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Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study. J Clin Med 2020; 9:jcm9072305. [PMID: 32698514 PMCID: PMC7408799 DOI: 10.3390/jcm9072305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = -0.08, p = 0.375) and worse treatment outcome (B = -0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatology.
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Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2019; 10:708. [PMID: 31649563 PMCID: PMC6796791 DOI: 10.3389/fpsyt.2019.00708] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs. Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD. Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD. Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Viktoria Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Effectiveness of yoga in eating disorders – A case report. Complement Ther Med 2019; 42:145-148. [DOI: 10.1016/j.ctim.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/09/2018] [Indexed: 02/04/2023] Open
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Bilgin A, Baumann N, Jaekel J, Breeman LD, Bartmann P, Bäuml JG, Avram M, Sorg C, Wolke D. Early Crying, Sleeping, and Feeding Problems and Trajectories of Attention Problems From Childhood to Adulthood. Child Dev 2018; 91:e77-e91. [DOI: 10.1111/cdev.13155] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ayten Bilgin
- University of Warwick
- Istanbul Medeniyet University
| | | | - Julia Jaekel
- University of Warwick
- University of Tennessee Knoxville
| | | | | | - Josef G. Bäuml
- Technical University Munich
- TUM-NIC Neuroimaging Center, Technical University Munich
| | - Mihai Avram
- Technical University Munich
- TUM-NIC Neuroimaging Center, Technical University Munich
| | - Christian Sorg
- Technical University Munich
- TUM-NIC Neuroimaging Center, Technical University Munich
| | - Dieter Wolke
- Department of Psychology
- Warwick Medical School, University of Warwick
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Attention-deficit/hyperactivity disorder symptoms and psychological comorbidity in eating disorder patients. Eat Weight Disord 2018; 23:513-519. [PMID: 28534123 DOI: 10.1007/s40519-017-0395-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE There is some evidence that eating disorders (ED) and Attention-deficit/hyperactivity disorder (ADHD) share common clinical features and that ADHD might contribute to the severity of eating disorders. A greater understanding of how the presence of comorbid ADHD may affect the psychopathological framework of eating disorder seems of primary importance. The aim of our study was to evaluate rates of ADHD in three ED subgroups of inpatients: anorexia nervosa restricting type (AN-R), anorexia nervosa binge-eating/purging type (AN-BP) and bulimia nervosa (BN). The secondary aim was the evaluation of the associated psychological characteristics. METHOD The sample consisted of 73 females inpatients (mean age 28.07 ± 7.30), all with longstanding histories of eating disorder (ED). The presence of a diagnosis of ADHD was evaluated in a clinical interview based on DSM-IV-TR criteria. The following psychometric instruments were used: the eating attitude test (EAT-40), the Bulimic Investigatory Test, Edinburgh (BITE), the Eating Disorder Inventory (EDI-2), the Wender Utah Rating Scale (WURS), the Brown Attention Deficit Disorder Scale (BADDS), the Hamilton scales for Anxiety (HAM-A) and Depression (HAM-D), and the Barrat Impulsivity Scale (BIS-10). RESULTS Among the three ED subgroups, 13 patients reported comorbidity with ADHD; three in the AN-R subtype, nine in the AN-BP and one in the BN. The remaining 60 patients (n = 34 AN-R; n = 19 AN-BP; n = 7 BN) presented only a diagnosis of ED. The EAT (p = 0.04) and HAM-A (p = 0.02) mean scores were significantly higher in patients with comorbid ADHD. CONCLUSIONS In our study the comorbidity between ADHD and ED appeared to be frequent, particularly among patients with AN-BP. ED inpatients with higher level of anxiety and more abnormal eating attitudes and bulimic symptoms should be assessed for potentially associated ADHD.
