Puberty, sexual development and eating disorders in adolescent outpatients

Balancing Performance and Health in Elite Hungarian Athletes: The Relationship Among Disordered Eating Risk, Body Composition, and Nutrition Knowledge

BACKGROUND

disordered eating (DE) and eating disorders (ED) can negatively impact athletes' health, wellbeing, and athletic performance.

OBJECTIVE

this cross-sectional study aims to assess DE risk, body composition, and nutrition knowledge among elite Hungarian athletes.

METHODS

DE risk was assessed using DESA-6H and EAT-26 scales, nutrition knowledge through the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ), and body composition with the OMRON BF511 device. The data were analyzed using Kendall's tau correlations, Mann-Whitney U tests, and ROC analysis.

RESULTS

a total of 71 athletes participated (39.4% males, mean age = 24.8 years, SD = 4.8 years and 60.6% females, mean age = 24.3 years, SD = 4.3 years). At-risk scores on the DESA-6H scale were recorded for nine athletes (12.7%), while 32.4% scored in the risk zone on the EAT-26, with female athletes in aesthetic, endurance and weight-dependent sports being most affected. Low BF was observed in four males and four females. Nutrition knowledge (49.1%) was below the acceptable threshold. DESA-6H significantly correlated with EAT-26 scores, BMI, sports nutrition knowledge, and A-NSKQ total scores. A statistically significant difference by gender was found in the EAT-26 total score (p = 0.019, d = 0.65). Risk groups significantly differed in A-NSKQ scores (p = 0.026, d = 0.511) and sport nutrition knowledge, specifically (p = 0.016, d = 0.491). Using EAT-26 to identify at-risk athletes and the DESA-6H recommended cut-off, the ROC analysis showed a sensitivity of 29.1% and a specificity of 95.7%.

CONCLUSIONS

insufficient nutrition knowledge plays a role in being at-risk for DE and ED. These results underscore the need for early detection, early sport nutrition education across all elite athletes, with particular attention to female athletes in aesthetic, endurance and weight-dependent sports, and for monitoring these athletes to prevent DE. Further work is warranted to optimize screening tools such as EAT-26 and DESA-6H for elite athletes.

Eating disorders and the risk of developing cancer: a systematic review

PURPOSE

Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer.

METHODS

A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types.

RESULTS

From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa).

CONCLUSIONS

The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex).

LEVEL OF EVIDENCE

Level I, systematic review.

A Systematic Literature Review of Factors Affecting the Timing of Menarche: The Potential for Climate Change to Impact Women's Health

Menarche is the first occurrence of a woman’s menstruation, an event that symbolizes reproductive capacity and the transition from childhood into womanhood. The global average age for menarche is 12 years and this has been declining in recent years. Many factors that affect the timing menarche in girls could be affected by climate change. A systematic literature review was performed regarding the timing of menarche and four publication databases were interrogated: EMBASE, SCOPUS, PubMed, and Cochrane Reviews. Themes were identified from 112 articles and related to environmental causes of perturbations in menarche (either early or late), disease causes and consequences of perturbations, and social causes and consequences. Research from climatology was incorporated to describe how climate change events, including increased hurricanes, avalanches/mudslides/landslides, and extreme weather events could alter the age of menarche by disrupting food availability or via increased toxin/pollutant release. Overall, our review revealed that these perturbations in the timing of menarche are likely to increase the disease burden for women in four key areas: mental health, fertility-related conditions, cardiovascular disease, and bone health. In summary, the climate does have the potential to impact women’s health through perturbation in the timing of menarche and this, in turn, will affect women’s risk of disease in future.

Relationship between disordered eating and self-identified sexual minority youth in a sample of public high school adolescents

PURPOSE

To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents.

METHODS

The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression.

RESULTS

Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05).

