Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment.

Several studies have related motivation to change and treatment response in adult patients with bulimia nervosa but there are no longitudinal studies analysing this relationship in adolescents. The objective was to determine whether motivation to change is related to clinical improvement after treatment in adolescent patients with bulimia nervosa. The Bulimia Nervosa Stages of Change Questionnaire, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI) were administered at the beginning of treatment to 40 adolescent patients with bulimia nervosa (DSM-IV) (mean age = 16.2 years). Thirty-one patients were re-assessed after 6 months of treatment. The majority of clinical and psychological variables improved significantly at the second evaluation. There were significant correlations between initial motivation to change and improvement in number of binges and the EDI-2 scales of Bulimia and Interoceptive Awareness. In the stepwise multiple linear regression analysis, which included initial motivation to change and other potential confounding variables such as age, BDI, duration of disorder and body mass index, only motivation to change was selected as a predictor of improvement in number of binges (standardized ß coefficient = 0.45; p = 0.012) and of decrease on the Bulimia scale (standardized ß coefficient = 0.43; p = 0.029). Regarding improvement in Interoceptive Awareness, only the BDI score was selected as an independent predictor (ß coefficient = 0.58; p = 0.002). In conclusion, in adolescent patients receiving treatment for bulimia nervosa, improvement in bulimic symptomatology seems to be especially related to initial motivation to change.

Relationship between clinical and neuropsychological characteristics in child and adolescent first degree relatives of subjects with schizophrenia.

INTRODUCTION: Studies have shown higher rates of psychopathology and cognitive difficulties among relatives of schizophrenia patients than among the general population. This study aimed to analyze the relationship between clinical and neuropsychological characteristics in children and adolescents at high genetic risk for schizophrenia. METHODS: Participants were 26 children and adolescent first-degree relatives of subjects diagnosed with schizophrenia (high-risk [HR] group) and 20 controls whose parents and siblings did not meet DSM-IV criteria for any psychotic disorder. These two groups were matched by age, sex and socio-economic status and clinical and neuropsychological assessments were completed by all participants. RESULTS: Among HR children 42.3% were diagnosed with one or more DSM-IV axis I psychiatric disorders. The most common diagnoses were attention deficit/hyperactivity disorder (ADHD) (34.6%) and generalized anxiety disorder (3.8%) There were significant differences between HR children and controls with respect to prodromal symptoms, behavioral problems and premorbid adjustment, as well as on the majority of intelligence subscales, working memory and logical memory. When differences between HR with ADD (HR-ADD), HR without ADD (HR-NADD) and controls were analyzed, significantly higher scores on clinical scales of prodromal symptoms, behavioral problems and premorbid adjustment were found in HR-ADD than in HR-NADD or controls. There were no significant differences in cognitive domains between HR-ADD and HR-NADD, but there were between HR-ADD and controls and between HR-NADD and controls on the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index and GAI. CONCLUSIONS: Compared to controls, HR children showed more clinical symptoms and cognitive abnormalities. HR children with ADD had worse clinical symptoms than did HR without ADD, although there were no differences in terms of cognitive abnormalities. Both HR groups seem to have similar deficits in neuropsychological performance.

Plasma homovanillic acid in adolescents with bulimia nervosa.

Dopaminergic abnormalities in bulimia nervosa have been reported in some studies, but results are not consistent across studies. In the present study, clinical characteristics, plasma level of homovanillic acid (pHVA) and two scales - the Eating Attitudes Test (EAT) and the Beck Depression Inventory (BDI) - were assessed in 36 adolescent bulimia nervosa patients (mean age16.3 years, S.D. 1.1) who were consecutively seen on an Eating Disorder Unit. Levels of pHVA were also measured in 16 healthy control adolescents from the general population. Patients had significantly higher mean pHVA than controls. Eighteen patients (50%) had a pHVA level equal to or higher than the mean of control subjects plus one standard deviation, and this group of patients had significantly higher mean BDI scores and non-significantly higher mean EAT scores, although they did not differ from the other patients in age, time elapsed since the onset of disorder, body mass index and number of binges or vomits. Moreover, in logistic regression analysis the BDI score proved to be an independent predictor of high pHVA. The level of pHVA is increased in bulimia nervosa patients with high scores on measures of depressive and eating symptomatology.

Changes in regional cerebral blood flow after body image exposure in eating disorders.

