Eating Disorders Among a Community-based Sample of Chilean Female Adolescents

The purpose of this study was to explore the prevalence and correlates of eating disorders among a community-based sample of female Chilean adolescents. Data were collected through structured interviews with 420 female adolescents residing in Santiago, Chile. Approximately 4% of the sample reported ever being diagnosed with an eating disorder. Multivariate logistic regression analyses revealed that those with higher symptoms of anxiety and who had tried cigarettes were significantly more likely to have been diagnosed with an eating disorder. Findings indicate that Chilean female adolescents are at risk of eating disorders and that eating disorders, albeit maladaptive, may be a means to cope with negative affect, specifically anxiety.     

Attention-deficit/hyperactivity disorder–specific stimulant misuse,mood, anxiety,and stress in college-age women at high risk for or with eating disorders

ABSTRACT

Objective: To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. Participants: Four hundred forty-eight college-age women aged 18–25 at high risk for or with a clinical or subclinical eating disorder. Methods: Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. Results: Greater eating disorder pathology, objective binge eating, purging, eating disorder–related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. Conclusions: ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.     

Suicidal Ideation and Comorbid Disorders in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Population at Risk

ABSTRACT

The purpose of this study was to examine the level of suicidal ideation and comorbid disorders (major depressive disorder, generalized anxiety disorder) among adolescents and young adults with diagnosed Asperger's syndrome (AS). A cross-sectional study using a self-administrated mail questionnaire and a Web-based questionnaire were used. Two samples were selected for this study. The first sample used snowball sampling, starting with parents of adolescents and young adults with diagnosed AS who participated in a qualitative study conducted in 2002. The second sample consisted of a volunteer sample of parents who visited Web sites for parents and individuals with diagnosed autism spectrum disorder. The sample included 10 adolescents and young adults with diagnosed AS. Fifty percent of the sample had a clinically significant level of suicidal ideation, 20% met criteria for a diagnosis of major depressive disorder, and 30% met criteria for generalized anxiety disorder.     

The Concurrence of Eating Disorders with Histories of Child Abuse Among Adolescents

This study examined the relationship between eating disorders and reported history of physical or sexual abuse among male and female adolescents. A survey administered to high school students in a rural midwestern slate school system contained questions on eating behaviors, weight, lifestyle habits, parental substance abuse, and history of physical abuse, extrafamilial sex abuse and incest. Results showed that eating disorders were correlated with all three types of abuse. There were differences in prevalence of eating and weight problems and of child abuse according to gender and race. Presence of an eating disorder correlated with presence of other addictive behaviors, family history of substance abuse, and with low selfesteem, hopelessness and anxiety.     

Ethnic and class factors affecting mental health clinic service

Service delivery by a mental health clinic to clients from an older suburban catchment area containing both lower and middle class blacks and whites was studied. The epidemiologic method was employed, relating service delivery to the characteristics of the various population groups within the catchment. The findings indicate that low service rates for blacks were not related to ethnicity alone, but to the combination of black ethnicity and low social status; however, middle class blacks and middle class whites who entered treatment received similar service. Poor blacks had higher admission rates than poor whites with similar need indicators. In continued treatment, poor blacks received lowest service rates while minority status poor whites living in a predominantly black area received highest service rates. Social class mediated black service utilization. Severity of illness, interacting with social class and minority status mediated white service utilization. Outreach is suggested not only for poor blacks but also for poor whites, especially those living in areas in which they represent an ethnic minority.     

Treatment outcomes among adolescents with substance abuse problems: the relationship between comorbidities and post-treatment substance involvement

This study examines comorbid mental disorders in relation to post-treatment outcomes (12 months post-intake) among adolescents (N=419) who entered three residential drug treatment programs. When contrasted with youths who had no comorbid mental disorders or youths with a single comorbid condition, those with combined internalizing and externalizing disorders (mixed comorbidity) had higher levels of substance-related problems and poly-drug use at entry to treatment, and poorer outcomes, e.g. relapse, particularly evident for drugs other than alcohol or marijuana. A significantly higher proportion of those with mixed comorbidity were admitted to short term residential treatment, as compared to long term residential care. However, the effects of comorbidity were independent of both planned and actual length of stay, suggesting that comorbidities can negatively impact treatment outcome in multiple ways, apart from length of stay. Since co-occurring problems appear to profoundly limit treatment effectiveness, treatment strategies that address comorbidity are needed to improve outcomes.     

Eating disorders across the life span

Clearly, eating disorders appear in both men and women across the entire life span. Nurses must be aware of eating disorder issues in populations such as children and adolescents, adult men, middle-aged women, and older adults so that proper screening and treatment can occur to reduce the consequences of these potentially life-threatening illnesses.     

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

Concept of self,mediating factors,and adolescent deviance

This study of 9,752 adolescents lends support for the authors’ theoretical model of low self esteem and self confidence predicting lack of purpose in life and poor academic performance, which in turn affects various forms of deviance—delinquency, drug abuse, alcohol abuse, and eating disorder. Academic performance is more important than a sense of purpose in life as a mediating variable for alcohol use, but purpose in life is a more important mediator for eating disorder. Subsamples based on gender, age, social class and ethnicity show similar patterns of relationship between the independent, intervening, and dependent variables to those of the total population.     

