September 5, 2006
Please see the following articles from Archives of General Psychiatry and Pediatrics.
Taylor CB, Bryson S, Luce KH, Cunning D, Doyle AC, Abascal LB, Rockwell R, Dev P, Winzelberg AJ, Wilfley DE. Prevention of eating disorders in at-risk college-age women. Arch Gen Psychiatry. 2006 Aug; 63(8):881-8.
CONTEXT: Eating disorders, an important health problem among college-age women, may be preventable, given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors. OBJECTIVE: To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders (EDs) in young women at risk for developing EDs. SETTING: San Diego and the San Francisco Bay Area in California. PARTICIPANTS: College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2000, and October 10, 2003.Intervention A randomized controlled trial of an 8-week, Internet-based cognitive-behavioral intervention (Student Bodies) that included a moderated online discussion group. Participants were studied for up to 3 years. MAIN OUTCOME MEASURES: The main outcome measure was time to onset of a subclinical or clinical ED. Secondary measures included change in scores on the Weight Concerns Scale, Global Eating Disorder Examination Questionnaire, and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood. Moderators of outcome were examined. RESULTS: There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention (P < .001), 1 year (P < .001), and 2 years (P < .001). The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group (P = .02). Over the course of follow-up, 43 participants developed subclinical or clinical EDs. While there was no overall significant difference in onset of EDs between the intervention and control groups, the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses: (1) participants with an elevated body mass index (BMI) (> or =25, calculated as weight in kilograms divided by height in meters squared) at baseline and (2) at 1 site, participants with baseline compensatory behaviors (eg, self-induced vomiting, laxative use, diuretic use, diet pill use, driven exercise). No intervention participant with an elevated baseline BMI developed an ED, while the rates of onset of ED in the comparable BMI control group (based on survival analysis) were 4.7% at 1 year and 11.9% at 2 years. In the subgroup with a BMI of 25 or higher, the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group (95% confidence interval, 0% for intervention group; 2.7% to 21.1% for control group). For the San Francisco Bay Area site sample with baseline compensatory behaviors, 4% of participants in the intervention group developed EDs at 1 year and 14.4%, by 2 years. Rates for the comparable control group were 16% and 30.4%, respectively. CONCLUSIONS: Among college-age women with high weight and shape concerns, an 8-week, Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs, at least in some high-risk groups. To our knowledge, this is the first study to show that EDs can be prevented in high-risk groups.
Taylor CB, Bryson S, Celio Doyle AA, Luce KH, Cunning D, Abascal LB, Rockwell R, Field AE, Striegel-Moore R, Winzelberg AJ, Wilfley DE. The adverse effect of negative comments about weight and shape from family and siblings on women at high risk for eating disorders. Pediatrics. 2006 Aug; 118(2):731-8.
OBJECTIVE: Our purpose with this work was to examine the relationship between negative comments about weight, shape, and eating and social adjustment, social support, self-esteem, and perceived childhood abuse and neglect. METHODS: A retrospective study was conducted with 455 college women with high weight and shape concerns, who participated in an Internet-based eating disorder prevention program. Baseline assessments included: perceived family negative comments about weight, shape, and eating; social adjustment; social support; self-esteem; and childhood abuse and neglect. Participants identified 1 of 7 figures representing their maximum body size before age 18 and parental maximum body size. RESULTS: More than 80% of the sample reported some parental or sibling negative comments about their weight and shape or eating. Parental and sibling negative comments were positively associated with maximum childhood body size, larger reported paternal body size, and minority status. On subscales of emotional abuse and neglect, most participants scored above the median, and nearly one third scored above the 90th percentile. In a multivariate analysis, greater parental negative comments were directly related to higher reported emotional abuse and neglect. Maximum body size was also related to emotional neglect. Parental negative comments were associated with lower reported social support by family and lower self-esteem. CONCLUSIONS: In college women with high weight and shape concerns, retrospective reports of negative comments about weight, shape, and eating were associated with higher scores on subscales of emotional abuse and neglect. This study provides additional evidence that family criticism results in long-lasting, negative effects.
August 23, 2006
Please see below the link to the following article from Journal of Consulting and Clinical Psychology.
The Prevention of Depressive Symptoms in Children and Adolescents: A Meta-Analytic Review. Jason L. Horowitz, Ph.D., Judy Garber, Ph.D. Journal of Consulting and Clinical Psychology 2006: Vol. 74, No. 3, 401-415.