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Carlucci S, Ivanova I, Bissada H, Tasca GA. Validity and reliability of the attention deficit hyperactivity disorder self-report scale (ASRS-v1.1) in a clinical sample with eating disorders. Eat Behav 2017; 26:148-154. [PMID: 28390269 DOI: 10.1016/j.eatbeh.2017.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 11/15/2022]
Abstract
Individuals with eating disorders (EDs) commonly experience comorbid attention deficit hyperactivity disorder (ADHD). The shared features of EDs and ADHD, such as inattention, impulsivity and hyperactivity, may exacerbate ED symptomatology and pose challenges to treatment. It is important to screen patients with EDs for symptoms of ADHD to optimize their treatment outcomes. However, the psychometrics of common measures of ADHD have not yet been examined within an ED population. An example of such a measure is the ADHD self-report scale (ASRS-v1.1) symptom checklist, which identifies the presence of ADHD symptoms. This study reports a psychometric study of the ASRS-v1.1 in a clinical sample of 500 adults with an ED. A confirmatory factor analysis indicated the ASRS-v1.1 maintained its two-factor structure of inattention and impulsivity/hyperactivity. The item loadings demonstrated path invariance across ED diagnostic groups indicating construct validity. Further, the subscales exhibited good internal consistency and they were significantly correlated with other measures of impulsivity indicating convergent validity. The ED sample had significantly higher mean scores than published nonclinical norms indicating predictive validity, but the ASRS-v1.1 scores were not significantly different among ED diagnostic groups. Results suggest the ASRS-v1.1 is a valid and reliable screening tool for identifying symptoms of ADHD among adults seeking treatment for ED.
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Affiliation(s)
| | - Iryna Ivanova
- Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada
| | - Hany Bissada
- Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada
| | - Giorgio A Tasca
- University of Ottawa, 75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada; Ottawa Hospital Research Institute, Ottawa, ON K1G 0H9, Canada; The Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1G 0H9, Canada.
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The Comorbidity of ADHD and Eating Disorders in a Nationally Representative Sample. J Behav Health Serv Res 2016; 42:437-51. [PMID: 25007864 DOI: 10.1007/s11414-014-9422-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence suggests a comorbidity of childhood attention-deficit/hyperactivity disorder (ADHD) and subsequent eating disorders. However, most studies have assessed this comorbidity among patient populations as opposed to nationally representative samples and have not explored differences by subtype of each disorder. The current study aims to investigate the association between both clinical (i.e., diagnosed) and subclinical (i.e., presence of behaviors but not all diagnostic criteria) ADHD and eating disorders via a secondary data analysis of the National Longitudinal Study of Adolescent Health (n = 12,262). Results reveal that those with clinical ADHD are more likely to experience (a) clinical eating disorder, (b) clinical-level binging and/or purging behaviors, and (c) clinical-level restrictive behaviors. Those with subclinical ADHD (both inattentive and hyperactive/impulsive) were more likely to experience subclinical binging and/or purging behaviors but not subclinical restrictive behaviors. Implications of study findings pertain to both secondary/targeted prevention of eating disorders and tertiary prevention via patient-specific treatment plans.
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Levin RL, Rawana JS. Attention-deficit/hyperactivity disorder and eating disorders across the lifespan: A systematic review of the literature. Clin Psychol Rev 2016; 50:22-36. [PMID: 27693587 DOI: 10.1016/j.cpr.2016.09.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 09/07/2016] [Accepted: 09/21/2016] [Indexed: 12/25/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) and eating disorders are common and concerning mental health disorders. There is both empirical and theoretical support for an association between ADHD and eating disorders or disordered eating. This systematic review aims to summarize the extant literature on the comorbidity of ADHD and eating disorders across the lifespan, including the influences of sex, age, eating disorder diagnosis, and potential mediators. A total of 37 peer-reviewed studies on diagnosed ADHD and eating disturbances were identified through key research databases. Twenty-six studies supported a strong empirical association between ADHD and eating disorders or disordered eating. The systematic review findings suggest that children with ADHD are at risk for disordered eating, while adolescents, emerging adults, and adults are at risk for both eating disorders and disordered eating. Methodological considerations, future research, and clinical implications are discussed.
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Affiliation(s)
- Rivka L Levin
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Jennine S Rawana
- York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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Robinson T, Jacobsen R, Foster T. Group Narrative Therapy for Women With Attention-Deficit/Hyperactivity Disorder. ADULTSPAN JOURNAL 2015. [DOI: 10.1002/j.2161-0029.2015.00034.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tina Robinson
- Department of Counseling; Loyola University; New Orleans
- Now at Perspectives Behavioral Health Management; Fort Smith; Arkansas
| | - Rae Jacobsen
- Department of Counseling; Loyola University; New Orleans
| | - Thomas Foster
- Department of Counseling; Loyola University; New Orleans
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Ioannidis K, Serfontein J, Müller U. Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: clinical case report, literature review, and diagnostic challenges. Int J Eat Disord 2014; 47:431-6. [PMID: 24311027 DOI: 10.1002/eat.22231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 11/07/2022]
Abstract
There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account.
