Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report

Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes

Background: This systematic review investigated the impact of familial factors on individuals aged 10-17 who have clinical signs or symptoms of eating disorders. Simultaneously, it scrutinized the involvement of the family in therapy, as well as other forms of intervention. Methods: The PsycINFO, PubMed, and Scopus databases were used to search for research material comprehensively. After applying specific criteria, 46 articles were deemed suitable and included in the systematic review. The study comprised a cohort of 4794 adolescents who received a diagnosis of either Anorexia Nervosa (AN), Bulimia Nervosa (BN), or Binge-Eating Disorder (BED). In addition, controls were utilized for 1187 adolescents, 1563 parents, 1809 siblings, and 11 other relatives. Results: The connection between family factors and eating disorders is primarily determined by the families' level of functioning, satisfaction with the family dynamic, parents' attitudes toward their children, and the role of food within the family system. Family Therapy was the most used psychotherapeutic approach in the treatment of AN. The incidence of reports in BN closely paralleled that of Cognitive-Behavioral Therapy (CBT) models. Articles about (Enhanced) CBT were exclusively associated with BED. Conclusions: Family-based approaches are crucial in comprehending, preventing, and addressing eating disorders in adolescents. Incorporating the study of family dynamics and actively engaging families in the treatment process can significantly enhance recovery rates and decrease the occurrence of relapses.

Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research

PURPOSE OF REVIEW

The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions.

RECENT FINDINGS

Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.

Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating

BACKGROUND

Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT).

METHODS

Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design).

RESULTS

The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up.

CONCLUSIONS

This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial

BACKGROUND

Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce.

METHODS

The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment.

DISCUSSION

The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT).

TRIAL REGISTRATION

German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.

A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

BACKGROUND

Eating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research.

METHODS

PsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders.

RESULTS

Eligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking.

CONCLUSIONS

CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.

Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis

Emotion dysregulation is a transdiagnostic phenomenon in Eating Disorders (ED), and Dialectical Behaviour Therapy (DBT) (which was developed for reducing dysregulated emotions in personality disorders) has been employed in patients with ED. This systematic review and meta-analysis investigated whether the effect of DBT was stronger on emotion dysregulation, general psychopathology, and Body Mass Index (BMI) in participants with ED, when compared to a control group (active therapy and waitlist). Eleven studies were identified in a systematic search in accordance with PRISMA guidelines. Most studies included participants with Binge Eating Disorder (BED) (n = 8), some with Bulimia Nervosa (BN) (n = 3), and only one with Anorexia Nervosa (AN). The pooled effect of DBT indicated a greater improvement in Emotion Regulation (ER) (g = −0.69, p = 0.01), depressive symptoms (g = −0.33, p < 0.00001), ED psychopathology (MD = −0.90, p = 0.005), Objective Binge Episodes (OBE) (MD = −0.27, p = 0.003), and BMI (MD = −1.93, p = 0.01) compared to the control group. No improvement was detected in eating ER following DBT (p = 0.41). DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation, ED psychopathology, and BMI in ED. The limitations included the small number of studies and high variability.

Dialectical behavioral therapy for the treatment of adolescent eating disorders: a review of existing work and proposed future directions

Over the past several decades, Dialectical Behavior Therapy (DBT) has been adapted for a range of presenting problems related to emotion dysregulation. Considerable enthusiasm exists regarding the use of DBT for treating eating disorders; however, to date, there have been no reviews summarizing empirical efforts to adapt DBT for eating disorders in youth. Accordingly, in the present narrative review, we provide a comprehensive summary of existing work testing DBT for adolescent eating disorders. First, we briefly review existing work applying DBT to eating disorders in adults and general adolescent samples. We then review research focused specifically on the use of DBT for adolescent eating disorders, including both those studies applying DBT as the primary treatment and investigations of DBT as an adjunctive treatment. Overall, initial results for DBT-based approaches are promising. However, rigorous empirical work testing DBT for treating adolescent eating disorders remains limited; the majority of existing research is comprised of case series and small-scale studies. Therefore, we close with specific recommendations for future research testing this approach.