August 22, 2006
Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244-251
As body dissatisfaction is common among adolescents, Neumark-Sztainer and colleagues (2006) conducted a longitudinal study to examine whether body satisfaction was associated with health-promoting (e.g., regular physical activity) or health-compromising behaviors (e.g., binge eating). A total of 2516 junior and senior high school students (1130 males and 1386 females) completed assessments of body satisfaction, dieting and weight control behaviors, binge eating, smoking, physical activity, fruit and vegetable intake, body mass index (BMI), and sociodemographic characteristics at two time points. Lower levels of body satisfaction at the first assessment predicted higher levels of health-compromising behaviors, specifically unhealthy weight control behaviors, binge eating, and dieting, and lower levels of health-promoting behaviors, like moderate-to-vigorous physical activity and fruit and vegetable intake, five years later. While a number of the associations between body satisfaction and health behaviors were still statistically significant after controlling for BMI at the first assessment, the relationships were weaker and less consistent. Only one suggestion of a positive impact of low body satisfaction emerged, with males demonstrating an inverse relationship between body satisfaction and healthy weight control behaviors at the second assessment. Thus, body satisfaction may play a significant role in the health-behaviors of adolescents over a five-year period, and as such, programs to address body satisfaction and promote healthy behaviors among adolescents may be needed.
Taylor, C. B., Bryson, S., Luce, K. H., Cunning, D., Celio Doyle, A., Abascal, L. B., Rockwell, R., Dev, P., Winzelberg, A. J., & Wilfley, D. E. (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 63, 881-888
Overconcern with shape and weight is a risk factor for the development of eating pathology, including eating disorders. Taylor and colleagues (2006) evaluated an 8-week Internet-based intervention designed to reduce weight and shape concerns to determine if the intervention would prevent the onset of eating disorders. Participants included 480 college-aged women (aged 18-30 years) considered to be at high risk for the development of an eating disorder because of high shape and weight concerns. Two hundred and forty-four women were randomized to receive the intervention and 236 were randomized to a wait-list control group. Reductions in shape and weight concerns were observed among participants receiving the intervention after eight weeks that were maintained over a one-year follow-up. However, except among a small subgroup of women with higher body max indices and women with low-level compensatory behaviors at the beginning of the study, a similar reduction was not observed for the onset of eating disorders. Thus, a brief cognitive-behavioral program was successful in decreasing a known risk factor for the development of eating disorders, but it did not decrease the incidence of eating disorders for the participant group as a whole. And although this study was not specifically focused on adolescents, the findings suggest that future research could apply similar programs to a younger cohort to determine whether early intervention would increase the success of the program.
June 20, 2006
Lock, J., Couturier, J., & Agras, W. S. (2006). Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 666-672.
A specific form of family therapy, developed at the Maudsley Hospital in the United Kingdom, has shown promise as a treatment for adolescents with anorexia nervosa. This study was designed to examine the long-term outcomes of adolescents (aged 12-18 years) diagnosed with anorexia nervosa who received either a short (6-month) or long (12-month) course of the Maudsley form of family therapy. A total of 71 (83%) adolescents or their parents provided some follow-up data, including 35 (49%) adolescents who completed the Eating Disorder Examination (EDE; Cooper & Fairburn, 1987), an interview assessing specific eating disorder psychopathology. The follow-ups were conducted a mean of 3.96 (range of 2.3-6.0) years after the end of treatment. No statistically significant differences were observed between the adolescents who received the short and long versions of family therapy for body mass index, global EDE scores, and need for additional treatment. Thus, providing adolescents with a shorter version of the Maudsley family therapy was not associated with lower body weights or increased treatment utilization almost four years after the end of treatment. This finding suggests that six months of family therapy is sufficient to produce short- and long-term improvements equivalent to those observed with twelve months of treatment.
Walsh, B. T., Kaplan, A. S., Attia, E., Olmsted, M. Parides, M., Carter, J. C., Pike, K. M., Devlin, M. J., Woodside, B., Roberto, C. A., & Rockert, W. (2006). Fluoxetine after weight restoration in anorexia nervosa: A randomized controlled trial. Journal of the American Medical Association, 295, 2605-2612.
