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Farrow JE, Blom TJ, Kwok WY, Hardesty KE, Strawn JR, DelBello MP. Prevalence and Correlates of Eating Disorder Symptoms in Adolescents with Bipolar I Disorder. J Child Adolesc Psychopharmacol 2024; 34:226-232. [PMID: 38656909 DOI: 10.1089/cap.2024.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Objective: To investigate the prevalence and correlates of eating disorder symptoms in adolescents with bipolar I disorder (BP I). Methods: We retrospectively collected a DSM-IV-TR-based diagnostic assessment of 179 adolescents with BP I and evaluated clinical variables in those with and without eating disorder symptoms. For comparison, we retrospectively evaluated eating disorder symptoms in adolescents with generalized anxiety disorder (GAD). Results: Thirty-six percent of adolescents with BP I experienced lifetime eating disorder symptoms; among comorbid adolescents, 74% reported eating disorder cognitions and 40% reported symptoms related to bingeing, 25% purging, and 17% restricting. BP I adolescents with (vs. without) eating disorder symptoms had higher Children's Depression Rating Scale-Revised scores (40.5 vs. 34.5; p < 0.001; effect size = 0.59) and were more likely to be female (75% vs. 45%; p < 0.001; odds ratio = 3.8). There were no differences in Young Mania Rating Scale scores (p = 0.70); lifetime presence of attention-deficit/hyperactivity disorder (p = 0.86) and alcohol (p = 0.59) or substance (p = 0.89) abuse/dependence symptoms; age of BP I onset (p = 0.14); inpatient hospitalization status at baseline (p = 0.53); presence of lifetime inpatient hospitalization (p = 0.64) or suicide attempt (p = 0.35); seriousness of suicidality (p = 0.86); body mass index (p = 0.48); and second-generation antipsychotic (SGA; p = 0.32) or non-SGA mood stabilizer (p = 0.09) use. Eating disorder cognitions (rather than behaviors) were higher in the GAD group (58%) compared with the BP I group (27%; p = 0.004). Limitations: A retrospective study is subject to recall bias and limits our understanding of the temporal relationship between eating disorder and mood symptoms. Conclusions: Eating disorder symptoms are frequently comorbid in adolescents with BP I. The comorbidity is associated with more severe depression but does not confer a more severe illness course.
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Affiliation(s)
- Jenni E Farrow
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Thomas J Blom
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wan Y Kwok
- Department of Psychiatry, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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2
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Obeid N, Valois DD, Bedford S, Norris ML, Hammond NG, Spettigue W. Asceticism, perfectionism and overcontrol in youth with eating disorders. Eat Weight Disord 2021; 26:219-225. [PMID: 31916047 DOI: 10.1007/s40519-019-00837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Personality traits such as perfectionism and asceticism, and combinations of these traits (i.e., overcontrol) have been related to eating disorder (ED) diagnosis, symptoms, and chronicity in adult patients with EDs. However, as limited evidence exists in adolescents, the aim of the present study was to examine these links in a clinical sample of adolescents with EDs. METHOD A retrospective chart review was conducted on 178 adolescents (91% females; Mage = 15.73 years, SD = 1.31) receiving services at a tertiary care pediatric ED program. An examination of variability in mean levels of perfectionism, asceticism, and overcontrol across ED symptom groups (restrictive and binge/purge ED subtypes) was conducted to learn of diagnostic differences, while correlations were used to explore the association of these personality traits with comorbid anxiety and depressive symptoms. Hierarchical linear regression was used to assess whether overcontrol was related to length of stay (LOS) in an inpatient program. RESULTS Results indicated that adolescents with binge-purge symptoms had higher levels of perfectionism, asceticism and overcontrol compared to those with restrictive symptoms, and that greater levels of perfectionism, asceticism and overcontrol were associated with elevated depression and anxiety symptoms. Additionally, overcontrol predicted greater LOS in the inpatient ED program. CONCLUSION Results suggest the importance of assessing, monitoring and targeting overcontrol in treatment for adolescents with EDs given its impact on comorbid symptoms and LOS. LEVEL OF EVIDENCE Level III, evidence obtained from case-control analytic studies.