CONCLUSIONS

Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

PREDICTORS OF EATING DISORDER RISK IN ANOREXIA NERVOSA ADOLESCENTS

SUMMARY – The purpose of the present study was to examine the association among the risk of eating disorder (ED), psychological adjustment, empathy, attachment style and thin-ideal internalization among adolescents with anorexia nervosa (AN), as compared to a healthy control (HC) group. The Questionnaire of General Data, the Eating Disorders Inventory-3 (EDI-3), the Questionnaire of Sociocultural Attitudes Towards Appearance-3 (SATAQ-3), the Experiences in Close Relationships-Revised (ECR-R) and the Basic Empathy Scale (BES) were administered to 35 female adolescents with AN and 35 HC adolescents. Eating disorder risk was found to be highest in AN females with higher levels of general psychological maladjustment (GPMC), followed by HC females with higher thin-ideal internalization. In the AN group, attachment style and thin-ideal internalization in combination with GPMC were not indicated as significant predictors of eating disorder risk. Study data provide support to conceptualizations of EDs that emphasize the role of general psychological maladjustment in the development of EDs.

Does exposure to PM10 decrease age at menarche?

BACKGROUND

There has been a consistent decrease in age at menarche in South Korea. A potential risk factor for early menarche is exposure to particulate matter (PM), because endocrine-disrupting compounds emitted into air from anthropogenic sources may be incorporated into PM. The objective of this study was to examine the association between pre-menarcheal exposure to PM ≤ 10 μm in diameter (PM₁₀) and age at menarche in adolescents of South Korea using Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012 data.

METHODS

We used self-reported age at menarche of 639 girls aged 13-17 years in this study. The cut-off age for early menarche was set to 12 years. Based on each subject's address, 1-year, 2-year, and 3-year averages of annual mean PM₁₀ concentrations (models 1-3) were linked to KNHANES. Models were adjusted for body mass index (BMI), city size, household income level, maternal age at menarche, and second-hand smoke exposure at home. SURVEYREG and SURVEYLOGISTIC procedures were used to address the complex survey design of KNHANES.

RESULTS

Overall analysis showed that exposure to PM₁₀ has a significant effect on decreasing age at menarche. Multiple linear regression results suggested that each 1 μg/m³ increase in 1-year, 2-year, 3-year averages of annual mean PM₁₀ concentrations accelerated age at menarche by 0.046 years (95% CI: -0.064, -0.027; p < .0001), 0.038 years (95% CI: -0.059, -0.018; p = 0.0003),and 0.031 years (95% CI: -0.047, -0.015; p = 0.0002), respectively. Adjusted ORs for a 1 μg/m³ increase in PM₁₀ concentration were 1.08 (95% CI: 1.04 -1.12) for model 1, 1.06 (95% CI: 1.02 -1.10) for model 2, and 1.05 (95% CI: 1.01 -1.09) for model 3.

CONCLUSION

Our findings suggest that elevated PM₁₀ concentration can decrease age at menarche. This is the first study that investigates the association between exposure to PM₁₀ and age at menarche using a nationally representative sample of Koreans.

Predictors and long-term health outcomes of eating disorders

Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health. We studied predictors of self-reported eating disorders and associations with later health events. We estimated odds ratios (ORs) for these associations in 47,759 participants from the Sister Study. Two percent (n = 967) of participants reported a history of an eating disorder. Risk factors included being non-Hispanic white, having well-educated parents, recent birth cohort (OR = 2.16, 95% confidence interval [CI]: 2.01–2.32 per decade), and having a sister with an eating disorder (OR = 3.68, CI: 1.92–7.02). As adults, women who had experienced eating disorders were more likely to smoke, to be underweight, to have had depression, to have had a later first birth, to have experienced bleeding or nausea during pregnancy, or to have had a miscarriage or induced abortion. In this descriptive analysis, we identified predictors of and possible long-term health consequences of eating disorders. Eating disorders may have become more common over time. Interventions should focus on prevention and mitigation of long-term adverse health effects.

