20
EDRS 2013
16
MULTIPLE INFORMANT REPORTS FOR THE ASSESSMENT OF
EATING DISORDER SYMPTOMS IN ADOLESCENCE
Sonja A. Swanson
1
,
Kate Aloisio
2
,
Nicholas J. Horton
2
,
Kendrin R.
Sonneville
3
,
Ross D. Crosby
4
,
Kamryn T. Eddy
5
,
Alison E. Field
1,3,6
,
Nadia
Micali
7
1
Harvard School of Public Health, Boston, MA, USA,
2
Smith College,
Northampton, MA, USA,
3
Boston Children’s Hospital and Harvard Medical
School, Boston, MA, USA,
4
Neuropsychiatric Research Institute, Fargo,
ND, USA,
5
Massachusetts General Hospital, Boston, MA, USA,
6
Brigham
and Women’s Hospital and Harvard Medical School, Boston, MA, USA,
7
University College London, London, United Kingdom
Epidemiologic studies of adolescent psychiatric disorders often collect
information from adolescents and parents, yet most eating disorder
epidemiologic studies rely only on the adolescent and rarely incorporate
multiple informants. 7968 adolescents from the Avon Longitudinal
Study of Parents and Children (ALSPAC), and their parents, were sent
questionnaires at participants’ ages 14 and 16. Both adolescents and
parents were asked questions about the adolescent’s eating disorder
symptoms, including binge eating, vomiting, laxative use, fasting, and
thinness. We assessed the association between parent and adolescent
symptom reports (ages 14, 16) and the adolescent’s measured BMI at
age 17.5. Parents and adolescents were largely discordant on symptom
reports (kappas<0.3), with the parent generally less likely to report bulimic
symptoms than the adolescent but more likely to report thinness. Female
adolescents were 1.4-4.2 times more likely to report bulimic symptoms
than males, while prevalence estimates according to parent reports of
female vs. male adolescents were similar. Both parent and adolescent
symptom reports were predictive of subsequent BMI; parentally-reported
binge eating was more strongly predictive. Epidemiologic eating disorder
studies should consider the value added from incorporating parental
reports. In particular, studies of male eating disorder presentations may be
improved by using multiple sources of information.
17
EVALUATION OF DIMENSIONAL, CATEGORICAL, AND MIXTURE
MODELS OF DISINHIBITED EATING (DE) BEHAVIORS IN CHILDREN
AND ADOLESCENTS
Anna Vannucci
1,2
,
Marian Tanofsky-Kraff
1,2
,
Ross D. Crosby
3
,
Lauren B.
Shomaker
2
,
Lisa M. Ranzenhofer
1,2
,
Louise Hannallah
1,2
,
Kelly R. Theim
1
,
Tania Condarco
4
,
Susan Z. Yanovski
4
,
Jack A. Yanovski
2
1
Uniformed Services University, Bethesda, MD, USA,
2
Eunice Kennedy
Shriver National Institute of Child Health and Human Development, NIH,
Bethesda, MD, USA,
3
Neuropsychiatric Research Institute, Fargo, ND,
USA,
4
National Institute of Diabetes and Digestive and Kidney Diseases,
NIH, Bethesda, MD, USA
It is unknown if loss of control (LOC) eating, emotional eating (EE), and
eating in the absence of hunger (EAH) represent distinct DE patterns or
reflect a broad disinhibition dimension. Factor mixture modeling was used
to examine the latent structure of DE behaviors in 692 youth (14.3±2.3y;
68%
girls; 38% White; BMIz 1.0±1.0). LOC and eating pathology were
assessed via EDE. EE, EAH, and psychopathology were measured by
questionnaire. Body composition was measured by BodPod or DEXA.
A subset (n=235) ate from two test meals that modeled DE and normal
eating. The best-fitting model was a 4-class, 1-dimension solution.
Classes were: LOC/high-EE (LOC
EE
=206), LOC/high-EAH (LOC
EAH
=95),
EE (n=42), and no DE (NDE=349). All models controlled for demographics
and adiposity. LOC
EE
reported more LOC episodes than LOC
EAH
and had
the highest EDE global scores and symptoms of depression and anxiety
(
ps<.01). LOC
EAH
was higher on these measures than EE and NDE
(
ps<.01). LOC
EE
consumed the most snacks; LOC
EAH
and EE consumed
more snacks than NDE (p=.02). The severity dimension resembled
disinhibition, which was positively associated with objective binge
episode frequency, EDE eating concern, depressive symptoms, emotion
dysregulation, and snack intake (ps<.02). Specific combinations of LOC,
EE, and EAH may contribute to categorical distinctions of DE behaviors.
Including a disinhibition dimension across DE categories may be beneficial
for further characterizing heterogeneity within classes.
18
GENERAL AND TREATMENT-SPECIFIC PREDICTORS OF OUTCOME
IN A PEDIATRIC WEIGHT CONTROL TRIAL
Andrea B. Goldschmidt
1
,
John R. Best
2
,
Richard I. Stein
2
,
Brian E.
Saelens
3
,
Leonard H. Epstein
4
,
Denise E. Wilfley
2
1
The University of Chicago, Chicago, IL, USA,
2
Washington University
School of Medicine, Saint Louis, MO, USA,
3
Seattle Children’s Hospital
Research Institute and University of Washington, Seattle, WA, USA,
4
University at Buffalo, Buffalo, NY, USA
Objective
:
We studied general and treatment-specific predictors of child
zBMI outcome in 150 overweight children (
M
zBMI=2.21±0.30) and their
parents participating in family-based behavioral weight loss treatment
(
FBT), followed by randomization to either social facilitation maintenance
(
SFM) addressing social support and body image; behavioral skills
maintenance (BSM) addressing relapse prevention and adjusting FBT
skills for maintenance; or no-maintenance treatment control.
