Ego boundary disturbance in juvenile anorexia nervosa

Tested the hypothesis that ego boundary disturbance is present in adolescent females with anorexia nervosa. Twenty anorexics were compared to 20 female depressed controls on Rorschach scales designed to measure theoretically relevant aspects of boundary impairment. Results showed that anorexics scored higher on scales that measure inner-outer and conceptual boundary disturbance and produced significantly more responses that emphasized the solidity of object boundaries. Boundary scores were unrelated to degree of weight loss and global symptom severity, and follow-up testing after normal weight was restored revealed little change from initial levels. These findings are discussed in relation to current theory on the role of developmental ego pathology in the origins and phenomenology of anorexia nervosa.

Reliability of psychiatric diagnosis in hospitalized adolescents. Interrater agreement using DSM-III

To determine the reliability of psychiatric diagnosis in hospitalized adolescents, 95 consecutively admitted patients were diagnosed independently by two experienced clinicians using DSM-III criteria. Diagnostic judgments were based on joint interview of the patient via a structured mental-status examination, nursing observations, and referral materials. Concordance was analyzed by the kappa coefficient. A total of 13 DSM-III categories were used to classify this cohort, with the majority of categories representing traditional syndromes of functional psychopathology. There was complete agreement between the raters for more than three fourths of the patients. Levels of agreement for the categories of schizophrenia and major affective disorder were similar to values obtained in recent studies of adult patients. The results are discussed in relation to historical conceptions of adolescent psychopathology.

Body image disturbance in anorexia nervosa during the acute and recuperative phase

Perception of body size, subjective experience of body image distortions and differentiation of body concept in the human figure drawing were assessed in adolescent anorexia nervosa patients and controls shortly after hospital admission, and again 6 months later during the recuperative phase. Size estimation was not found to be a distinguishing variable, as both groups exhibited overestimation tendencies of comparable magnitude at both time periods. By contrast, experiences denoting estrangement from the body, insensitivity to body sensations, and weakness of body boundaries were more prevalent in anorexics, and persisted at high levels after frank symptoms of weight and eating disorder had subsided. Anorexics were also shown to depict the human figure with less differentiation relative to controls. Within the anorexic sample the presence of vomiting was linked to greater subjective experience of body image distortion, and such phenomena appear to be a more enduring feature in this subgroup. Overall, the results were viewed as lending support to the argument that defects in body image formation render the anorexic vulnerable to their manifest pathology, which is itself activated by maturational conflicts unique to adolescence.

The structuring of interpersonal relations in schizophrenic adolescents: a decentering analysis of Thematic Apperception Test stories

This study tested the hypothesis that schizophrenics employ more developmentally immature levels of decentering in their structuring of interpersonal relations. A 9-point scale of interpersonal decentering, developed originally by Feffer, was applied to Thematic Appercetion Test stories produced by schizophrenic adolescents and a control group of psychiatrically disturbed patients equivalent in age and intellectual functioning. Results provided convincing support for the hypothesis tested and suggest the theoretical utility of viewing interpersonal deficit in schizophrenia from a cognitive-developmental perspective.

Affective disorder in adolescence: issues in misdiagnosis

This case report describes a young adolescent female with bipolar manic-depressive illness, (MDI), whose behavioral symptomatology was originally attributed to non-affective forms of psychopathology. We review her entire clinical course to date and elucidate several factors that may account for diagnostic error.