Weak associations between pubertal development and psychiatric and behavioral problems

Pubertal development has been associated with adverse outcomes throughout adolescence and adulthood. However, much of the previous literature has categorized outcome variables and pubertal timing measures for ease of mean difference or odds ratio interpretation. We use a UK-representative sample of over 5000 individuals drawn from the Twins Early Development Study to extend this literature by adopting an individual differences approach and emphasizing effect sizes. We investigate a variety of psychiatric and behavioral measures collected longitudinally at ages 11, 14 and 16, for multiple raters and for males and females separately. In addition, we use two measures of pubertal development: the Pubertal Development Scale at each age, as well as the age of menarche for girls. We found that pubertal development, however assessed, was linearly associated with a range of psychiatric and behavioral outcomes; however, the effect sizes of these associations were modest for both males and females with most correlations between -0.10 and 0.10. Our systematic analysis of associations between pubertal development, and psychiatric and behavioral problems is the most comprehensive to date. The results showing linearity of the effects of pubertal development support an individual differences approach, treating both pubertal development and associated outcomes as continuous rather than categorical variables. We conclude that pubertal development explains little variance in psychiatric and behavioral outcomes (<1% on average). The small effect sizes indicate that the associations are weak and should not warrant major concern at least in non-clinical populations.

Childhood body mass index in adolescent-onset anorexia nervosa

OBJECTIVE

Although weight history is relevant in predicting eating disorder symptom severity, little is known about its role in the etiology of anorexia nervosa (AN). This study aimed to determine whether BMI or BMI trajectory differed between individuals who later developed adolescent-onset AN and a comparison group of HCs between school grades 1 through 6.

METHOD

This study was based on longitudinal data that identified 51 adolescents with AN and 51 matched HCs. Cases were identified through community screening in Sweden and included individuals born in 1969 through 1977. Measured weights and heights were retrieved and BMIs and weight trajectories of the AN and HC groups were compared using growth curve analysis. Main outcome measures included measured BMI and BMI trajectories from grades 1-6. Secondary outcomes examined included ponderal index at birth and maternal body weight.

RESULTS

Individuals who later developed AN had higher BMIs than HCs between grades 1 and 6, by an average of 1.42 BMI-units. There was no difference in rate of weight gain between groups. Ponderal index at birth was higher for the AN as compared with HC group. Maternal weight did not differ significantly between groups.

DISCUSSION

These findings, combined with those previously reported on the premorbid BMIs of those with bulimia nervosa, suggest that a predisposition toward elevated premorbid BMIs during childhood characterizes those who later develop anorexia or bulimia nervosa. These findings are consistent with a transdiagnostic perspective and suggest shared risk factors for AN and obesity. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1002-1009).

Eating Disorders and Breast Cancer

BACKGROUND

Eating disorders such as anorexia nervosa and bulimia nervosa affect overall and reproductive health and may also affect breast cancer risk. We studied the association between self-reported eating disorders and breast cancer risk in a prospective cohort study.

METHODS

In 2003-2009, the Sister Study enrolled women ages 35-74 years who had a sister with breast cancer but had never had it themselves. Using data from 47,813 women, we estimated adjusted HRs and 95% confidence intervals (CI) for the association between eating disorders and invasive breast cancer over a median of 5.4 years of follow-up.

RESULTS

Three percent (n = 1,569) of participants reported a history of an eating disorder. Compared with women who never had an eating disorder, women who reported eating disorders in the past had reduced breast cancer risk (HR = 0.62; 95% CI, 0.42-0.92).

CONCLUSIONS

In this large prospective, observational cohort study, we observed an inverse association between having a history of an eating disorder and invasive breast cancer.

IMPACT

Historical eating disorders may be associated with a long-term reduction in breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(2); 206-11. ©2016 AACR.