Acceptance-based skill acquisition and cognitive reappraisal in a culturally responsive treatment for binge eating in adolescence

Emotional overeating, or eating in excess to soothe negative emotions, is a high-risk behavior for the future development of the binge-eating disorder (BED). The Emotional Overeating Intervention (EOI) is a culturally responsive, 10-week condensed dialectical behavior therapy (DBT) skills group intervention for adolescents endorsing emotional-overeating and binge-eating behaviors. The present study served as a secondary analysis of the intervention data, with the aim of using quantitative measures and qualitative interviews to examine intervention acceptability and DBT skill acquisition. Data were analyzed using descriptive statistics for quantitative surveys and qualitative content analysis for interviews. Among the 15 adolescents (M_age = 15.40 years; 73.3% identifying as female; 100% identifying as Black) who participated in the EOI pilot trial, most identified learning acceptance-based DBT skills, particularly radical acceptance, as both highly acceptable and the most useful aspect of treatment. Participants reported increases in distress tolerance appraisal and emotion regulation cognitive reappraisal scale scores from baseline to post-intervention. Accordingly, acceptance-based DBT skills may be associated with change-based cognitive strategies, which may contribute to improvements in emerging BED pathology. Findings serve as an initial step in informing preventative models of scalable interventions for subthreshold BED among adolescents, by identifying variables that warrant investigation as potential mechanisms of change.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

OBJECTIVES

Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline.

METHODS

Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.

RESULTS

Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed.

CONCLUSIONS

Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Binge Eating Disorder in Children and Adolescents

Binge eating disorder onset often occurs during adolescence, yet the diagnosis and treatment of the disorder in this age group has been inadequately studied. Criteria and challenges in making the diagnosis in children and adolescents are reviewed, as well as prevalence rates, current treatment options, and complications.

[E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder]

E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder Abstract. Eating disorders can often be treated with psychotherapy, but mostly due to a lack of trained clinicians, the majority of the persons concerned do not receive any treatment. In recent years, internet-based psychotherapy (e-therapy) was proposed and tested in several pilot projects as a novel possibility to offer a larger number of places on a treatment program with a constant number of available clinicians. Recent results are promising, but before an implementation into standard care can take place, more detailed knowledge must be provided as to which patients may be recommended this type of therapy as an equivalent alternative to traditional face-to-face therapy.

Description of an intervention to treat binge-eating behaviors among adolescents: Applying the Template for Intervention Descriptions and Replication

Binge-eating disorder (BED) is related to deleterious physical, social, and psychological outcomes among adolescents, and is more common among racial and ethnic minorities. Dialectical behavior therapy (DBT), an evidence-based treatment for disorders of emotion dysregulation, has demonstrated efficacy in treating disordered eating patterns. While DBT interventions have demonstrated success among adults with BED, less is known about adaptation of DBT for adolescents presenting with BED and subthreshold binge-eating behaviors. This paper describes the Emotional Overeating Intervention, a 10-week DBT skills-based group intervention for adolescents exhibiting binge-eating behaviors. The Template for Intervention Description and Replication (TIDieR) checklist is used to describe the intervention with the intention of providing necessary details to implement the intervention in clinical practice or replicate the intervention for further study. The rationale for a condensed version of DBT, potential modifications for future implementation, and the importance of adapting the intervention in a developmentally and culturally responsive manner are discussed. This adapted treatment modality can guide future studies examining interventions for adolescents exhibiting binge-eating behaviors.

The moderating role of resilience on the relationship between perceived stress and binge eating symptoms among young adult women

OBJECTIVE

Adolescence and young adulthood are developmental periods during the life course that are sometimes associated with heightened stress and engagement in binge eating. Binge eating has been linked to psychiatric comorbidity, poorer physical health, and lower quality of life. However, less is known about protective factors that could buffer against binge eating behaviors. The current study examined the moderating role of resilience on the relationship between perceived stress and binge eating symptoms among emerging adult female college students.

