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Diagnostica 09/2012; 58(3):127-144. · 0.72 Impact Factor
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ABSTRACT: Most studies on the relationship between childhood trauma and anorexia nervosa (AN) have focused on the role of childhood sexual and physical trauma in adult patients. Little is known about the role of emotional trauma and eating disorders. The aim of the present study was to examine childhood sexual, physical, and emotional traumatization in adolescents with anorexia nervosa restricting type (AN-R) in comparison to those with anorexia nervosa binge-eating/purging type (AN-BP) and a healthy control group.
The sample included 50 patients with AN-R (mean age = 15.8 ± 1.6 years), 27 with AN-BP (mean age = 16.1 ± 1.1 years), and 44 healthy female control participants (mean age = 15.7 ± 1.3 years). AN diagnosis was confirmed by the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX). Childhood sexual, physical, and emotional traumatization was assessed by a self-report questionnaire (Childhood Trauma Questionnaire; CTQ).
The results indicated higher rates of sexual, physical, and emotional abuse and physical and emotional neglect in patients with AN-BP than in patients with AN-R and healthy control participants. No significant differences in childhood traumatization were found between patients with AN-R and control participants.
Our results underline the importance of detecting the full range of possible childhood traumatic experiences in adolescents with AN, rather than focusing simply on childhood sexual traumatization. Sexual, physical, and emotional childhood traumatization are particularly important in the history of adolescent patients with AN-BP, in contrast to patients with AN-R, and should be screened for in the diagnosis and therapy of eating disorders.
Psychopathology 01/2012; 45(1):61-6. · 1.82 Impact Factor
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ABSTRACT: Competitive sport has been under increasing discussion as a possible favourable factor in the development of eating disorders among children and adolescents. The aim of this study was to determine the frequency of sport-specific eating disorders, in line with the concept of anorexia athletica. This prospective field study included one experimental group and two control groups (disease and healthy). Fifty-two pre-professional ballet dancers aged 13-20 years were tested for clinical eating disorders, anorexia athletica criteria, eating disorder related psychopathology and self-concept, and were compared with 52 patients with anorexia nervosa and 44 non-athletic controls of the same age. The study was conducted using semi-structured interviews as well as self-report questionnaires. A clinical eating disorder diagnosis was made in 1.9% of the ballet dancers versus 0% of the high school students; anorexia athletica was diagnosed in 5.8% of the dancers versus 2.3% of the students. Ballet dancers scored lower than patients with anorexia nervosa with regard to eating disorder related psychopathology and higher than the patients with regard to self-concept. We conclude that more sensitive tools to differentiate between sport-specific (eating) patterns, anorexia athletica and clinically relevant eating disorders are needed, especially for aesthetic sports such as ballet. It remains an important goal to identify athletes with symptoms of anorexia athletica irrespective of their physique and/or sport.
Journal of Sports Sciences 08/2011; 29(11):1115-23. · 1.93 Impact Factor
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ABSTRACT: Cognitive flexibility and the flexible learning and relearning of stimulus-reward-associations are important for decision-making and goal-directed behavior. Studies on patients with anorexia nervosa (AN) have shown difficulties in cognitive functions associated with malnutrition and extreme underweight. However, to date we find a lack of neuropsychological studies on cognitive flexibility among adolescent patients with AN. Furthermore, the underlying biological mechanisms remain unclear. Therefore, we aim to examine cognitive functions, especially reward association learning, as a measure of cognitive flexibility in adolescent patients with AN and investigate the relationship between Agouti-related protein (AGRP) and cognitive functions.
The study population consists of 30 patients with AN (M(age)=16.2 ± 1.2) and a healthy control group (CG) of 28 female adolescents (M(age)=16.3 ± 1.3). All subjects completed a neuropsychological test battery including the probabilistic Object Reversal Task, the Digit Symbol Test and the Trail Making Test. Patients with AN were explored before and after weight gain, the CG initially and after 3 months.
