healthy control adolescent girls participated in the experiment. EDI, BAT, Fallon-Rozin Test and Anamoprhic Micro Body Image Assesment Programme questionnaires and body-image tests were applied to discriminate anorexia nervosa group from healthy control group. The Hungarian version of Faux Pas Recognition Test was applied to evaluate ToM functioning. Compared to healthy control group, impairment in ToM functioning was found in AN group, especially in affective mental state attribution. Our results can raise new aspects for research, therapy and prevention of anorexia nervosa.

[Game rules Representing the characteristics of regulation in child and adolescent anorexia nervosa with World-Playing Test.]

One of the most crucial problems concerning the pathogenesis of anorexia nervosa is the deficit of regulation. This problem appears in the symptoms, in the cognitive infexibility, in the levels of self organizations, in mother- child and familial relationships. The present paper tries to search for paralells addressing deficits of regulation by overviewing the theories of anorexia nervosa. Moreover, the World-Playing Test is presented as a projective method for the detection of these deficits. The test was used in 50 adolescent anorexia nervosa cases in the last years. The idiosyncratic traits of psychopathology are noticeable in the characteristics of buildups. The deficits of regulation appeared in signs as perceptual rigidity, perfectionism, compulsions, overwhelming and unregulated emotions, and in connection with these traits, the need of permanent control. The World-Playing Test proved to be an effective and rich psychodiagnostic method, which helps us not only to verify general theoretical conclusions, but also to understand the individual psychodynamic organization.

[Game rules. Representing the characteristics of regulation in child and adolescent anorexia nervosa with World-Playing Test]. / Játékszabályok. A szabályozás jellegzetességeinek bemutatása a serdülôkori anorexia nervosában a világjátékon keresztül.

One of the most crucial problems concerning the pathogenesis of anorexia nervosa is the deficit of regulation. This problem appears in the symptoms, in the cognitive infexibility, in the levels of self organizations, in mother-child and familial relationships. The present paper tries to search for paralells addressing deficits of regulation by overviewing the theories of anorexia nervosa. Moreover, the World-Playing Test is presented as a projective method for the detection of these deficits. The test was used in 50 adolescent anorexia nervosa cases in the last years. The idiosyncratic traits of psychopathology are noticeable in the characteristics of buildups. The deficits of regulation appeared in signs as perceptual rigidity, perfectionism, compulsions, overwhelming and unregulated emotions, and in connection with these traits, the need of permanent control. The World-Playing Test proved to be an effective and rich psychodiagnostic method, which helps us not only to verify general theoretical conclusions, but also to understand the individual psychodynamic organization.