A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders.

OBJECTIVE: The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD: Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS: Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS: This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.

Validity and utility of the current definition of binge eating.

OBJECTIVE: Binge eating, a cardinal symptom of bulimia nervosa (BN) and binge eating disorder (BED), continues to pose challenges in terms of its definition and thus construct validity and clinical utility. This article reviews the available empirical data that support or refute the current DSM-IV-TR defined characteristics of a binge episode. METHOD: A systematic literature review was conducted using Medline/PubMed electronic database on DSM-IV-TR defined binge characteristics and associated attributes. RESULTS: Data support the current DSM guidelines indicating that binge episodes typically occur in less than 2 h. Size of binge episodes has variability across BN and BED diagnostic groups. Loss of control (LOC) continues to be a core feature of binge eating. Negative affect is the most widely reported antecedent. Strikingly, little is known about binge episodes among individuals with anorexia nervosa-binge/purge subtype. DISCUSSION: Available empirical evidence supports the current DSM duration and LOC attributes of a binge episode in BN and BED. However, a more controversial issues is the extent to which size is important in the definition of a binge episode (e.g., subjective vs. objective episodes) across diagnostic categories and the extent to which binge size informs prognosis, treatment, and clinical outcomes. Further study of binge eating attributes in AN is needed.

Predicting adolescent eating and activity behaviors: the role of social norms and personal agency.

Guided by the theory of planned behavior, this 2-week longitudinal study examined health behaviors in a sample of 279 adolescents. Social norms and perceived behavioral control (PBC) were tested as predictors of self-reported intentions and behaviors in 2 domains, eating and physical activity. Differentiating, as opposed to aggregating, parent and peer norms provided unique information. For PBC, the authors distinguished global causality beliefs from self-related agency beliefs and intraself (effort, ability) from extraself (parents, teachers) means. Intraself agency beliefs strongly predicted healthy intentions, whereas intraself causality beliefs had a negative influence. Patterns differed somewhat across behaviors and gender. Results highlight theoretical issues and provide potential targets for research on health promotion programs for youth.