Methods
:
Regression and repeated-measures ANCOVA examined child and parent
anthropometric, demographic, and psychosocial predictors (measured at
baseline and post-FBT) of zBMI outcome at short- and long-term follow-
ups.
Results
:
Lower child baseline zBMI and age, and greater parent
baseline self-efficacy and BMI reduction during FBT predicted better FBT
outcome (overall model,
p
<.001). Children with high post-FBT eating
pathology (
p
=.009) lost
more
relative weight in SFM vs. BSM or control
from post-FBT to 2-year follow-up, whereas those whose parents reported
high post-FBT social support (
p
=.04) lost more in BSM vs. control.
Children with low post-FBT parent-reported behavioral problems lost
less
relative weight in control vs. SFM or BSM (
p
<.001).
Conclusion
:
SFM
improved weight outcomes for children presenting with initially higher
eating pathology, while extending FBT skills was effective for those with
higher family support. Those with fewer behavioral problems may need
more prolonged support.
19
TRANSITION PATTERNS IN BINGE EATING EPISODE TYPES AMONG
ADOLESCENTS RECEIVING PSYCHOTHERAPY TREATMENT FOR
BULIMIA NERVOSA
Carol B. Peterson
1
,
Daniel Le Grange
2
,
Ross D. Crosby
3
,
Kelly C. Berg
1
,
Sonja A. Swanson
4
,
Stephen A. Wonderlich
3
,
Scott J. Crow
1
1
University of Minnesota, Minneapolis, MN, USA,
2
University of Chicago,
Chicago, IL, USA,
3
Neuropsychiatric Research Institute and University of
North Dakota School of Medicine and Health Sciences, Fargo, ND, USA,
4
Harvard University, Boston, MA, USA
Purpose:
This investigation examined binge eating transition patterns
among adolescents with bulimia nervosa in psychotherapy treatment,
particularly the extent to which patterns were consistent with the Binge
Drift Hypothesis (Hildebrandt & Latner, 2006) and were characterized by
migration from objective bulimic episodes (OBEs) to subjective bulimic
episodes (SBEs) followed by remission.
Methods:
62
bulimic adolescents
received 20 sessions of manual-based psychotherapy over 6 months.
The Eating Disorder Examination was administered at baseline, end of
treatment, and 6-month follow-up. Markov modeling was used to examine
transition patterns among 4 categories: OBEs only; SBEs only; both
OBEs and SBEs; and neither OBEs nor SBEs (none).
Results
:
Although
binge eating transitions were generally variable between assessments
with 52.4% changing categories, 47.6% remained consistent. None of the
participants exhibited a pattern consistent with the Binge Drift Hypothesis
over the three time points. Although the most common transition patterns
were characterized by binge eating at baseline followed by the none
category (29%), the transition patterns of 10% of the sample that migrated
to a less severe category by follow-up were variable.
Conclusions
:
These
data suggest that bulimic adolescents do not appear to transition from
OBEs to SBEs to remission over the course of treatment and follow-up
and that binge eating transitions patterns are characterized by variability
over time.
20
OUTCOME OF CHILDHOOD-ONSET ANOREXIA NERVOSA EIGHT
YEARS AFTER INPATIENT TREATMENT
Beate Herpertz-Dahlmann
1
,
Jennifer A Vloet
1
,
Astrid Dempfle
2
,
Karin M
Egberts
3
,
Viola Kappel
4
,
Ernst Pfeiffer
4
,
Katharina Buehren
1
1
Department of Child and Adolescent Psychiatry, Psychosomatics and
Psychotherapy, University Clinics RWTH Aachen, Aachen, Germany,
2
Institute of Medical Biometry and Epidemiology, Philipps-University
of Marburg, Marburg, Germany,
3
Department of Child and Adolescent
Psychiatry, Psychosomatics and Psychotherapy, University Wuerzburg,
Wuerzburg, Germany,
4
Department of Child and Adolescent Psychiatry,
Psychosomatics and Psychotherapy, Charité Berlin, Berlin, Germany
Introduction:
In European countries and the US, incidence rates of
childhood anorexia nervosa (AN) (age of onset <14) are considerably
increasing (British Social and Health Care Information Centre, 2012;
Halmi 2009). However, there are only a few studies on long-term outcome
of childhood-onset AN with small sample sizes and inconsistent results.
Thus, we investigated the outcome of patients with childhood-onset
AN eight years after inpatient treatment in a multisite study.
Methods:
55
of 69 (77%) patients with childhood-onset AN could be followed up
and assessed personally. Outcome of AN, cross-over into other eating
disorders, Morgan-Russell General Outcome and psychiatric comorbidity
(
according to DSM-IV criteria) were investigated with structured
standardized interviews and self-report questionnaires.
Results:
Only
40%
of the patients had a good outcome according to the Morgan&
Russell criteria, one third had an intermediate and nearly one fourth a poor
outcome. One patient had died from AN. 17% of the former patients still
met the diagnostic criteria of an eating disorder and one fourth those for
a comorbid psychiatric disorder. Higher BMI at referral to hospital and at
discharge were related to a better outcome.
Conclusion:
The long-term
outcome of patients with childhood-onset anorexia nervosa is much worse
compared to that of adolescents. Early diagnosis and adequate weight
rehabilitation seem to be of great importance for a better outcome.
ORAL ABSTRACTS