The relationship between disordered eating and sexuality amongst adolescents and young adults

Research shows that gay and bisexual males are at increased risk for disordered eating symptoms (DES); however, studies examining DES amongst lesbians and bisexual women have produced mixed findings. Furthermore, few studies have included questioning or "unsure" individuals. This study examined DES symptoms in adolescents and young adults across self-reported sexual attraction and behavior. Participants were recruited from ten primary care sites in Pennsylvania and administered the Behavioral Health Screen (BHS) - a web-based screening tool that assesses psychiatric symptoms and risk behaviors - during a routine visit. As expected, males who were attracted to other males exhibited significantly higher disordered eating scores than those only attracted to members of the opposite sex. Males who engaged in sexual activities with other males also exhibited significantly higher scores than those who only engaged in sexual activities with females. Amongst females, there were no significant differences in DES scores between females who were only attracted to females and those only attracted to males. Those who reported being attracted to both sexes, however, had significantly higher scores, on average, than those only attracted to one sex. More surprisingly, females who were unsure of who they were attracted to reported the highest DES scores of all. These findings are contrary to previous assumptions that same-sex attraction plays a protective role against eating pathology in females. Females who are unsure or attracted to both sexes may actually be at increased risk for developing DES.

A systematic review of interventions to reduce stress in adolescence

Adolescence can be a stressful developmental phase, placing youth at risk for negative health outcomes. Evidence-based interventions are crucial to helping adolescents manage stress; yet, most of the literature on adolescent stress is observational and descriptive. We systematically reviewed the literature on stress management interventions for adolescents and found there is evidence to support the effectiveness of interventions that aim to develop cognitive skills among adolescents; however, most studies had small samples and relied on different operational definitions of outcomes. Few included biological indicators of stress. Further study is needed to develop interventions to enhance adolescents' capacity to manage stress.

Puberty as a critical risk period for eating disorders: a review of human and animal studies

This article is part of a Special Issue "Puberty and Adolescence". Puberty is one of the most frequently discussed risk periods for the development of eating disorders. Prevailing theories propose environmentally mediated sources of risk arising from the psychosocial effects (e.g., increased body dissatisfaction, decreased self-esteem) of pubertal development in girls. However, recent research highlights the potential role of ovarian hormones in phenotypic and genetic risk for eating disorders during puberty. The goal of this paper is to review data from human and animal studies in support of puberty as a critical risk period for eating disorders and evaluate the evidence for hormonal contributions. Data are consistent in suggesting that both pubertal status and pubertal timing significantly impact risk for most eating disorders in girls, such that advanced pubertal development and early pubertal timing are associated with increased rates of eating disorders and their symptoms in both cross-sectional and longitudinal research. Findings in boys have been much less consistent and suggest a smaller role for puberty in risk for eating disorders in boys. Twin and animal studies indicate that at least part of the female-specific risk is due to genetic factors associated with estrogen activation at puberty. In conclusion, data thus far support a role for puberty in risk for eating disorders and highlight the need for additional human and animal studies of hormonal and genetic risk for eating disorders during puberty.

Emotional distress and disordered eating practices among southern Italian women

This study is one of the first to examine the narrative links connecting social change, contested gender norms, body image, and eating disordered practices among southern Italian women. The research is based on 16 months of fieldwork, and I compare and contrast the stories of 23 educated women in southern Italy to highlight the contentious realities of entering adolescence in conservative social contexts where gender relations and value systems are undergoing rapid transformations. I examine how these young women dealt with conflicting cultural expectations of womanhood and whether it affected their emotional, psychological, and physical well-being. Their stories shed light on how parental control, community surveillance, and conflicts in developing gender identities and maturing womanly bodies contributed to their emotional distress. Distressed young women used rebellion and manipulation and control of food and the body to negotiate unjust social relations, specifically gender relations, that delegitimized their selves and, in some cases, their bodies.

Love hurts (in more ways than one): specificity of psychological symptoms as predictors and consequences of romantic activity among early adolescent girls

OBJECTIVE

Research has linked adolescent romantic and sexual activities to depressive symptoms. The current study examines whether such activities are uniquely linked to depressive symptoms versus symptoms of other disorders (including anxiety, externalizing, and eating disorders), and whether co-occurring symptoms more precisely account for the association between depressive symptoms and romantic involvement.

