Daniel le Grange

Attrition is common in the treatment of anorexia nervosa and its causes are complex and incompletely understood. In particular, its relationship with adaptive function and motivational stage of change has been little studied. This study aimed to (1) investigate and (2) compare the strength of associations between adaptive function, stage of change and other previously found factors such as illness sub-type and treatment attrition in women with severe and enduring anorexia nervosa (SE-AN). Participants were 63 adult women with SE-AN of at least 7 years duration who were enrolled in a multi-site randomized controlled trial conducted from July 2007 through June 2011. Treatment comprised 30 outpatient visits over 8 months of either Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN) or Specialist Supportive Clinical Management (SSCM) both of which were modified for severe and enduring illness. Assessments were done at baseline, end of treatment, and 6 and 12 month post treatment follow-up. Demographic variables, duration of illness, specific and generic health related quality of life (QoL), eating disorder (ED) and mood disorder symptoms, social adjustment, body mass index (BMI), and motivation for change were assessed with interview and self-report questionnaires. Treatment attrition was defined as leaving therapy after either premature termination according to trial protocol or self-instigated discharge. Binary logistic regression was used to investigate relative strength of associations. Those who did not complete treatment were significantly more likely to have the purging sub-type of anorexia nervosa and poorer ED related QoL. There were no significant differences between attrition and which therapy was received, educational level, and global ED psychopathology, stage of change, BMI, social adjustment, duration of illness or level of depression. The strongest predictors on multivariable analysis were ED QoL and AN-purging subtype. This study supported previous findings of associations between attrition and purging subtype. Furthermore, we found associations between a potentially important cycle of attrition, and poorer EDQoL, which has not been previously reported. Contrary to expectations we did not find an association with BMI, severity of ED symptoms, low level of motivation to change ED features, or level of education.

Objective Anorexia nervosa (AN) was first described more than 130 years ago, yet few psychological treatments have been formally studied. Our objective was to review the available studies to understand whether these may highlight directions for future investigation. Method Medline and PsycINFO were consulted to identify relevant treatment studies. Twenty psychotherapy treatment studies were identified for review. These were divided in terms of patient age (adolescent vs. adult) and type of study (uncontrolled vs. controlled). Results Without exception, adolescent studies (uncontrolled or controlled) involved the parents or family in the treatment. The adult studies were much more varied in terms of treatments that were compared. Most studies were statistically underpowered and only one utilized manualized treatments. More recent investigations have attempted to remedy these methodologic shortcomings. Discussion The review highlights the effectiveness of one particular treatment modality for adolescents, but emphasizes the compelling need for further and larger systematic investigation into treatments for both adolescent and adult AN. © 2005 by Wiley Periodicals, Inc.

Recent surveys in South Africa have demonstrated that disordered eating is equally common among black and white female students. Self-report measures have been used in these surveys to establish levels of disordered eating. One study in Tanzania, where a two-stage design was implemented, showed that upon interview the majority of participants did not present with disordered eating. The absence of two-stage studies in South Africa brings into question some of the findings from these surveys. In the present study, we surveyed a sample of black and white high school students in South Africa to establish the prevalence of disordered eating. In the second phase of this study, we attempted to interview those black students from one particular school who scored high on the eating disorder measures. This process proved both challenging and elucidating. While a significant number of young black females endorsed eating disorder symptoms on self-report, interviews with some participants showed that self-starvation and related symptoms had a different meaning from what we would typically expect from someone with an eating disorder. Consequently, this study highlights the need to revisit the methods typically employed in cross-cultural research in eating disorders. Careful consideration of a variety of cultural factors that may alter the meaning of standard measures is called for.

Background There are few reports that describe the manifestation of bulimia nervosa (BN) among adolescents. Moreover, none make reference to the comparative clinical manifestation of adolescent BN and adolescent anorexia nervosa. Nor are any reports available of how distinct partial-syndrome BN cases are from those that meet full diagnostic criteria for BN. Objectives To describe 3 groups of adolescents, those with a full-syndrome eating disorder (BN and anorexia nervosa) or partial-syndrome BN, and to compare these groups along demographic, general psychopathology, and eating disorder variables. Design The study population included 120 adolescents with eating disorders who were initially seen at The University of Chicago Eating Disorders Program, Chicago, Ill, for treatment. All participants completed an assessment prior to treatment. Measures Weight and height were obtained from all participants. Participants also completed a baseline demographic questionnaire (eg, menstrual status, ethnicity, family status), Beck Depression Inventory, Rosenberg Self-Esteem Scale, and the Eating Disorder Examination. Results Partial-syndrome BN cases are clinically quite similar to their full-syndrome counterparts. Only objective binge eating episodes and purge frequency distinguished BN and partial-syndrome BN cases. Anorexia nervosa cases, on the other hand, were quite distinct from BN and partial-syndrome BN cases on almost all variables. Conclusion Early recognition and swift treatment of eating disorders in adolescents, regardless of whether a diagnostic threshold is met, are imperative because they will lead to early intervention thereby potentially improving eating disorder recovery rates.

Despite the fact that anorexia nervosa is a debilitating disorder with serious psychological and medical sequelae, few psychological treatments have been studied. Of these, interventions that involve the parents of the adolescent have proved to be most promising. This is especially true for those cases with a short duration of illness (<3 years). Even more compelling is the fact that the benefits of this family‐based treatment have been shown to be enduring at 5‐year follow‐up. Examination of the available treatment studies, both controlled trials as well as case series, indicates that most adolescents with anorexia nervosa, even those who are severely ill, can be treated quite successfully as outpatients. The important caveat is that outcome appears to be most successful when the patient's parents are viewed as a resource rather than a hindrance. Optimism regarding these encouraging findings should be tempered until larger scale randomised trials have been conducted.

The rarity of identical twins with anorexia nervosa (AN) makes formulating an effective treatment approach for this subset of individuals quite difficult. Clinicians may be applying treatment strategies that have been designed for individuals with an eating disorder. However, these approaches might have to be modified for the treatment of identical twins. The few available case studies have not discussed the challenges a clinician faces when treating identical twins with AN. In this report we describe the presentation of the case of adolescent monozygotic twins who were simultaneously concordant for AN. We discuss their unique presentation and our approach to their treatment.