Relationships of 'perceptual distortion' and 'cognitive evaluation' components of body image disturbances to brain activity were investigated. Changes in regional cerebral blood (rCBF) of nine patients with anorexia nervosa restrictive type (AN), 13 patients with bulimia nervosa purging type (BN) and 12 controls following three experiments with single photon emission computed tomography (SPECT) were compared: at rest, following a landscape video presentation (neutral stimulus), and after their filmed body image (positive stimulus) exposure. Body distortion was measured with the Silhouette test and body dissatisfaction with the Body Shape Questionnaire (BSQ). Patients with AN showed a hyperactivation of the left parietal and right superior frontal from neutral to positive stimulus. Patients with BN showed a hyperactivation of the right temporal and right occipital areas. Changes in BSQ responses were associated with changes in the right inferior frontal and right temporal rCBF, whereas changes in body distortion were related to the left parietal. The activation of the right temporal after the own body image exposure might be in accordance with the aversive events' response. Functional abnormalities in AN might be related to the storage of a distorted prototypical image of the body in the left parietal lobe.

Eating disorders in ballet dancing students: problems and risk factors.

OBJECTIVE: To study the prevalence of symptoms of eating disorders and risk eating behaviours and the relationship between life at a dance school and the risk of developing an eating disorder (ED) in an adolescent population of Spanish dance students. METHODS: Questionnaires were used to assess attitudes to eating, cultural influences on the body shape model, eating disorders (DSM-IV) and risk factors for eating disorders in 76 adolescent dance students (age 12-17 years) at the Barcelona Theatre Institute. Subjects were compared with a community sample of 453 female adolescents. To study the relationship between ED and characteristics of this particular school, an original questionnaire was administered to 105 students at the school aged from 12 to 21 years. RESULTS: The prevalence of eating disorders and several risk attitudes and behaviours were similar in the dance students and the female adolescents from the general population. Students at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies. In contrast, Body Mass Index (BMI) had hardly any influence on these experiences. Depressive symptoms were associated almost exclusively with experience of stressors and aversive situations. CONCLUSIONS: Dance school students do not necessarily present a greater risk of ED than other girls of the same age. The risk of ED may be associated with greater pressure from coaches, with attitudes related to the ED itself, or with depressive symptoms, rather than with the BMI.

Psychopathological and nutritional correlates of plasma homovanillic acid in adolescents with anorexia nervosa.

Dopaminergic abnormalities have been described in anorexia nervosa but studies about plasma level of homovanillic acid (pHVA) have yielded conflicting results probably due to the small number and the heterogeneity of patients. Plasma HVA, nutritional and hormonal parameters and several scales - the Eating Attitudes Test (EAT), the Beck Depression Inventory (BDI), the Leyton Obsessional Inventory-child version (LOI-C) and the State and Trait Anxiety Inventory (STAI) - were assessed in 44 adolescent anorexia nervosa patients (mean age 14.7 years, SD 1.7) consecutively admitted to an Eating Disorder Unit. They were evaluated at admission, at discharge and, in 34 cases, after 9 months of follow-up. pHVA was also assessed in 16 control adolescents. Patients had significantly higher pHVA than controls (p = .002). About 31% of patients had a very high level of pHVA, a significantly higher (p = .006) mean score in the BDI and a non significantly higher mean score in the EAT. After weight recovery some laboratory parameters improved as well as the EAT (p = .019), the BDI (p = 001) and the Interference score of the LOI-C (p = .004). Moreover, pHVA decreased significantly (p=.036). At follow-up, patients with normal weight had lower (p = .037) pHVA than patients with low weight. The conclusion would be that there is a dopaminergic dysfunction in anorexic patients, specially in a subgroup with high depressive and anorexic symptomatology. With weight recovery and psychopathological improvement, pHVA tends to normalization.

Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire.

OBJECTIVE: To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. METHOD: Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. RESULTS: The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). CONCLUSION: The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.

Cue exposure in the treatment of resistant adolescent bulimia nervosa.

OBJECTIVE: A percentage of bulimic patients do not greatly improve with the usual treatment. Therefore, the objective was to further evaluate cue exposure (CE), in order to attain better results in clinical settings. METHOD: Twenty-two adolescent patients who fulfilled DSM-IV diagnostic criteria for bulimia nervosa (mean age 16.7, SD 1.5) and who were resistant to the usual treatment followed a program of 12 CE sessions. Clinical characteristics were evaluated and different psychopathological scales were administered at the beginning and the end of the CE program and at 6 month follow-up. Subjective anxiety and physiological parameters were recorded during the sessions. RESULTS: A significant decrease was observed in subjective anxiety (p = .023), heart rate (p < .001), and blood pressure (p = .001) during the first session. A decrease in these parameters was also recorded between the first and the last session. The number of binges per week (p = .005) and the mean score for the psychopathological scales decreased significantly from the beginning of the treatment, and were significantly lower at the end of the CE program and at follow-up. Purging behaviors per week only decreased significantly after the end of the CE session during the follow-up (p = .04). CONCLUSION: Anxiety, binging, purging, and psychopathological scales improve with a CE program in resistant bulimia nervosa.