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Fernández-Aranda F, Agüera Z, Castro R, Jiménez-Murcia S, Ramos-Quiroga JA, Bosch R, Fagundo AB, Granero R, Penelo E, Claes L, Sánchez I, Riesco N, Casas M, Menchon JM. ADHD symptomatology in eating disorders: a secondary psychopathological measure of severity? BMC Psychiatry 2013; 13:166. [PMID: 23758944 PMCID: PMC3693886 DOI: 10.1186/1471-244x-13-166] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/05/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) has commonly been described in psychiatric disorders. Although several studies have found positive associations between abnormal eating patterns during childhood and ADHD, there is a lack of studies on ADHD and Eating Disorders (ED). The aims of this exploratory study were 1) to assess the ADHD symptoms level in ED and to ascertain whether there are differences among ED subtypes; 2) to analyze whether the presence of ADHD symptoms is associated with more severe eating disorder symptoms and greater general psychopathology; and 3) to assess whether the ADHD symptoms level is associated with specific temperament and character traits. METHODS 191 female ED patients were included. Assessment was carried out with the EDI-2, ASRS-v1.1, the SCL-90-R and the TCI-R. RESULTS The ADHD symptoms level was similar in bulimia, eating disorder not otherwise specified and binge eating subtypes, and lower in anorexic patients. Obsessiveness and Hostility were significantly positively associated with ADHD symptoms. A path model showed that ADHD was associated with high Novelty Seeking and low Self-Directedness, whereas ED severity was influenced by ADHD severity and low Self-Directedness. CONCLUSIONS Bingeing/purging ED subtypes have a high ADHD symptoms level, also related with more severe eating, general and personality psychopathology.
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Affiliation(s)
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Rita Castro
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain,Clinical Sciences Department, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jose Antoni Ramos-Quiroga
- Department of Psychiatry, University Hospital of Vall d´Hebron, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain,Department of Psychiatry and Legal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rosa Bosch
- Department of Psychiatry, University Hospital of Vall d´Hebron, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Ana Beatriz Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Penelo
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laurence Claes
- Department of Psychology, University of Leuven, Leuven, Belgium
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Miquel Casas
- Department of Psychiatry, University Hospital of Vall d´Hebron, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain,Department of Psychiatry and Legal Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jose Manuel Menchon
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain,Clinical Sciences Department, School of Medicine, University of Barcelona, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
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Stulz N, Hepp U, Gächter C, Martin-Soelch C, Spindler A, Milos G. The severity of ADHD and eating disorder symptoms: a correlational study. BMC Psychiatry 2013; 13:44. [PMID: 23375103 PMCID: PMC3566966 DOI: 10.1186/1471-244x-13-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorders (ADHD) and eating disorders (ED) share several clinical features. Research on the association between ADHD and ED is still quite sparse and findings are ambiguous. METHODS Correlations between the severity of ADHD key features (Barratt Impulsiveness Scale, and Attention Deficit/Hyperactivity Disorder-Self-Rating questionnaire) and the severity of specific ED symptoms (Structured Interview for Anorexia and Bulimia Nervosa) were examined in 32 female patients diagnosed with ED. RESULTS Most correlations between the severity of ADHD features and the severity of ED symptoms were low (r<0.30) and did not reach statistical significance. The only exception was a statistically significant, but counterintuitive association between impulsivity and the avoidance of fattening food. CONCLUSIONS The findings in this small sample suggest a weak link between the severity of ADHD key features and the severity of single ED symptoms in female patients with ED. The role of ADHD features for the development, maintenance, and treatment of EDs seems to be intricate and requires further study.
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Affiliation(s)
| | - Urs Hepp
- Psychiatric Services Aargau AG, Haselstrasse 1, CH-5401, Baden, Switzerland
| | - Céline Gächter
- Cantonal Hospital Aarau, Tellstrasse 15, CH-5001, Aarau, Switzerland
| | - Chantal Martin-Soelch
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
| | - Anja Spindler
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
| | - Gabriella Milos
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
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