Many of the symptoms observed among patients with anorexia nervosa resemble those of other disorders (e.g., depression, obsessive-compulsive disorder) that are responsive to antidepressant medication treatment. However, antidepressant medications are not effective for the acute treatment of low-weight individuals with anorexia nervosa. One previous study (Kaye, Nagata, Weltzin, et al., 2001) suggested that antidepressant medication might be helpful in delaying relapse among patients with anorexia nervosa after weight restoration, and this study was designed to examine whether fluoxetine, a selective serotonin reuptake inhibitor, reduced the rate of relapse among a large sample of weight-restored patients with anorexia nervosa. A total of 93 females between the ages of 16 and 45 with anorexia nervosa were randomly assigned to receive double-blind medication, fluoxetine (60 mg) or placebo, and cognitive behavior therapy (50 sessions) over a one year period. Forty of the 93 randomized patients completed treatment. No significant differences were observed between the fluoxetine and placebo on almost all measures of outcome, including time to relapse, study completion, body mass index, and psychological measures. Therefore, antidepressant medication was not helpful in preventing relapse among weight-restored patients with anorexia nervosa. This study was not specifically focused on adolescents, but it did include a significant number of patients under the age of 21, and therefore, the findings are likely applicable to older adolescents and young adults.
February 2, 2006
Please see below the link to the following article from American Journal of Psychiatry.
Suicide Risk During Antidepressant Treatment. Gregory E. Simon, MD,
M.P.H., James Savarino, Ph.D., Belinda Operskalski, M.P.H., Philip S. Wang, MD, Dr. P.H.. Am. J. Psychiatry 2006: 163: 41-47.
May 2, 2006
Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review.
Bell J, Mutch C.
The Langton Centre, Surry Hills, New South Wales, Australia.
The aim of this study was to compare retention and re-entry to treatment between adolescent subjects treated with methadone, those treated with buprenorphine, and those treated with symptomatic (non-opioid) medication only. We used a retrospective file review of all patients aged less than 18 at first presentation for treatment for opioid dependence. The study was conducted at the Langton Centre, Sydney, Australia, an agency specialising in the treatment of alcohol and other drug dependency. Sixty-one adolescents (age range 14 - 17 years at the time of commencing treatment); mean reported age of initiation of heroin use was 14 +/- 1.3 years (range 11 - 16). Sixty-one per cent were female. The first episode of treatment was methadone maintenance in 20 subjects, buprenorphine in 25, symptomatic medication in 15; one patient underwent assessment only. These 61 subjects had a total of 112 episodes of treatment. Subjects treated with methadone had significantly longer retention in first treatment episode than subjects treated with buprenorphine (mean days 354 vs. 58, p<0.01 by Cox regression) and missed fewer days in the first month (mean 3 vs. 8 days, p<0.05 by ttest). Subsequent re-entry for further treatment occurred in 25% of subjects treated with methadone, 60% buprenorphine and 60% symptomatic medications. Time to re-entry after first episode of buprenorphine treatment was significantly shorter than after methadone treatment (p<0.05 by Kaplan - Meier test). Methadone maintenance appears to have been more effective than buprenorphine at preventing premature drop-out from treatment of adolescent heroin users. [Bell J, Mutch CJ. Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review. Drug Alcohol Rev 2006;25:167 - 171].
January 9, 2006
Please see below links to two press releases from the national Monitoring the Future Study, which annually surveys nationally representative samples of students in grades 8, 10, and 12--some 50,000 in all, located in about 400 secondary schools. This study tracks the substance using habits of American adolescents, including their use of cigarettes, alcohol, steroids, and a wide range of illicit drugs.
The two press releases are available at http://monitoringthefuture.org/press.html . Please see the first two press releases listed.
Monographs published from the 2004 study may be viewed at http://monitoringthefuture.org/pubs.html . The monographs are the first three listed. The monographs for the 2005 results are forthcoming.
January 24, 2006
Wilson, G. T. & Sysko, R. (2006). Cognitive behavioural therapy for adolescents with bulimia nervosa. European Eating Disorders Review, 14, 8-16.
While much is known about the effectiveness of psychological treatments for bulimia nervosa (BN) among adults, there are no published controlled studies of psychological treatments for adolescents. Wilson and Sysko (2006) suggest that cognitive behavior therapy (CBT) could be an appropriate treatment to adapt for adolescents with BN because of the efficacy of CBT for adults with BN, the efficacy of CBT for adolescents with other disorders (e.g., anxiety disorders), and the clinical and conceptual fit between CBT and adolescents with BN. The authors propose adaptations to a recently described version of CBT (Fairburn, Cooper, & Shafran, 2003) in the areas of motivation, cognitive processing, interpersonal functioning, and family involvement to make the treatment developmentally appropriate. This paper highlights the need for controlled studies of psychological treatments, including CBT, for adolescents with BN.
Silberg, J. L., & Bulik, C. M. (2005). The developmental association between eating disorders symptoms and symptoms of depression and anxiety in juvenile twin girls. Journal of Child Psychology and Psychiatry, 46, 1317-1326.