Subtle deficits in cognitive flexibility were found in patients with AN compared to the CG. After weight gain, the AN group improved relative to their baseline values in most of the variables but did not reach CG values. They still showed slight impairments. Moreover the study revealed a clear association between AGRP levels and cognitive flexibility.
Cognitive flexibility plays an important role in AN and may be modulated by abnormal levels of the appetite-regulating peptide AGRP. Even subtle impairments in cognitive flexibility can be relevant for the ability to fully engage in therapy and therefore may hinder a prosperous treatment.
Psychoneuroendocrinology 04/2011; 36(9):1396-406. · 5.81 Impact Factor
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ABSTRACT: The present study aimed to ascertain the occurrence of personality disorders (PD) in adolescent patients with anorexia (AN) and bulimia nervosa (BN) by means of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II).
99 female adolescent patients (57 AN - restrictive type, 17 AN - binge-purging type, 25 BN; M(age) = 16.3 +/- 1.6) were consecutively assessed by means of SCID-II. Furthermore, the influence of age, axis-I-comorbidities, and type of treatment according to PD were examined.
30.3% of the patients met the criteria for PD according to SCID-II. AN patients of the binge-purging type showed higher prevalences of PD and higher dimensional scores than the other eating disorder groups. Moreover, our findings indicate that age and axis-I-comorbidities are associated with the development of PD.
Significant differences in the occurrence of PD in the three eating disorder groups were found. Patients of the AN binge-purging type are more often affected than restricting AN or BN patients are. This, and also the influence of age and axis-I-comorbidities, should be taken into account in the treatment of patients with eating disorders.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 09/2010; 38(5):341-50. · 0.99 Impact Factor
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ABSTRACT: The present study examines the psychometric properties of the German version of the Eating Disorder Inventory EDI-2 (1997) in 371 adolescents aged 13 to 18 years. Internal consistency, convergent and divergent validity were examined and a confirmatory factor analysis was conducted. Internal consistency was high for the group of patients and satisfactory for both control groups. Associations with other clinical instruments point in the expected direction and support the external validity of the EDI-2. The EDI-2 differentiated very well between the group of eating disorder patients (n=71) and the female (n=150) and male control groups (n=150). A discriminant analysis demonstrated that 86.0% of the cases were correctly classified, and a confirmatory factor analysis largely supported the six-factor structure generated by the German version of the EDI-2 (Thiel et al., 1997).
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 05/2010; 38(3):219-28. · 0.99 Impact Factor
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ABSTRACT: The subjective evaluation of a psychotherapeutic treatment may be an essential aspect of the recovery from an eating disorder. Our study investigates the subjective treatment evaluation by patients with eating disorders and the accordance with their parents' and psychotherapist's evaluation.
In a sample of 41 eating-disorder patients (M(Age) = 16.3; SD = 1.26), their parents and psychotherapists, we used a questionnaire (FBB) to assess satisfaction with Dialectical Behavioral Therapy treatment.
Our results show good ratings, as well as good correlations between patients and parents.
The findings implicate the importance of assessing a subjective therapy rating in addition to objective parameters.
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 01/2010; 38(1):51-7. · 0.99 Impact Factor
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ABSTRACT: Family diseases represent a risk factor in the multifactorial etiology model regarding the genesis of eating disorders. In German-speaking countries only a few studies give attention to this topic. The aim of this study is to investigate the occurrence frequency of psychiatric disorders and personality styles among parents of juvenile patients with eating disorders. Furthermore a comparison between parents of patients with restrictive anorexia nervosa (AN-R) and parents of patients with bulimia nervosa (BN) is carried out. Psychiatric disorders listed on Axis I and Axis II of DSM-IV (American Psychiatric Association (APA), 1994) and personality styles were assessed in 73 mothers and fathers of 27 patients with AN-R and 13 patients with BN. The results show a high psychiatric strain among parents of patients with AN-R and BN. However the overall psychiatric strain does not differ among the parents of patients with AN-R and BN. Depressive disorders were more frequently observed among mothers of patients with AN-R. Parents of patients with BN showed higher occurrences of paranoid and schizotypal personality styles. A vulnerability of psychiatric disorders is indicated among parents of patients with eating disorders in general but nonspecific for AN-R or BN.