METHOD

Participants were 297 young adult women aged 18-25 years (M_age = 19.22, SD = 1.51; 52% self-identifying as a racial/ethnic minority) with Body Mass Index ranging from 15 to 66 (M_BMI = 25.01, SD = 6.18). Women completed this cross-sectional study while they were attending universities in the Western or Southern United States. Participants provided demographic and height/weight information, and completed the following measures: Perceived Stress Scale, Binge Eating Scale, and Brief Resilience Scale.

RESULTS

Higher perceived stress was significantly associated with more severe binge eating symptoms (b = 0.31; p < .01). In addition, higher resilience was associated with lower binge eating pathology (b = -0.20; p < .01). Moderation was supported as the relationship between perceived stress and binge eating symptoms varied by resilience level (b = -0.16; p < .01).

CONCLUSIONS

Women who perceived higher stress were more likely to engage in binge eating relative to women experiencing low stress; however, resilience attenuated this association. Resilience could be targeted to reduce the negative effects of perceived stress on eating behaviors in young women.

Practice parameter for the assessment and treatment of children and adolescents with eating disorders

This Practice Parameter reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents. Where empirical support is limited, clinical consensus opinion is used to supplement systematic data review. The Parameter focuses on the phenomenology of eating disorders, comorbidity of eating disorders with other psychiatric and medical disorders, and treatment in children and adolescents. Because the database related to eating disorders in younger patients is limited, relevant literature drawn from adult studies is included in the discussion.

A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders

OBJECTIVE

The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training.

METHOD

Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals.

RESULTS

Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment.

CONCLUSIONS

This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.

An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents

Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.

La regulación emocional: precisiones y avances conceptuales desde la perspectiva conductual

La Regulación emocional (RE) ha sido un concepto que ha cobrado relevancia en los últimos años en diferentes áreas aplicadas de la psicología, debido al papel que parece tener en el funcionamiento de los individuos en los diferentes contextos. En la psicología conductual ha sido abordada principalmente por dos perspectivas terapéuticas: la cognitiva-conductual y el análisis clínico conductual. La primera de ellas atiende a aspectos de tipo mediacional para la explicación y la segunda a conceptos del análisis del comportamiento. Las diferencias en estos dos puntos de vista, para explicar este fenómeno dentro de una aproximación conductual, han derivado en dos problemas principales: (a) no existe una definición unificada de la Regulación emocional y (b) los mecanismos explicativos son inciertos. Se menciona la importancia de revisar el fundamento conceptual de este término y el desarrollo de investigaciones que den cuenta de los procesos que lo explican.

Dialectical behaviour therapy with adolescents

BACKGROUND

  Dialectical behaviour therapy (DBT) is the first empirically validated treatment for chronically suicidal patients diagnosed with borderline personality disorder (BPD). Numerous randomised clinical trials conducted with adults with BPD have demonstrated that DBT is effective in reducing suicidal and non-suicidal self-injurious (NSSI) behaviours. Other research on the use of DBT for adults has shown that the treatment is effective in reducing a variety of problem behaviours in a range of therapeutic settings. In the last decade, a number of studies have evaluated DBT as a promising treatment for adolescents with different psychological disorders and behaviours, including borderline personality disorder (BPD), eating disorders, externalising disorders, and suicidal and NSSI behaviours. This article reviews the literature on the use of DBT with adolescents.

RESULTS

  Overall findings indicate some empirical support for the conclusion that DBT is a promising treatment for adolescents with BPD symptomatology, suicidal ideation and comorbid depression, bipolar disorder, disordered eating behaviours and aggressive and impulsive behaviours. Adolescents in these studies were also hospitalised less frequently when treated with DBT. Moreover, studies conducted with these populations suggest that DBT may be adapted for use in outpatient, inpatient, community, and residential treatment settings.

