A comparison between young males and females with anorexia nervosa in a clinical setting.

BACKGROUND: Knowledge of eating disorders in young and adolescent males is sparse. AIM: To investigate clinical presentations in males and females with anorexia nervosa (AN). METHODS: Using a retrospective case-control design, data were collected from case records for 41 males diagnosed with AN. Data for a comparison group of 41 females with AN were collected, matched to the males by age and date at admission. The collected data covered demographic, medical, psychiatric, and treatment information. RESULTS: No differences were found between the sexes in the percentage of expected weight (%EBW) at admission or discharge, or in psychiatric comorbidity. Treatment duration was equal for both sexes, but males received fewer treatment sessions than did females. CONCLUSION: These results indicate that the clinical presentations of young males and females with AN were very similar in terms of clinical characteristics.Impact StatementWhat is already known about this subject? Research on AN in male children and adolescents is sparse. Previous studies comparing male and female patients with EDs have found both differences and similarities between sexes.What does this study add? This study found few differences in terms of clinical presentation of AN between the sexes.

Long-Term Outcome of Adolescent Anorexia Nervosa: Family Treatment Apartments Compared With Child Psychiatric Inpatient Treatment.

Introduction: The family is rarely involved in treatment when the patient with anorexia nervosa (AN) is hospitalized. Family treatment apartment (FTA) represents an intervention that includes the family in the intensive treatment of AN. This study compares the short- and long-term outcomes of adolescents treated in FTA with those who received inpatient hospital care. In FTA, the parents are responsible for providing meal support, whereas in hospital care, the staff is responsible. Methods: Sixty-eight previous patients admitted during the period 1990-2009 participated in a follow-up, 43 from the FTA where the whole family is admitted for treatment and 25 from regular psychiatric inpatient care. The follow-up consisted of a personal meeting with structured interviews, measurement of height and weight, and self-rating questionnaires. Result: Readmissions due to weight loss within 6 months from discharge were less common in the FTA group. At follow-up, 14.2 years after admission, there was no difference in eating disorder pathology between the groups. There were significantly lower scores on general psychiatric pathology and significantly higher scores on quality of life in the FTA group. Discussion: The treatment in FTA aims to give the family the ability to handle AN when it is most challenging. FTA may thus provide a helpful context for treatment with a basic sense of security along with skills that could contribute to better general mental health at follow-up.

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care.

BACKGROUND: Restrictive eating disorders with pronounced starvation are serious psychiatric conditions that often begin during childhood or adolescence. An early and efficient intervention is crucial to minimize the risk of the illness becoming longstanding and to limit the consequences. There is good evidence that weight gain during the first month of treatment provides a better prognosis. Only a limited amount of young people suffering from severe restrictive eating disorder receive an evidence-based treatment at present in Sweden. The ROCKETLAUNCH project intends to implement key components of the evidence-based family therapy during the first month of treatment in child and adolescent psychiatric outpatient care. METHODS: From the southern part of Sweden, 12 local child and adolescent psychiatric outpatient services will take part. All patients with a restrictive eating disorder and pronounced starvation together with their families will be asked to take part in the study. We expect that one hundred 50 patients will be assessed every year. The patients and their families will receive 1 month of intense manualized treatment. Body weight, days in inpatient care, eating disorder, and other psychopathology-related symptoms, will be evaluated after one month and at 12-month follow-up. Economic evaluation of ROCKETLAUNCH will also be carried out alongside the intervention. At each outpatient clinic, data from the 10 previous patients will be gathered to compare the treatment provided at ROCKETLAUNCH with the standard treatment in Sweden. DISCUSSION: We expect that by implementing the key components of the evidence-based family therapy during the first month of treatment, the prognosis of young newly diagnosed patients with severe restrictive eating disorders, primarily anorexia nervosa will improve, which, in turn, will reduce the need for psychiatric inpatient care. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT04060433.

Long-term follow-up study of low-weight avoidant restrictive food intake disorder compared with childhood-onset anorexia nervosa: Psychiatric and occupational outcome in 56 patients.

OBJECTIVE: To compare long term outcome between childhood-onset Anorexia Nervosa (AN) and low-weight Avoidant/Restrictive Food Intake Disorder (ARFID) in regard to psychiatric diagnoses, social and occupational functioning. METHOD: A consecutive series of 56 children originally treated for low-weight restrictive eating disorder (ED) were followed up after a mean of 15.9 years. ARFID-diagnoses were assigned retrospectively. RESULTS: Thirty-seven patients originally had AN and 19 patients were diagnosed retrospectively with ARFID. At follow-up, in the AN-group 21.6% had a current ED, 24.3% had another psychiatric diagnosis, and 54.1% did not have any psychiatric diagnosis. In the ARFID-group, 26.3% had a current ED, 26.3% had another psychiatric diagnosis, and 47.4% had no psychiatric diagnosis. In the ARFID-group ED diagnoses at follow-up were all ARFID, whereas the AN-group showed heterogeneity. Morgan Russell Outcome Assessment Schedule indicated similar outcome in the AN- and ARFID-group. Occupational functioning did not differ significantly between the AN- and ARFID-group. DISCUSSION: The AN-group showed high rate of ED at follow up. The ARFID-group had a similar outcome to AN. In the ARFID-group, all ED-cases at follow up had ARFID, possibly indicating symptomatic stability. Low-weight ARFID should be treated as seriously as childhood onset AN.