METHOD

Early adolescent girls (N = 83; mean age = 13.45) participated in baseline and 1-year follow up data collection.

RESULTS

Romantic (i.e., dating and sexual) activities were longitudinally related to numerous types of symptoms. The association between depressive symptoms and romantic variables remained when considering co-occurring symptoms. Girls with more comorbid disorders reported more romantic activities.

CONCLUSIONS

Results suggest that the maladaptive consequences and precipitants of adolescent romantic activities extend beyond depression, but also imply that this association is not secondary to comorbid symptoms. Future work should clarify causal pathways.

Environmental and genetic pathways between early pubertal timing and dieting in adolescence: distinguishing between objective and subjective timing

BACKGROUND

Early pubertal timing in girls is associated with elevated risk for dieting and eating pathology. The relative importance of biological versus socio-environmental mechanisms in explaining this association remains unclear. Moreover, these mechanisms may differ between objective measures of pubertal development and girls' subjective perceptions of their own maturation.

METHOD

The sample comprised 924 sister pairs from the National Longitudinal Study of Adolescent Health. Objective pubertal timing (menarcheal age), girls' perceptions of pubertal status and timing relative to peers, dieting and disordered eating behaviors were assessed during a series of confidential in-home interviews.

RESULTS

Behavioral genetic models indicated that common genetic influences accounted for the association between early menarcheal age and increased risk for dieting in adolescence. In contrast, girls' subjective perceptions of their timing relative to peers were associated with dieting through an environmental pathway. Overall, subjective and objective measures of pubertal timing accounted for 12% of the variance in dieting.

CONCLUSIONS

Genetic differences in menarcheal age increase risk for dieting among adolescent girls, while girls' perceptions of their maturation represent an environmentally mediated risk.

Reported early family environment covaries with menarcheal age as a function of polymorphic variation in estrogen receptor-α

Age at menarche, a sentinel index of pubertal maturation, was examined in relation to early family relationships (conflict, cohesion) and polymorphic variation in the gene encoding estrogen receptor-α (ESR1) in a midlife sample of 455 European American women. Consistent with prior literature, women who reported being raised in families characterized by close interpersonal relationships and little conflict tended to reach menarche at a later age than participants reared in families lacking cohesion and prone to discord. Moreover, this association was moderated by ESR1 variation, such that quality of the family environment covaried positively with menarcheal age among participants homozygous for minor alleles of the two ESR1 polymorphisms studied here (rs9304799, rs2234693), but not among women of other ESR1 genotypes. In addition, (a) family relationship variables were unrelated to ESR1 variation, and (b) genotype-dependent effects of childhood environment on age at menarche could not be accounted for by personality traits elsewhere shown to explain heritable variation in reported family conflict and cohesion. These findings are consistent with theories of differential susceptibility to environmental influence, as well as the more specific hypothesis (by Belsky) that girls differ genetically in their sensitivity to rearing effects on pubertal maturation.

Menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group

OBJECTIVE

To examine chronology and experience of menarche, puberty, and first sexual activities in eating-disordered patients as compared with a psychiatric and a nonpsychiatric control group.

METHOD

We interviewed 150 females, namely 50 patients with anorexia or bulimia nervosa (ED), 50 patients with polysubstance dependence (PSD-CO), and 50 healthy controls (HE-CO) (defined by DSM-IV) on chronology and their experience of menarche, puberty, and first sexual activities adjusted for childhood sexual abuse.

RESULTS

ED women were similar to HE-CO in age at menarche and most sexual milestones, but differed significantly from PSD-CO women, who were "early starters." Regarding their experience of menarche, pubertal body changes, and first sexual activities, however, ED women rated these variables significantly more negatively than did either of the comparison groups. These significant differences remained after adjusting for sexual abuse.