Praxis der Kinderpsychologie und Kinderpsychiatrie 01/2010; 59(4):302-13. · 0.58 Impact Factor
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ABSTRACT: Serotonin (5-HT) pathways play an important role in the pathophysiology of anorexia nervosa (AN). In this study, we investigated functional characteristics of the platelet 5-HT transporter and platelet 5-HT content in AN patients at various stages of their illness in comparison to healthy control woman (HCW) controlling for the 5-HTTLPR deletion/insertion polymorphism and other confounding variables. Fasting blood samples of 58 acutely underweight AN patients (acAN, BMI = 15.2 ± 1.4), 26 AN patients of the initial acAN sample after short-term/partial weight restoration (BMI = 17.3 ± 0.9), 36 weight-recovered AN patients (recAN, BMI = 20.7 ± 2.2) and 58 HCW (BMI = 21.6 ± 2.0) were assessed for kinetic characteristics of platelet 5-HT uptake (V (max), K (m)) and platelet 5-HT content. Plasma leptin served as an indicator of malnutrition. Mean V (max) and K (m) values were significantly higher in recAN subjects in comparison to HCW (2.05 ± 0.62 vs. 1.66 ± 0.40 nmol 5-HT/10(9) platelets min and 432 ± 215 vs. 315 ± 136 nmol, respectively) but there were no differences in platelet 5-HT content (464.8 ± 210.6 vs. 472.0 ± 162.2 ng 5-HT/10(9) platelets). 5-HT parameters in acAN patients and HCW were similar. 5-HTTLPR variants were not related to 5-HT platelet variables. In the longitudinal part of the study we found significantly increased 5-HT content but unchanged 5-HT uptake in AN patients after short-term/partial weight restoration. Our results highlight the importance of malnutrition for the interpretation of abnormalities in neurotransmitter systems in AN. Changes in platelet 5-HT transporter activity were related to the stage of the illness but not to 5-HTTLPR genotype. Increased V (max) and K (m) in recovered AN patients might mirror adaptive modulations of the 5-HT system.
Archiv f ur Psychiatrie und Nervenkrankheiten 12/2009; 260(6):483-90. · 2.75 Impact Factor
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ABSTRACT: To examine differences in body size estimation in adolescents with different types of eating disorders.
A total of 129 patients with eating disorders (M(age) = 16.0 +/- 1.8) and 354 healthy control participants (CP) (M(age) = 15.2 +/- 2.1) completed the EDI-2 and were asked to estimate the circumference of selected body parts by using string (BID-CA).
CP showed an average overestimation of 8-16%, depending on the estimated body part. Eating disorder patients overestimated their body parts on average by about 30%. Thigh and waist estimations were the best variables for discriminating between patients with eating disorders and CP. No significant differences were found between bulimia nervosa and anorexia nervosa patients.
Body image distortion plays an important role in both anorexia nervosa and bulimia nervosa. The BID-CA is well suited to discriminate between healthy and disordered overestimation of body parts.
European Eating Disorders Review 11/2009; 17(6):468-75. · 1.38 Impact Factor
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ABSTRACT: The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN) and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3) admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year after being discharged. Assessments were made at the beginning and at the end of the inpatient treatment as well as at the 1-year follow-up. Self-rating data and expert-rating interview data were obtained. Adequate data for 55 (96.5%) cases allowed for the assignment of an outcome category. A total of 28.1% of the patients' cases showed a good outcome, meaning the patients fully recovered, and 8.8% had an intermediate outcome, and 59.6% of the patients' cases had a poor outcome. Significant predictors of poor outcome included the patient's BMI at the beginning of the treatment as well as psychiatric comorbidity, and purging behavior. Adolescent AN is a severe disorder with a poor outcome in a substantial amount of adolescents.