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Affiliation(s)
- Nicole Obeid
- Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. .,Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Darcie D Valois
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | | | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H 8L, Canada
| | - Nicole G Hammond
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, K1H 8L1, Canada
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3
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Spettigue W, Norris ML, Douziech I, Henderson K, Buchholz A, Valois DD, Hammond NG, Obeid N. Feasibility of Implementing a Family-Based Inpatient Program for Adolescents With Anorexia Nervosa: A Retrospective Cohort Study. Front Psychiatry 2019; 10:887. [PMID: 31849732 PMCID: PMC6901823 DOI: 10.3389/fpsyt.2019.00887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Manualized Family Based Therapy (FBT) is the treatment of choice for adolescent anorexia nervosa, but it is an outpatient treatment. Very little research has examined whether or how the principles of FBT might be successfully adapted to an inpatient setting, and there is little other evidence in the literature to guide us on how to best treat children and adolescents with eating disorders (EDs) while in hospital. This paper describes and provides treatment outcomes for an intensive inpatient program that was designed for the treatment of adolescents less than 18 years of age with severe anorexia nervosa, based on the principles of FBT. Each patient's family was provided with FBT adapted for an inpatient setting for the duration of the admission. Parents were encouraged to provide support for all meals in hospital and to plan meal passes out of hospital. Methods: A retrospective cohort study was conducted that examined the outcomes of 153 female patients admitted over a 5-year period. Outcome data focused primarily on weight change as well as psychological indicators of health (i.e., depression, anxiety, ED psychopathology). Results: Paired t-tests with Bonferroni corrections showed significant weight gain associated with a large effect size. In addition, patients showed improvements in scores of mood, anxiety, and ED psychopathology (associated with small to medium effect sizes), though they continued to display high rates of body dissatisfaction and some ongoing suicidality at the time of discharge. Conclusion: This study shows that a specialized inpatient program for adolescents with severe EDs that was created using the principles of FBT results in positive short-term medical and psychological improvements as evidenced by improved weight gain and decreased markers of psychological distress.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Mark L. Norris
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Ingrid Douziech
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Darcie D. Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole G. Hammond
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Morgan-Lowes KL, Clarke PJF, Hoiles KJ, Shu CY, Watson HJ, Dunlop PD, Egan SJ. The relationships between perfectionism, anxiety and depression across time in paediatric eating disorders. Eat Behav 2019; 34:101305. [PMID: 31226667 DOI: 10.1016/j.eatbeh.2019.101305] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/17/2019] [Accepted: 06/05/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim was to examine in children and adolescents with eating disorders the relationship between perfectionism, anxiety, and depression at intake assessment and whether intake perfectionism was significantly associated with anxiety and depression at 6 months and 12 months post-intake review. METHOD Participants were 167 females aged 10-17 years (M = 14.6, SD = 1.20) with a diagnosis of an eating disorder, who were assessed at intake to an eating disorders treatment program to receive either inpatient, day or outpatient care. Participants were re-assessed at 6 and 12 months post-intake review. RESULTS At intake and 6 and 12 months post intake review perfectionism had a significant positive correlation with anxiety and depression. Perfectionism did not however determine change in anxiety and depression over time at 6 and 12 months post-intake review. CONCLUSIONS Despite perfectionism being significantly associated with anxiety and depression, further research is required to explore the relationships between perfectionism, anxiety and depression over time.
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Affiliation(s)
| | | | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia.