CONCLUSION

These findings suggest a negative body attitude in ED patients already at pubertal age, namely years before onset of the disorder. Prospective data are needed.

Detrimental Psychological Outcomes Associated with Early Pubertal Timing in Adolescent Girls

Though often discussed as though it were a discrete event, puberty comprises one segment of a larger developmental continuum and is notable for rapid transformation across a multitude of domains. Research suggests that an earlier rate of pubertal maturation in girls correlates with a number of detrimental outcomes compared with on-time or later maturation. The present review synthesizes the research on negative psychological sequelae of early pubertal timing in adolescent girls. Emphasis is on three theoretical perspectives by which precocious development is believed to affect the emergence of adverse outcomes: biological, psychosocial, and selection effects.

Psychosocial functioning needs attention in adolescent eating disorders

We studied the differences in psychosocial functioning in the early stages of adolescent anorexia nervosa (AN) and bulimia nervosa (BN). The study group comprised 57 adolescent eating disorder (ED) outpatients (girls). Psychosocial functioning was evaluated by GAF (Global Assessment of Functioning), and by Morgan-Russell psychosocial subscales. GAF scores were very low in both AN and BN. On the Morgan-Russell subscales, bulimics reported more unsatisfactory relationships with family and impairment in work/school. Anorectics tended to have more difficulties in emancipation from family and in social contacts. Multivariate analysis showed associations of BN and high GSI with difficulties in relationships with family and of AN with difficulties in emancipation from family and with fewer social activities. Longer duration of illness predicted best impaired working ability. In adolescent EDs, psychosocial functioning is markedly impaired. We emphasize the importance of evaluating psychosocial functioning at the very onset of ED.

Romantic relationships for women with anorexia nervosa: an integrative literature review

OBJECTIVE

To critically appraise literature concerning romantic relationships for women with anorexia nervosa (AN), and to gain perspective on future research directives.

METHOD

Key electronic databases, reference lists, and journals were searched. The search was limited to features of romantic relationships and their quality. Nineteen studies were critiqued and abstracted.

RESULTS

All 19 studies used a quantitative design; no qualitative studies were retrieved. Methodological strengths of these studies included confounder control and appropriate statistical analyses for design. Weaknesses included a failure to declare study designs, address sources of bias, and justify study samples, as well as a lack of con-founder control.

DISCUSSION

The review drew attention to the varied relational experiences and marked relationship dissatisfaction expressed by women with AN. However, an understanding of relationship quality and its dynamic nature remains limited. Future research should focus on how meanings are negotiated in relationships, providing detailed descriptions of the women's experiences, which is best done with qualitative study. Well-conducted longitudinal research should address questions that cannot be answered by current research designs, such as temporality.

Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients

OBJECTIVE

This study evaluated the differences in suicidal behaviour between adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, menarche timing, duration of eating disorder (ED), depression and general psychopathological symptoms (GSI) with suicidal behaviour in adolescent ED.

METHODS

The study group comprised 57 adolescent outpatients (girls) attending for assessment because of eating disorders. Suicidal ideation, deliberate self-harm and suicidal attempts were assessed in self-report questionnaires.

RESULTS

In both ED groups, one adolescent had attempted suicide before assessment. Suicidal ideation and/or deliberate self-harm were reported in over half of the cases. Bulimics had significantly more suicidal ideation and deliberate self-harm than anorectics. In multivariate analysis, BN and depression predicted suicidal ideation, but only GSI persisted as predicting deliberate self-harm.

CONCLUSIONS

Suicidal behaviour is common in adolescent ED. Type of ED (BN), depression and higher GSI are strongly associated with suicidal ideation and deliberate self-harm. Our results point to the need to evaluate psychopathological symptoms in adolescent ED, especially in BN, in the initial assessment to prevent severe suicidal behaviour.

Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

OBJECTIVE

Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED.

METHODS

The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory.

RESULTS

Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image.

DISCUSSION

Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.