Vulnerability and Comorbidity Factors of Female Problem Gambling

This study helps to address a deficiency of gender-specific research into problem gambling. It focuses on the gambling behaviors, family and personal histories and comorbid psychological disorders of 365 female gamblers from across Ontario, Canada, who responded to a mail-in survey. Specifically, this study looks at rates of depression and anxiety, concurrent struggles with other behaviors (such as alcohol and drug use, disordered eating, overspending and criminal activity) and abuse history reported by female gamblers. The reported rates are considerably higher than for the general female population. The findings of this study agree with previous research. They suggest that prevention strategies and treatment practices for female problem gamblers should take into account women’s mental health, addiction and trauma history as contributing factors in the development of problematic gambling.     

Effective management of adolescents with anorexia and bulimia

1. Anorexia and bulimia are common among adolescents, and both are complex, chronic disorders with high comorbidity and significant complications and mortality. 2. Eating disorders cultivate shame, denial, and lack of insight, making treatment difficult and necessitating careful development of a therapeutic alliance. 3. Treatment goals are to correct the biological and psychological sequelae, prevent or correct complications, restore normal eating patterns, reduce binging and purging, promote understanding and change in dysfunctional behaviors and attitudes, improve intrapersonal and interpersonal functioning, restore normal exercise patterns, and address comorbid psychopathology and psychological conflicts.     

Family-based interventions for child and adolescent disorders

Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.     

Research on the treatment of couple distress

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.     

The effect of race/ethnicity on the relation between substance use disorder diagnosis and substance use treatment receipt among male serious adolescent offenders

The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N = 638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.     

Associations Between Psychological,Physical, and Sexual Intimate Partner Violence and Health Outcomes Among Women Veteran VA Patients

Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.     

Eating disorders and body image of undergraduate men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. OBJECTIVE AND PARTICIPANTS: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. METHODS: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. RESULTS: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. CONCLUSIONS: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

Predictors of treatment satisfaction among older adults with anxiety in a primary care psychology program

Increasing numbers of patients are treated in integrated primary care mental health programs. The current study examined predictors of satisfaction with treatment in patients from a randomized clinical trial of late-life generalized anxiety disorder (GAD) in primary care. Higher treatment satisfaction was associated with receiving CBT rather than enhanced usual care. Treatment credibility, treatment expectancies, social support, and improvements in depression and anxiety symptoms predicted higher treatment satisfaction in the total sample. In the CBT group, only credibility and adherence with treatment predicted satisfaction. This suggests that older patients receiving CBT who believe more strongly in the treatment rationale and follow the therapist's recommendations more closely are likely to report satisfaction at the end of treatment. In addition, this study found that adherence mediated the relationship between treatment credibility and treatment satisfaction. In other words, patients’ perceptions that the treatment made sense for them led to greater treatment adherence which then increased their satisfaction with treatment.     

Eating Disorders and Body Image of Undergraduate Men

Eating disorders and body dissatisfaction among undergraduate men are less documented and researched than are eating disorders and body dissatisfaction among undergraduate women. Objective and Participants: In this study, the authors examined these issues in undergraduate men to identify similarities and differences between this population and undergraduate women. Methods: In a random sample of undergraduates, the authors categorized respondents by gender and by presence or absence of an eating disorder. The authors compared undergraduate men with an eating disorder with (1) undergraduate women with an eating disorder and (2) undergraduate men without an eating disorder. Results: The patterns of responses suggest that undergraduate men with an eating disorder are preoccupied with body shape and tone but not necessarily with losing weight. Conclusions: The authors discuss implications for future prevention as well as clinical and research efforts based on male symptoms within the diagnostic category of bulimia nervosa and eating disorder, not otherwise specified.     

Keynote Address

Abstract

Because of the increasing prevalence of eating disorders in college populations, it is increasingly important for student health services to identify affected individuals. Therefore, the authors analyzed the student health forms of member schools of the New York State College Health Association for the presence of items that would identify an eating disorder. Directors of health services that include specific questions about eating disorders on health forms were then surveyed for their opinions about this practice.

Specific items about eating disorders (anorexia nervosa, bulimia, vomiting to lose weight, laxative use to lose weight) were included on 5 of 111 forms. Less specific items including dissatisfaction with weight, being on a diet, or binge eating appeared on 10% of forms.

Approximately one-third of the students known by health service staffs to have an eating disorder reported this on their health form, when provided a specific opportunity to do so. Even though underreporting by students is potentially a problem in such circumstances, the health service directors all recommended the inclusion of items relating to eating disorders on student health forms.

“Human Papillomavirus Type 16 and Early Cervical Neoplasia,” CHRISTOPHER P. CRUM, et al. Flat warts (condylomata) of the uterine cervix are sometimes cytologically atypical and have abnormal mitotic figures; they are thought to be possible precursors of cancer of the cervix. Flat warts are caused by any of a number of types of human papillomaviruses (HPVs), one of which (HPV 16) has been previously associated with invasive cancer of the cervix. To determine whether HPV 16 is also associated with flat warts with abnormal mitoses, we analyzed 23 flat warts by DNA-hybridization techniques for the presence of HPV 16 and other HPV types, and correlated the results with the histology. Of 10 lesions with abnormal mitotic figures, 7 contained HPV 16, and 1 contained another type of HPV. Of 13 lesions without abnormal mitotic figures, only 1 contained HPV 16, and 7 contained other types of HPV.

We conclude that the presence of HPV 16 correlates with the presence of abnormal mitotic figures in flat warts of the cervix, and that this type of flat wart is a precursor of invasive cancer of the cervix. (New England Journal of Medicine 1984;310:880–3.)