Disordered eating in a Swedish community sample of adolescent girls: subgroups, stability, and associations with body esteem, deliberate self-harm and other difficulties.

BACKGROUND: The developmental study of subtypes of disordered eating (DE) during adolescence may be relevant to understand the development of eating disorders. The purpose of the present study was to identify subgroups with different profiles of DE in a community sample of adolescent girls aged 13-15 years, and to study the stability of these profiles and subgroups over a one-year interval in order to find patterns that may need to be addressed in further research and prevention. METHODS: Cluster analysis according to the LICUR procedure was performed on five aspects of DE, and the structural and individual stability of these clusters was analysed. The clusters were compared with regard to BMI, body esteem, deliberate self-harm, and other kinds of psychological difficulties. RESULTS: The analysis revealed six clusters (Multiple eating problems including purging, Multiple eating problems without purging, Social eating problems, Weight concerns, Fear of not being able to stop eating, and No eating problems) all of which had structurally stable profiles and five of which showed stability at the individual level. The more pronounced DE clusters (Multiple eating problems including/without purging) were consistently associated with higher levels of psychological difficulties and lower levels of body esteem. Furthermore, girls that reported purging reported engaging in self-harm to a larger extent. CONCLUSIONS: Subgroups of 13-15 year old girls show stable patterns of disordered eating that are associated with higher rates of psychological impairment and lower body esteem. The subgroup of girls who engage in purging also engage in more deliberate self-harm.

[Early weight gain in anorexia nervosa is associated with a favourable prognosis]. / Tidig viktuppgång vid anorexia nervosa ger god prognos - Intensiv familjebaserad behandling ger bäst resultat.

In adolescent anorexia nervosa starvation with long-standing low weight worsens prognosis. Rapid weight gain at the start of treatment is associated with a favourable medical and psychological outcome. There is an increasing evidence base for family based treatment as the most efficacious treatment for adolescents with anorexia nervosa. It is essential for child and adolescent mental health services to promptly provide assessment to prevent further weight loss. Intensive family based treatment should be initiated without delay aiming rapid weight recovery. This is preferably managed at specialised eating disorders units.

Childhood Anorexia Nervosa Compared with Low Weight Food Intake Disorder Without Weight and Shape-Related Psychopathology: A Retrospective Study of 102 Patients.

OBJECTIVE: To compare the clinical presentation of children with anorexia nervosa (AN group) with that of children with low-weight food intake disorder without weight and shape-related psychopathology (non-AN group). METHOD: Medical and psychiatric data were obtained from the case records of a consecutive series of 102 children with an eating disorder and a pronounced low weight who were below the age of 13 at the start of treatment. RESULTS: Fifty-eight patients constituted the AN group, and 44 constituted the non-AN group. The non-AN group was younger and had a longer duration of symptoms than the AN group. The non-AN group also had a lower maximum premorbid weight and shorter stature. There were no differences in medical severity, but the AN group had more psychiatric treatment. DISCUSSION: The non-AN group seems to have a medically equally severe disorder as the AN group, but is less often detected and properly treated. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.

[Eating disorder and the family--a review]. / Atstörning och familjen--en översikt.

The importance of the family in eating disorders has been the subject of a great deal of speculation ever since anorexia nervosa was first described some 130 years ago. Given the importance of the family in child and adolescent development, it also has great bearing on how young people learn to deal with food. But the research is inconclusive as to the family's precise role in the development of an eating disorder. There is no support in the literature on which to base a comprehensive understanding of the family setting in which a member develops an eating disorder; this also applies to anorexia nervosa cases. When groups of families afflicted with different psychiatric disorders are compared, it seems that families in which bulimia nervosa occurs tend to be more dysfunctional than families afflicted with anorexia nervosa. It also seems that families afflicted with anorexia nervosa function better than families afflicted by other psychiatric disorders. In this article the research on family functioning in relation to anorexia nervosa and bulimia nervosa is reviewed and its relevance discussed.

Anorexia nervosa in teenagers: change in family function after family therapy, at 2-year follow-up.

Family therapy has emerged as the treatment of choice for young patients with anorexia nervosa, yet there is insufficient knowledge about what actually happens within the family unit in these cases. The purpose of the present study was to investigate how a family undergoing treatment due to an anorectic child changes their mode of functioning. Twenty-six families were studied. The concepts chosen in the study were closely linked to fundamental principles advocated by the therapeutic model used in the treatment, using a multi-method approach with both observer ratings and self-rating questionnaires. According to observer ratings, the families had changed towards a more functional pattern on all dimensions rated. They had a clearer hierarchy and a higher degree of competency. Cohesion and Adaptability had changed towards a more balanced pattern, away from enmeshment and rigidity. According to self-ratings, the families changed toward more expressiveness. Families where the patient had recovered were less enmeshed at follow-up. We also found a tendency towards higher degree of competence in these families.