Silberg & Bulik (2005) investigated the relationship between genetic and environmental factors and symptoms of eating disorders, depression, and anxiety. The participants were 408 monozygotic twins and 198 dizygotic female twins between 8 and 13 or 14 and 17 years old from the Virginia Twin Study of Adolescent Behavioral Development. The results indicated that there may be one genetic pathway influencing liability to symptoms of eating, anxiety, depression, and a distinct genetic factor related to risk for early eating disorders symptoms. The study found evidence of a shared environmental factor that influenced early depression and early eating disorders symptoms and another common factor affecting risk for symptoms of later eating disorders and both early and later separation anxiety. Thus, the results suggest that there are genetic associations between symptoms of anxiety, depression, and eating, and that there are both significant genetic and environmental influences on the development of eating, depression, and anxiety symptoms.
November 29, 2005
Binford, R. B., & Le Grange, D. (2005). Adolescents with bulimia nervosa and eating disorder not otherwise specified-purging only. International Journal of Eating Disorders, 38, 157-161.
As described in Treating and Preventing Adolescent Mental Health Disorders (Eating Disorders Commission, 2005) the majority of patients, adolescent or adult, who present for treatment do not meet full criteria for the two eating disorders (anorexia nervosa or bulimia nervosa) described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Most patients are diagnosed with an eating disorders not otherwise specified (EDNOS), a category that is not well understood. It is important to understand the similarities and differences between the presentation of patients diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) and those who are classified as having an EDNOS. The purpose of the Binford & Le Grange (2005) study was to examine the differences between adolescents diagnosed with DSM-IV BN and adolescents meeting criteria for an EDNOS who reported purging behaviors in the absence of consuming large amounts of food (EDNOS-P). Fifty-six adolescents participated in the study (n=36 BN, n=20 EDNOS-P) by completing an interview and self-report questionnaires. Participants with DSM-IV BN did not significantly differ from participants with EDNOS-P in weight or on a measures of eating disorder symptoms including self-induced vomiting, laxative abuse, exercise, dietary restraint or psychological assessments, including Beck Depression Inventory scores. Adolescents with EDNOS-P did report significantly lower levels of self-esteem and fewer shape, eating, and weight concerns than the adolescents with BN. The authors hypothesize that for adolescents with EDNOS-P, the purging may be used as a means of weight control, rather than a way of compensating for episodes of binge eating. Thus, although there are similarities in the presentation of EDNOS-P and BN among adolescents, there may be differences in the motivations for continuing purging behaviors for patients with EDNOS-P, which could have implications for treatment.
October 4, 2005
Le Grange, D., Binford, R., & Loeb, K. L. (2005). Manualized family-based treatment for anorexia nervosa: A case series. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 41-46.
Le Grange, Binford, and Loeb (2005) describe an open case series of 45 children and adolescents with anorexia nervosa treated with the Maudsley method of family therapy (Lock, Le Grange, Agras, & Dare, 2001). On average, patients completed 17 treatment sessions over 9-10 months, and their mean body mass index increased from 16.9 kg/m2 (SD = 1.9) to 19.2 kg/m2 (SD=2.2). At the end of treatment, using Morgan-Russell outcome criteria, 56% (n=25) of the patients with anorexia nervosa had a good outcome, or had a weight > 85% of ideal and menses, 33% (n=15) had an intermediate outcome, or had a weight > 85% of ideal but intermittent menses, and 11% (n=5) had a poor outcome, or had a weight < 85% of ideal and no menses. This study provides preliminary support for the use of the Maudsley method of family therapy for the treatment of children and adolescents with anorexia nervosa.
Golden, N. H., Iglesias, E., Jacobson, M. S., Carey, D., Meyer, W., Schebendach, J., Hertz, S., & Shenker, I. R. (2005). Alendronate for the treatment of osteopenia in anorexia nervosa: A randomized double-blind placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism, 90, 3179-3185.
Golden et al. (2005) report the results of a double-blind randomized-controlled trial of alendronate (10 mg), or an equivalent dose of placebo, in the treatment of osteopenia among adolescents with anorexia nervosa. Thirty-two adolescents participated, all of whom received calcium (1200 mg) and Vitamin D (400 IU) in addition to the study medications. At follow-up, bone mineral density was significantly higher in adolescents who had been weight restored, in comparison to adolescents who were still at a low weight. Within the alendronate group, measures of bone mineral density increased in the lumbar spine and femoral neck, but this was not significantly different from placebo. Thus, the authors concluded that weight restoration is the most important determinant of bone mineral density; however, they suggest a larger randomized controlled trial because of beneficial effects observed for bone mineral density in the lumbar spine and femoral neck of patients in the alendronate group.