Self-oriented perfectionism in eating disorders.

OBJECTIVE: To assess perfectionism dimensions in eating disorders in comparison with other psychiatric disorders and subjects from the general population. METHOD: The Child and Adolescent Perfectionism Scale (CAPS), the Eating Disorders Inventory (EDI-2), and the Eating Attitudes Test (EAT) were administered to a group of 108 female eating-disordered patients (75 anorexia nervosa and 33 bulimia nervosa), to a group of 86 female psychiatric patients with anxiety (N = 32), depressive (N = 38), or adaptive disorders (N = 16), and to 213 healthy female participants. RESULTS: Both bulimic and anorexic patients scored higher on Self-Oriented Perfectionism (p < 0.001) than the other two groups but not on Socially-Prescribed Perfectionism (p = 0.054). Among patients with eating disorder, 17.6% obtained a score two standard deviations higher than the mean in the healthy comparison group on self-oriented perfectionism; this percentage was significantly higher than in the other two groups. The percentage of eating disorder patients with high socially-prescribed perfectionism was similar to that found in other psychiatric disorders. Moreover, self-oriented perfectionism was a predictor of an eating disorder. CONCLUSION: Self-oriented perfectionism is more specific to eating disorders than to depressive or anxiety disorders.

Parental psychopathology in child and adolescent obsessive-compulsive disorder.

PURPOSE: To identify the lifetime prevalence of obsessive-compulsive disorder (OCD) and other psychiatric diagnoses in parents of OCD pediatric patients as well as the frequency of onset of psychiatric disorders in the 6 months prior to evaluation. METHODS: Parents (n = 63) of 32 children and adolescents (20 males and 12 females; mean age of 13.3 +/- 2.4) with OCD and parents of (n = 63) 32 age and sex-matched controls with no psychiatric diagnosis were examined. The semi-structured SCID-I was used to identify axis I psychiatric disorders and SCID-II to evaluate personality disorders. RESULTS: Mothers of patients had significantly more psychiatric diagnoses than control mothers (P = 0.001). Only parents of patients had diagnosis of OCD (P = 0.01) and psychiatric diagnosis (Adjustment Disorders, Major Depression, Anxiety Disorders) with onset during the 6 months prior to evaluation (P = 0.001). The duration of disease in children appeared to be related to development of morbidity in parents (P = 0.04). Parents of patients also showed a higher incidence of personality disorders (P = 0.01), in particular avoidant (6 versus 1 parents, P < 0.055) and obsessive-compulsive (9 versus 2 parents, P = 0.016) personality disorders. CONCLUSIONS: The findings suggest that there may be an excess of psychopathology in parents of children with OCD as compared to parents of pediatric and non-psychiatric patients. Adjustment disorders with depressive and anxious symptoms are significantly more frequent in mothers of OCD children after the onset of the disease.

Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa.

OBJECTIVE: To analyze variables that predict weight maintenance in adolescent anorexia nervosa. METHOD: The Eating Attitudes Test, the Beck Depression Inventory, the Leyton Obsessional Inventory, the State and Trait Anxiety Inventory, and the Anorexia Nervosa Stages of Change Questionnaire were administered to 49 anorexia nervosa patients (mean age 14.3 years, SD 1.7) consecutively admitted to an eating disorder unit. They were evaluated at admission, at discharge, and after nine months follow-up. RESULTS: At discharge, patients had improved in body mass index (p < .001), eating attitudes (p = .002), depressive symptomatology (p = .001), and motivation to change (p < .001). Patients with good weight maintenance at follow-up had higher body mass index (p = .017) at admission, lower abnormal eating attitudes (p = .035), depressive symptomatology (p = .026), and higher motivation to change (p = .004) at discharge. Logistic regression analysis showed a high motivation to change at discharge and a high body mass index at admission to be predictors of weight maintenance. CONCLUSION: High motivation to change, low abnormal eating attitudes, depressive symptomatology at discharge, and high body mass index at admission are associated with weight maintenance in adolescent anorexia nervosa.

Eating disorders and body image in Spanish and Mexican female adolescents.

OBJECTIVE: To compare the prevalence of eating disorders (ED), socio-cultural risk factors, and body image characteristics in two populations of female adolescents, one Mexican and one Spanish, from similar socio-economic backgrounds. METHOD: A total of 467 Spanish and 329 Mexican girls aged from 11-12 to 17-18 years were assessed using the Eating Attitude Test-26 (EAT-26), the CETCA (Eating Disorders Assessment Questionnaire), the CIMEC (Questionnaire on Influences on Body Shape Model), and a survey of socio-demographic and risk factors produced for this study. RESULTS: One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase. CONCLUSIONS: Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society.

D8/17 monoclonal antibody: an unclear neuropsychiatric marker.