European Child & Adolescent Psychiatry 05/2009; 18(11):701-4. · 2.82 Impact Factor
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Stefan Ehrlich,
Roland Burghardt, Nora Schneider,
Martina Broecker-Preuss,
Deike Weiss,
Julia V Merle,
Eugenia Maria Craciun,
Ernst Pfeiffer,
Klaus Mann,
Ulrike Lehmkuhl,
Johannes Hebebrand
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ABSTRACT: In food-restricted rats, leptin as well as corticotropin releasing factor attenuate semistarvation-induced hyperactivity (SIH). Results from studies in patients with anorexia nervosa (AN) showed an association between excessive physical activity (PA) and leptin. One recent report suggests a role for cortisol in PA. In this study, we assessed the relationships between PA and both, cortisol and leptin levels at the same time in patients with acute anorexia nervosa (acAN) in comparison to recovered patients (recAN).
Plasma leptin, plasma cortisol, body mass index (BMI), and expert-ratings of qualities of PA were assessed in 36 acAN patients, 27 recAN patients and 44 healthy control woman (HCW). Regression analyses were used to predict PA using BMI, leptin and cortisol levels as predictor variables.
Leptin levels but not cortisol significantly contributed to the prediction of PA in acAN. In recAN PA was not elevated and not related to endocrine parameters but correlated positively with core eating disorder symptoms.
Our work lends support to the proposed inverse association between peripheral leptin levels and excessive physical activity in AN. This relationship is specific to the state of semistarvation. The role of additional mediators remains to be clarified.
Progress in Neuro-Psychopharmacology and Biological Psychiatry 04/2009; 33(4):658-62. · 3.25 Impact Factor
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ABSTRACT: A 15-year-old, female, formerly obese adolescent was referred to our day care clinic due to self-induced massive weight loss and depressive symptoms. Intense treatment, additional dialectical behavioral therapy and psychopharmacological treatment prevented further weight loss and improved her affective state. Due to remaining anorexic symptoms such as body image distortion, outpatient psychotherapeutic treatment is continued. This case report indicates the importance of further research on diagnostic crossover from obesity to atypical anorexia nervosa.
Obesity Facts 01/2009; 2(1):52-3. · 1.86 Impact Factor
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ABSTRACT: Apart from energy homeostasis leptin has been shown to be involved in a number of neuronal networks. The aim of this study was to investigate how the residual variance of leptin levels, after controlling for BMI, is linked to eating-disorder-specific psychopathology and sexual desire in patients with anorexia nervosa (AN) compared to healthy controls. The sample included 57 subjects with acute AN and 77 healthy controls. Psychopathology was determined by EDI-2 and SCL-90-R and sexual problems were rated according to the Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX). Plasma leptin was assessed by ELISA. Patients with a high drive for thinness had lower leptin levels at a given BMI and low leptin levels were associated with sexual problems, i.e. the absence of sexual desire and intimate relationships. Our results are in accordance with recent animal experiments linking low leptin levels with decreased sexual interest irrespective of body weight.
Acta Neurovegetativa 12/2008; 116(1):109-15. · 2.73 Impact Factor
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ABSTRACT: Most previous studies investigating amino acid levels in anorexia nervosa (AN) have focused on acutely underweight patients. The present study assessed the availability of aromatic amino acids in the plasma of weight-recovered outpatients with AN (recAN) in comparison to acutely underweight AN patients (acAN) and healthy control woman (HCW).
Plasma tryptophan (TRP), tyrosine (TYR), and phenylalanine (PHEN) as well as leptin concentration were determined in 32 recAN, 32 acAN, and 32 HCW.
Both recAN and acAN patients showed significantly lower levels of TRP and PHEN when compared to HCW. TYR was reduced in acAN patients only.
Normal weight and normal leptin levels but lower availability of TRP and PHEN in recAN patients might indicate that outside a tightly controlled setting these patients still engage in abnormal eating patterns. Reduced peripheral availability of these precursor amino acids could impact on 5-HT and catecholamine functioning in the brain.
International Journal of Eating Disorders 10/2008; 42(2):166-72. · 2.95 Impact Factor
