24
EDRS 2013
flexibility. Group 2 (59%) showed no weaknesses and strength in verbal
fluency. Neuropsychological performance may be a more reliable way of
grouping patients with eating disorders than current systems, offering good
concurrent validity with key clinical characteristics (body image disturbance,
rigidity in thinking and detail focus).
42
HOW DO WE DEFINE “RECOVERY” FROM ANOREXIA NERVOSA AND
BULIMIA NERVOSA AT 25 YEARS?
Kamryn T. Eddy
1,2
,
Aparna Keshaviah
1
,
Jennifer J. Thomas
1,2
,
Helen F.
Burton
1
,
Elizabeth Hastings
1
,
Katherine Edkins
1
,
Meera Krishna
1
,
David B.
Herzog
1
,
Debra L. Franko
1,3
1
Massachusetts General Hospital, Boston, MA, USA,
2
Harvard Medical
School, Boston, MA, USA,
3
Northeastern University, Boston, MA, USA
Introduction:
Eating disorder (ED) course is often protracted, with no
consensus about recovery definition. To empirically define “recovery,”
we examined long-term outcome in women with anorexia nervosa (AN)
and bulimia nervosa (BN).
Method:
Participants in a 10-year longitudinal
study with AN (n=100) and BN (n=76) were interviewed at 25 years. We
tested two recovery definitions at 25 years (≥12 months with residual
cognitive symptoms vs. completely absent symptoms) for positive and
negative percent agreement (PA) with the Eating Disorder Examination-
Questionnaire (EDE-Q) recovery definition (having global score within 1
standard deviation of the mean age and gender matched norm). We also
tested which definition at 10 years best predicted the optimal 25-year
definition.
Results:
At the 25-year follow-up, 61% of AN participants and
68%
of BN participants had recovered with residual symptoms, while 28%
with AN and 45% with BN had recovered with no symptoms. EDE-Q had the
highest PA with the residual symptoms definition in AN, and the absence of
symptoms definition in BN. These optimal 25-year recovery definition were
best predicted by residual symptoms at 10 years in AN, and by absence
of symptoms at 10 years in BN.
Conclusion:
The majority of participants
had achieved substantial symptomatic improvement at 25 years. However,
residual cognitive ED pathology may persist in AN even after recovery
while residual symptoms in BN may signify that the individual is not yet
recovered.
43
LOW MATERNAL VITAMIN D LEVELS DURING PREGNANCY PREDICT
INCREASED EATING DISORDER RISK IN FEMALE OFFSPRING
DURING ADOLESCENCE
Karina L. Allen
1,2
,
Susan M. Byrne
1
,
Merci M. H. Kusel
1
,
Prue H. Hart
1
,
Andrew J. O. Whitehouse
1
1
Telethon Institute for Child Health Research, Centre for Child Health
Research, The University of Western Australia, Perth, Australia,
2
School of
Psychology, The University of Western Australia, Perth, Australia
Introduction:
Season of birth has been linked to eating disorder risk in
some studies, but not all. Research has found that season of birth effects
with schizophrenia are partially accounted for by gestational differences in
vitamin D: low gestational vitamin D predicts increased schizophrenia risk.
The current study aimed to determine whether gestational vitamin D levels
would relate to eating disorder risk, and, if so, whether this effect would
account for any association between season of birth and eating disorders
in the sample studied.
Methods:
Participants were 526 mother-child dyads
from the Western Australian Pregnancy Cohort (Raine) Study. The Raine
Study has followed participants from 18 weeks gestation to age 20 years.
Maternal serum 25(OH)-vitamin D levels were measured at 18 weeks
pregnancy and grouped into quartiles. Offspring eating disorder symptoms
were assessed at ages 14, 17 and 20.
Results:
Maternal 25(OH)-vitamin
D quartiles were a significant predictor of eating disorder risk in female
offspring (n=308) in multivariate logistic regression models. After adjusting
for covariates, vitamin D in the lowest quartile was associated with a 1.8-
fold increase in eating disorder risk relative to concentrations in the highest
quartile. This association accounted for the relationship between offspring
season of birth and eating disorder risk.
Conclusions:
This is the first study
to link low gestational vitamin D to increased eating disorder risk in females.
