A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa

Article Abstract:

Anorexia nervosa is an eating disorder that primarily affects young women; it is characterized by avoidance of eating and other measures designed to prevent weight gain. The condition can last a lifetime, which itself can be shortened by the disease; a number of anorectics eventually die of starvation or related complications. Research has demonstrated that in many cases, complete recovery is possible, but the most effective treatment method to restore proper weight in the short term has not been determined. Although the cause of this disorder is not clear, the authors contend that a fundamental feature is an irrational fear of growing into adulthood, which manifests itself in a refusal to reach adult body weight. Therapy might involve establishing eating patterns by means of nutritional counseling in addition to individual and family psychotherapeutic techniques. To evaluate the effectiveness of such an approach to treating anorexia nervosa, a study of 90 female anorectics was conducted. The patients were assigned to one of four treatment groups: (1) inpatient treatment; (2) outpatient treatment (both individual and family therapy) combined with dietary counseling; (3) outpatient group psychotherapy plus dietary counseling; or (4) no further treatment. The details of the approach to both patient and parents in therapeutic sessions are described. The intermediate results of the study after one year of follow-up are presented. In general, those in the first three groups fared better, except for one girl in group 3, who died. Weight gain at the end of one year was highest among those in group 3, although those in group 1 gained weight faster. Weight gain in these groups led to resumption of menstruation for many patients. (One of the consequences of anorexia is amenorrhea.) Methodological problems with the study, especially the necessity of having a 'no treatment' group, are discussed. Nevertheless, the authors feel that the results of the three interventions, at the end of one year, are promising. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Adolescent psychotherapy

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Long-term outcome in early-onset anorexia nervosa

Article Abstract:

Anorexia nervosa is an eating disorder that usually begins during adolescence or even early adulthood, but can sometimes develop in children who have not yet reached puberty. The condition is not always diagnosed early when it does appear in children, due both to a lack of awareness that it can affect children, and to the fact that it is not necessarily considered abnormal when children avoid eating. Among the more serious consequences of early-onset anorexia are impaired growth and sexual development. Demographic and clinical features were evaluated in 15 children (12 girls) who were under the age of 13 at time of admission for treatment of anorexia nervosa. The fourteen surviving children (one boy died of the effects of the condition) were followed-up three or more years later. Clinical features used as evaluative criteria included food avoidance, weight loss, and at least two of the following: preoccupation with body weight or food intake, distorted body image, fear of fatness, self-induced vomiting or purging, or excessive exercising. When first admitted, eight children were exercising heavily and 11 had distorted images of their bodies. At follow-up, 10 subjects had gained weight to adequate levels, although six continued to worry about weight and diet. Of the female subjects, six attained normal menstruation and two others had irregular menstruation. Most of the patients were able to maintain employment or attendance at school. In terms of sexual relationships, the outcome was less favorable, with several either fearing or being disinterested in sexual relationships. Overall, 10 patients were judged to have a good psychiatric outcome, while five had some form of psychiatric disturbance (including the boy who died and a girl who became schizophrenic prior to follow-up). The results of this study confirm previous research suggesting that prevention of eating disorders hinges upon developing positive attitudes to individuality of body shape and sensible eating patterns. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects

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Anorexia nervosa in an 80-year-old woman

Article Abstract:

Recent reports indicate that anorexia nervosa, an eating disorder which usually manifests in adolescence, is becoming more prevalent in old age. Several explanatory theories have been advanced: (1) older women are becoming susceptible to social pressures to be thin; (2) late-onset anorexia is related to resentful dependence on others; (3) late-onset anorexia may represent an attempt to achieve control during a time of uncertainty. The case report of an 80-year-old woman is presented. She originally became anorexic at age 15, when she lost a great deal of weight, stopped menstruating, refused to eat, and missed a whole year of school. She became childlike, and overly dependent on her mother. At age 16, her mother, who was very obese, left home for several months. While her mother was away, the girl began to eat normally and to gain weight; menstruation resumed. She left home, attended college, and married at age 25. She remained healthy throughout her adult life. When she was 65, her husband died. This event seems to have triggered her late anorexic response. She became depressed, attempted suicide, and was hospitalized for a brief period. After that, she lived on a meager diet of fruit and vegetables, with occasional meat or fish, and used laxatives regularly to control her weight, which dropped down to 79 percent of her normal weight. The re-emergence of anorexia in this patient is viewed as an attempt to utilize an early, maladaptive coping skill, in order to keep emotions triggered by her husband's death (grief, panic, and depression) at bay. It is suggested that when elderly patients exhibit significant weight loss, the possibility of an eating disorder should be considered, and that anxieties about weight in the elderly should be fully investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Complications and side effects, Geriatric psychiatry

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