CONCLUSIONS

  The authors conclude that DBT may be effective in treating adolescents with additional disorders and dysfunctional behaviours not yet examined. Data from soon to be completed randomised controlled trials need to be published.

Dialectical behavior therapy for suicidal adolescents with borderline personality disorder

Although research to date on dialectical behavior therapy (DBT) for adolescents has its limitations, growing evidence suggests that DBT is a promising treatment for adolescents with a range of problematic behaviors, including but not limited to suicidal and nonsuicidal self-injury. This article introduces dialectical behavior therapy's theoretical underpinnings, describes its adaptation for suicidal adolescents, and provides a brief review of the empirical literature evaluating DBT with adolescents.

The application of mindfulness to eating disorders treatment: a systematic review

The present study is an exploratory examination of the efficacy of the application of mindfulness-based interventions to the treatment of eating disorders. It employs a systematic review technique in which terms from the Psychological Index Terms of the American Psychological Association (APA) were chosen and analyzed in conjunction with Boolean operators. Using data obtained by the online consultation of references from 12 different bibliographical databases, 8 studies were included in the systematic review. Each study reported satisfactory results, although trial qualities were variable and sample sizes were small. Nonetheless, the current study found initial evidence supporting the effectiveness of mindfulness-based interventions to the treatment of eating disorders. The application of mindfulness-based interventions to the treatment of eating disorders remains a promising approach worthy of further research.

Psychological inflexibility and symptom expression in anorexia nervosa

The purpose of this article is to outline a model of anorexia nervosa (AN) as a disorder of psychological inflexibility, motivated by an insatiable desire for prediction and control with related intolerance for uncertainty. We describe preliminary data that provide initial support for this conceptualization and point to the ways in which mindfulness and acceptance-based strategies might be particularly useful for treating AN. This article is not intended to be an exhaustive literature review, rather a conceptual framework to guide future research and treatment development.

Psychotherapy approaches for adolescents with eating disorders

PURPOSE OF REVIEW

Adolescence is the most common period for the onset of eating disorders, and early intervention is critical. Primary care providers should feel equipped to discuss psychotherapy approaches for eating disorders with adolescents and their families and to provide appropriate referrals. The present review focuses on six prominent treatment modalities and the evidence supporting each approach.

RECENT FINDINGS

Although the majority of studies about psychotherapy approaches for eating disorders focus on adult women, there is a growing body of research on effective treatments for an adolescent population. Family-based treatment (the 'Maudsley method') and supportive psychotherapy appear to be promising approaches for anorexia in teens. Treatments for bulimia yield extremely high relapse rates, but cognitive-behavioral therapy and family-based treatment are favored modalities. Dialectical behavior therapy and interpersonal psychotherapy may also be applicable to adolescent bulimia and binge eating. Most psychotherapists draw upon a variety of these treatment approaches, depending upon the patient's unique presentation. Regardless of the modality used, some degree of family involvement is important in limiting dropout and improving outcomes.

SUMMARY

Adolescent health providers need to be aware of the psychotherapy approaches recommended for teens with eating disorders in order to effectively refer patients to and collaborate with mental health providers.

A tale of two systems: co-occurring mental health and substance abuse disorders treatment for adolescents

Co-occurring disorders present serious challenges to traditional mental health and substance abuse treatment systems. Among adolescents in need of behavioral health services, co-occurring disorders are highly prevalent and difficult to treat. Without effective intervention, youth with co-occurring disorders are at increased risk of serious medical and legal problems, incarceration, suicide, school difficulties and dropout, unemployment, and poor interpersonal relationships. In general, current service systems are inadequately prepared to meet this need due to a variety of clinical, administrative, financial, and policy barriers. This article presents an overview of co-occurring disorders among adolescents, highlights general considerations for co-occurring disorders treatment, reviews selected treatment models and outcomes, and discusses recommendations and best practice strategies.

Overview of treatment modalities in adolescent anorexia nervosa

The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.