OBJECTIVE: It has been hypothesized that monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in patients with rheumatic fever, childhood onset obsessive-compulsive disorder (OCD), Tourette syndrome (TS) or prepubertal anorexia nervosa (AN). Our purpose was to replicate these studies in a Spanish population and to determine whether D8/17 identifies a subgroup of these patients, focusing especially on OCD subjects. METHOD: D8/17 expression was assessed with double immunofluorescence and flow cytometry using monoclonal immunoglobulin M (IgM) in three groups of patients with diagnoses of OCD (n = 17), TS (n = 5) and prepubertal AN (n = 5), recruited during 2001. RESULTS: In the sample studied the average percentage of B cells expressing D8/17 was 4.8%. The D8/17 positive proportion of B lymphocytes was above 11% in only two out of 17 OCD patients (7.4% of total sample) and in none of the TS or prepubertal AN patients. No statistically significant differences were found in mean percentages of D8/17 between the three groups. CONCLUSIONS: In the sample studied the expression of D8/17 in B cells was very low and the great majority of patients were negative for the D8/17 marker. The molecular characterization of D8/17 would be a major step forward in clarifying its implication for these diseases.

Anorexia nervosa in male adolescents: body image, eating attitudes and psychological traits.

PURPOSE: To evaluate body image and its relationship with psychological and behavioral traits associated with anorexia nervosa in male patients. METHODS: Thirty male adolescents with anorexia nervosa (AN) were compared with 421 male adolescents from the general population. Body image was evaluated with the Subjective Body Dimensions Apparatus. Eating attitudes were evaluated by the Eating Attitudes Test in its 26-item version (EAT-26). In 19 AN patients and 200 boys from the comparison group, the Eating Disorders Inventory (EDI) was also administered. RESULTS: AN patients had higher mean scores in the EAT-26 and the Body Dissatisfaction scale on the EDI, but not on the other EDI scales. Both groups overestimated all parts of their bodies but AN patients presented a greater overestimation of shoulders (p = .007), hips (p = .01) and thighs (p = .019). Correlations in the anorexic group were high and negative between body overestimation and body mass index and also high but positive between overestimation and the EAT and the Drive for Thinness scale on the EDI. Overestimation did not correlate significantly with other EDI scales. CONCLUSIONS: Male patients with anorexia nervosa overestimate some parts of their bodies more often than controls; this overestimation is related to body mass index, abnormal eating attitudes and drive for thinness, but not to other psychological traits evaluated by the EDI.

Body mass index in female Spanish Olympic athletes.

The purpose of this study was to examine the Body Mass Index of 180 female Spanish Olympic athletes (M age = 27.1 yr., SD = 5.9 yr.) who participate in presentation sports and nonpresentation sports, in comparison with 114 female nonathletes (M age = 20.7, SD = 1.5 yr.). Presentation sports athletes have a profile similar to that of a university student but by age with a lower Body Mass Index. In particular, rhythmic gymnasts have a lower weight and Body Mass Index than other athletes and nonathletes.

Perfectionism dimensions in children and adolescents with anorexia nervosa.

PURPOSE: To assess the dimensions of perfectionism in adolescents with anorexia nervosa in comparison with adolescents from the general population and to validate the Spanish versions of two measures of perfectionism. METHODS: The Child and Adolescents Perfectionism Scale (CAPS), the Perfectionistic Self-Presentation Scale (PSPS) scale, the Eating Attitudes Test (EAT), and the Beck Depression Inventory (BDI) were administered to a group of 71 anorexia nervosa patients (mean age 15.3 years). Moreover, the CAPS and the PSPS were also administered to 113 adolescents from the general population (mean age 14.6 years). The CAPS and the PSPS were administered again after 1 week in 68 subjects to evaluate test-retest reliability. RESULTS: Both the CAPS and the PSPS demonstrated good internal consistency (Cronbach alpha for anorexia nervosa patients = .91; Cronbach alpha for general population = .85) and the two scales of the CAPS also had alpha coefficients in excess of .7. One-week test-retest reliability was also adequate (r = .80). Anorexia nervosa patients had higher mean scores in Self-oriented perfectionism (p < .001) and Perfectionistic self-presentation (p < .001) but not in Socially prescribed perfectionism (p = .292). There were significant correlations among perfectionism and the EAT and the BDI. A percentage of anorexia nervosa patients between 39% and 42% obtained a score higher than the mean in the comparison group plus two standard deviations in Self-oriented perfectionism and Perfectionistics self-presentation. CONCLUSIONS: The Spanish version of the CAPS and the PSPS showed good psychometric properties. A percentage of 40% of adolescent patients with anorexia nervosa show high Self-oriented perfectionism and Perfectionistic self-presentation.