| | - Chloe Y Shu
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
| | - Hunna J Watson
- School of Psychology, Curtin University, Perth, Australia; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, United States; School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Patrick D Dunlop
- Future of Work Institute, Faculty of Business and Law, Curtin University, Perth, Australia
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
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Bulbena-Cabre A, Duñó L, Almeda S, Batlle S, Camprodon-Rosanas E, Martín-Lopez LM, Bulbena A. Joint hypermobility is a marker for anxiety in children. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:68-76. [PMID: 30926372 DOI: 10.1016/j.rpsm.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/12/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) has been found to be associated with anxiety disorders in clinical and nonclinical populations, but to date no studies have evaluated this association in children. The main goal of this study is to evaluate JHS along with anxiety, somatic and behavioral measures in children to clarify if JHS is associated with any of these variables in this age range. METHODS A sample of 160 children (74 girls and 86 boys) ranging from 5 to 17 o were recruited from a Child-Adolescent Mental Health clinic to participate in the study. All children underwent a diagnostic interview using the Mini International Neuropsychiatric Interview for Children and Adolescents. Instruments used include the Child Behavior Checklist (CBCL), the Screening Questionnaire to detect Hypermobility (SQ-CH) and the Children Manifested Anxiety Scale (CMAS-R). RESULTS The prevalence of JHS in this sample was 22%, and this was significantly higher in girls (31%) than in boys (14%) (χ2=6.83; P=.001). The JHS group scored significantly higher in the CMAS-R total anxiety (F=4.51; P=.035), CMAS-R Physiological anxiety (F=7.19; P=.008) and the CBCL somatic complaints (F=8.46; 0.004) and regression analyses showed that these 3 variables were predictors of JHS (χ2=36.77; P<.001; r2=0.22). The JHS group also scored higher in some behavioral measures. CONCLUSION Children with JHS have higher frequency of anxiety disorders and higher intensity of physiological anxiety, somatic complaints, and therefore, JHS might be used as marker for this anxiety phenotype in youngsters.
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Affiliation(s)
- Andrea Bulbena-Cabre
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, EE. UU.; Department of Psychiatry, New York Medical College, Nueva York, EE. UU.
| | - Lourdes Duñó
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Sara Almeda
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Santiago Batlle
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Ester Camprodon-Rosanas
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Luis Miguel Martín-Lopez
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
| | - Antonio Bulbena
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
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Drieberg H, McEvoy PM, Hoiles KJ, Shu CY, Egan SJ. An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders. Eat Behav 2019; 32:53-59. [PMID: 30594108 DOI: 10.1016/j.eatbeh.2018.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Perfectionism is a transdiagnostic factor across eating disorders, anxiety, and depression. Previous research has shown anxiety mediates the relationship between perfectionism and eating disorders in adults. The aim of this study was to investigate the relationships between anxiety/depression, perfectionism and eating disorder symptoms in children and adolescents with eating disorders. METHOD Structural equation modeling was used to investigate three models in a clinical sample of children and adolescents (N = 231, M age = 14.5, 100% female): (1) anxiety and depression as mediators of the relationship between perfectionism and eating disorder symptoms, (2) eating disorder symptoms as a mediator of the relationship between perfectionism and anxiety and/or depression, and (3) perfectionism as a mediator of the relationship between anxiety/depression and eating disorders. RESULTS Results indicated that both models 1 and 2 fit the data well, while model 3 provided a poor fit. These findings suggest that in clinical populations of children and adolescents, anxiety and depression mediate the relationship between perfectionism and eating disorder symptoms, and there is also a reciprocal relationship whereby eating disorders mediate the association between perfectionism, and anxiety and/or depression. DISCUSSION The results highlight the importance of further research to determine whether targeting perfectionism is helpful in the treatment of eating disorders and comorbid anxiety and depression in young people. It would be useful for clinicians to consider assessing for and treating perfectionism directly when it is elevated in children and adolescents with eating disorders.
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Affiliation(s)
- Haans Drieberg
- School of Psychology, Curtin University, Perth, Australia
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Kimberley J Hoiles
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia.
| | - Chloe Y Shu
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
| | - Sarah J Egan
- School of Psychology, Curtin University, Perth, Australia
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Araujo DS, Marquezin MCS, Barbosa TS, Fonseca FLA, Fegadolli C, Castelo PM. Assessment of quality of life, anxiety, socio-economic factors and caries experience in Brazilian children with overweight and obesity. Int J Dent Hyg 2016; 15:e156-e162. [DOI: 10.1111/idh.12248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/01/2022]
Affiliation(s)
- DS Araujo
- Department of Pediatric Dentistry; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - MCS Marquezin
- Department of Pediatric Dentistry; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - TS Barbosa
- Department of Pediatric Dentistry; Piracicaba Dental School; University of Campinas; Piracicaba SP Brazil
| | - FLA Fonseca
- Department of Biological Sciences; Universidade Federal de São Paulo; Diadema SP Brazil
| | - C Fegadolli
- Department of Biological Sciences; Universidade Federal de São Paulo; Diadema SP Brazil
| | - PM Castelo
- Department of Biological Sciences; Universidade Federal de São Paulo; Diadema SP Brazil
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