[Treatment of bulimia nervosa]. / Behandlung der Bulimia nervosa.

Many young women and also men are constantly dissatisfied with their body. In some cases the discontent with one's own body and the resulting restrictive eating behaviour can predetermine the path to bulimia nervosa. This article summarizes the treatment options and their respective evidence for bulimia nervosa. Apart from the choice of treatment setting, psychotherapeutic treatment measures and the role of psychopharmacologic drugs for the treatment of bulimia nervosa are discussed.

The assessment of body image distortion in female adolescents with anorexia nervosa: the development of a Test for Body Image Distortion in Children and Adolescents (BID-CA).

The purpose of this study was to develop an instrument (Test for Body Image Distortion in Children and Adolescents, BID-CA) suitable for adolescents to detect and quantify body image distortion. Participants were patients with anorexia nervosa (AN; N=75), healthy age-matched control participants (N=268) and age-matched thin female athletes (N=50) with a mean age of 15.2 (standard deviation =2.0) years. We assessed body image distortion (arm, waist, and thigh) using the BID-CA and two scales of the Eating Disorder Inventory-2 (EDI-2; Drive for Thinness, Body Dissatisfaction). Diagnostic validity of the BIDCA was analyzed with receiver operating characteristic (ROC) curves. Additional regression analyses revealed the variables BID-CA thigh and EDI-2 Drive for Thinness to be the best at predicting body image distortion among AN patients. In conclusion, the BID-CA showed good diagnostic validity. It is efficient, language independent, time-saving and seems appropriate for children and adolescents.

[Personality disorders in childhood and adolescence]. / Persönlichkeitsentwicklung im Kindes- und Jugendalter.

The diagnosis of a personality disorder is defined by the fact that personality traits are formed by early childhood, but German clinicians very rarely diagnose children and adolescents with personality disorders. Opponents of diagnosing personality disorders in childhood want to avoid labeling and refer to the developmental aspect of the personality. Supporters argue that children and adolescents already possess a describable personality and the developmental process continues into adulthood. By recognizing the pathological personality tendencies early enough allows an early therapy which can prevent an acute progression. The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. This empirical study indicated that one-third of the adolescents investigated were still diagnosed with a personality disorder 1 year after the primary assessment. However, the present categorizing diagnosis system proved to be insensible for childhood and adolescence. This supports the notion that dimensional systems are needed to diagnose personality traits in childhood in adolescence.

Psychopathology in underweight and weight-recovered females with anorexia nervosa.

OBJECTIVE: To compare general and eating disorder-specific psychopathology in patients with acute anorexia nervosa (acAN), weight-recovered patients (recAN) and healthy control women (HCW). METHODS: One hundred anorexia nervosa patients (66 acAN and 34 recAN) and 88 HCW were included in our study. Psychopathology was assessed by self-report questionnaires [Symptom Check List 90 Revised (SCL-90-R), Eating Disorder Inventory-2 (EDI- 2)] as well as by interview [Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX)] and compared using multivariate analysis of variance. Plasma leptin levels were determined using enzyme linked immunosorbent assay. RESULTS: Mean comparisons indicated highly significant differences between acAN and recAN subjects on all psychopatholgy variables, except for perfectionism. RecAN subjects did not differ from HCW. Partial weight recovery was associated with decreasing levels of psychopathology. Correlational analyses suggested strong negative associations between leptin levels and psychopathology. CONCLUSION: Prolonged malnutrition, as indicated by suppressed plasma leptin levels, is strongly related to eating disorder-specific as well as general psychopathological symptoms. Weight recovery is associated with the absence of psychopathology. These data emphasize the interaction between somatic and psychological variables.

Platelet monoamine oxidase activity in underweight and weight-recovered females with anorexia nervosa.

INTRODUCTION: Central serotonergic pathways may play an important role in the etiology of anorexia nervosa (AN). Although platelet monoamine oxidase activity (MAO-B) has been proposed as an index of cerebral serotonin activity, studies in patients with AN are scarce. METHODS: Platelet MAO-B activity was determined in 59 acutely underweight AN patients (acAN, aged 14-29 years, BMI=15.2+/-1.4), 35 weight-recovered AN patients (recAN, aged 15-29, BMI=20.8+/-2.2) and 59 healthy control women (HCW, aged 14-26, BMI=21.6+/-2.1). Plasma leptin served as an indicator of malnutrition. Results were compared by ANCOVA controlling for confounding variables. RESULTS: Platelet MAO-B activity in acAN patients (5.2+/-1.4 nmol/10 (9)pltx15 min) was similar to HCW (5.5+/-1.9) but significantly lower in recAN patients (4.4+/-1.5). BMI and leptin showed a significant negative correlation with MAO-B activity in AN patients, but not in HCW. DISCUSSION: Our results highlight the importance of malnutrition for the interpretation of abnormalities in neurotransmitter systems in AN. Whether low MAO-B activity in weight-recovered AN patients indicates a premorbid trait or a secondary change due to recovery remains to be elucidated.

[Diagnostic of personality disorders in adolescence according to SCID-II]. / Diagnostik von Persönlichkeitsstörungen im Jugendalter nach SKID-II.

OBJECTIVES: The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. Furthermore, the diagnostic concordance between SCID-II and the clinicians' estimations of personality disorders (PD) is assessed. In addition, we identified predicting factors for personality disorders in adolescent psychiatric inpatients. METHODS: 110 adolescent psychiatric inpatients aged 14-18 years were assessed by means of SCID-II and a personality and disorder inventory (PSSI). RESULTS: 32.7% of the inpatients met the criteria for PD according to SCID-II. While agreement between the presence of any PD based on SCID-II and that found according to clinicians' estimations was low, moderate and very good agreement between SCID-II and clinicians' estimations was found with regard to borderline PD and histrionic PD. Logistic regression analyses identified "anorexia nervosa (binge-purging)", "attention-deficit/hyperactivity disorder/conduct disorder (ADHD/CD)" and "socioeconomic status" as good predictors for PD. CONCLUSIONS: The SCID-II - which was primarily developed for use with adults - is suitable for use among adolescents. Anorexia nervosa (binge-purging type) and ADHD/CD are closely associated with the development of PD in adolescents.