SYMPOSIUM
Saturday, 10:00 - 12:00 PM
Waterford/Lalique
New Treatment Studies of Family Therapy for Adolescent
Anorexia Nervosa
44
A MULTISITE STUDY COMPARING TWO DIFFERENT FAMILY
THERAPIES FOR ADOLESCENT ANOREXIA NERVOSA
Stewert Agras
Stanford University, Stanford, CA, USA
Although Family-Based Treatment (FBT) based on the ‘Maudsley’ model
appears to be the most promising approach to the treatment of adolescent
anorexia nervosa (AN), and is superior to a particular form of individual
psychotherapy there has been no adequately powered comparison with
another form of family therapy. In this study 164 adolescents with AN were
randomly allocated to either FBT or to Systems Family Therapy (SFT)
at 6 specialized treatment sites. Participants in both conditions received
16-
sessions of treatment over a 9-month period. The principal outcome
measures were: Weight, Eating Disorders Examination (EDE-global score)
and a clinical outcome (Global EDE within 1SD of normal and weight equal
to or greater than 95%IBW). Final results from this study will be presented
including intent-to-treat and per-protocol analyses.
45
A MULTICENTRE RCT OF SINGLE AND MULTI FAMILY THERAPY FOR
ADOLESCENT ANOREXIA NERVOSA
Ivan Eisler
Kings College London and South London and Maudsley NHS Trust
A key aspect of eating disorders focussed family therapy is a strong
emphasis on enhacing family strengths and resilience, with parents taking
a central role in managing their child’s eating behaviour. Drawing on the
same concepts we have developed an intensive multi family approach
in which up to 8 families are seen together to provide opportunities for
mutual support and learning. The treatment is multifaceted combining
family therapy interventions with a range of other techniques including role
plays, motivational and cognitive techniques and creative techniques. The
presentation will descibe the results of a multi centre RCT in which 167
adolescents aged 13-20 with a diagnosis of AN or EDNOS (restricting)
were randomized to single family therapy or multi family therapy. End of
treatment and six month follow-up results, including treatment outcome
and health economic findings, will be presented and their implications
discussed.
46
AN RCT OF PARENT-FOCUSED AND FAMILY-BASED TREATMENT
FOR ADOLESCENT ANOREXIA NERVOSA
Daniel Le Grange
1,2
1
University of Melbourne,
2
The University of Chicago
There is robust efficacy data for family-based treatment (FBT) as the
most effective outpatient therapy for adolescent anorexia nervosa. FBT is
a conjoint treatment with the whole family as this is thought to allow the
therapist insight into family functioning and facilitate direct interventions in
family interactions. However, much of FBT involves the therapist assisting
parents to address eating disorder symptomatology, and support them in
the primary task of weight restoration and it may be possible to achieve
these goals without seeing the whole family together. This presentation will
describe a parent-focused treatment model (PFT) developed at The Royal
Children’s Hospital Melbourne and how it differs from conjoint FBT. An
ongoing RCT is comparing PFT and conjoint FBT, and explores mediators
and moderators of treatment outcome. Included in this presentation will be
a brief description of study design, assessment procedures, and progress
from the first three years of the RCT.
47
GROUP PARENT AND ADOLESCENT SKILLS TRAINING FOR
ADOLESCENT ANOREXIA NERVOSA: PRELIMINARY OUTCOMES,
ADVANTAGES, AND CHALLENGES
Nancy Zucker
Duke University School of Medicine
Parents play a critical role in the implementation of their child’s treatment
for adolescent anorexia nervosa whether through managing eating disorder
symptom or influencing features that increase vulnerability to disorder
onset and maintenance (e.g., deficits in emotion awareness and emotional
avoidance). We present preliminary outcome data from an outpatient
parent skills training group that enhances parents’ ability to “self-parent” by
teaching them to attune to and respond to their own emotional experience
and biological needs, to improve their resilience in helping their child,
and enhance their ability to serve as role models of adaptive emotional
expression and experience for their children. The adolescents learn similar
skills in a separate group. We present preliminary outcome data (z-BMI,
eating disorder attitudes, emotional awareness and regulation) in a cohort
of 21 parent-child dyads randomized to group treatments relative to 21
parent-child dyads randomized to the benchmark treatment (family based
treatment, Lock et al 2001). Advantages and challenges of this model will
be discussed.
ORAL ABSTRACTS
