[Eating disorders in childhood and adolescence. Anorexia nervosa, bulimia nervosa, binge eating disorder]. / Essstörungen im Kindes- und Jugendalter. Anorexia nervosa, bulimia nervosa, binge eating disorder.

The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.

Eating disturbances in siblings of patients with eating disorders.

OBJECTIVE: The purpose of this study was to investigate whether siblings of patients with eating disorders show a more disturbed eating behavior and a higher proneness to associated psychological characteristics than controls. METHOD: 84 patients with eating disorders of an outpatient clinic, their siblings (n=84) and a control group (n=84) with an age range 14-34 for the total sample were evaluated using the Eating Disorder Inventory-2. RESULTS: There was no significant difference between the siblings and the controls in disturbed eating behavior. DISCUSSION: The existence of an eating disorder in patients does not seem to be related to the development of eating disturbed behavior in their siblings.

Serum leptin monitoring in anorectic patients during refeeding therapy.

Circulating concentrations of leptin are exceedingly low in severe malnutrition as seen in the acute state of anorexia nervosa (AN). During refeeding therapy plasma leptin levels increase to normal and in some cases peak at values in excess of the BMI of matched controls even before a normal body weight has been achieved. Peak leptin levels are possibly the cause of an increased energy expenditure during this stage of the disorder and might predispose to renewed weight loss (rebound phenomenon). In this study we investigated the role of leptin fluctuations as a prognostic factor of therapeutic success in AN. In 11 anorectic female patients serum leptin levels, BMI and body fat percentage were evaluated in four-week intervals during a conventional refeeding program over three months (group 1). The results of the first two measurements were used to determine a range of increases in leptin levels in relation to increases in BMI. The values between the 25th and 75th percentiles determined the reference range. In a second group of 9 anorectic female patients serum leptin levels, BMI, body fat percentage and the increase in the leptin level in relation to the BMI of each subject were investigated for three months every two weeks. These patients were also treated according to the same conventional refeeding program, but the caloric intake was reduced or increased (+/-250 kcal/d) if the increase in the leptin level, in relation to the increase in the BMI, had exceeded or fallen short of the reference range. During the refeeding therapy every subject of each group experienced increases in serum leptin levels, BMI and body fat percentage. Six subjects of group 1 and six subjects of the second group had an increase in leptin levels in relation to the increase of the BMI out of the reference range at least once. To investigate the therapeutic outcome of leptin monitoring and the following alteration of caloric intake, weight gain of the patients of both groups during the whole treatment was compared. No significant difference was found. Our results probably do not support the findings that high leptin levels predispose to a renewed loss of weight. The outcome in our patients whose caloric intake was modified due to their serum leptin levels was not significantly improved.

[A group therapy programme for eating disorders with preventive goal]. / Von der Therapie zur Prävention: Ein Therapiemodell für Essstörungen.

Eating disorders tend to take a prolonged course because of high rates of comorbid psychiatric disorders and medical complications. We developed a cognitive behavioural group therapy programme, divided in 4 consecutively phases in a special unit. Included in the programme are therapeutic residence groups. Current and former patients are regular involved in preventive activities.

Eating disorder therapy concepts with a preventive goal.

In this paper, we describe our 4-phase-therapy program for eating disorders at a specialized unit. Core of the treatment is a 4-month day patient phase. Our approach, which implies a fixed structure in terms of time and content, is based on cognitive-behavioral group therapy. It follows the principle of self-management developed by Kanfer and involves patients in organizational and therapeutic activities. Patients' participation in our extensive efforts aiming at the prevention of eating disorders is invaluable for therapists and serves patients as an important protective factor.

Neuropsychological assessments before and after treatment in patients with anorexia nervosa and bulimia nervosa.

In psychiatric patients the identification of cognitive deficits which predict a poor clinical outcome is important for the development of specific treatment strategies aimed at the amelioration of these impaired cognitive functions to increase the likelihood of full clinical remission. However, such attempts are absent in bulimia nervosa (BU), are scarce in anorexia nervosa (AN) and, furthermore, provide conflicting results. In the present prospective study we investigated the neuropsychological demands in 12 patients with AN and in 14 patients with BU before, during, and after a treatment period. At the initial testing session, both patients samples showed similar and impaired performance levels on tasks measuring attentional demands and problem solving abilities, while their mnemonic functions were preserved. At the final testing session, which took place 7 months thereafter, the impaired cognitive functions had improved to a similar degree in the AN and the BU subgroups. However, although the eating disorder symptomatology had ameliorated in parallel, no direct associations could be established with the initial neuropsychological demands and their rectification, respectively. On an individual level, 11 patients initially showed obvious cognitive deficits. However, the clinical characteristics of this subgroup differed not from that found in the 15 'good performers'. These findings indicate that the cognitive functions in the acute AN and BU are similarly impaired, but also ameliorate in a similar manner with clinical remission. Because no associations were obvious between cognitive and clinical rectifications, significant contributions of mediating factors (e.g., changes in metabolic brain turnover and in steroid hormones) are suggested.

[Structured day care therapy program for eating disorders]. / Strukturiertes tagklinisches Therapie-Programm für Essstörungen.

A day hospital group treatment program is detailed which could offer effective treatment to many patients with anorexia nervosa and bulimia nervosa who would otherwise require inpatient treatment. Important clinical advantages over an inpatient program are described. The psychotherapy is cognitive-behavioral oriented and is done in groups. A multi-disciplinary team approach is used. The day hospital treatment program includes psychological, social and eating-related interventions. Main characteristics are the motivation-phase, the contact between patients of different therapy-phases, the involvement of families in therapy and the support of self-help. First empirical outcome results are presented.

[Behavior analysis of eating disorders]. / Verhaltensanalyse bei Essstörungen.

Modification of behavior is based on an analysis of behavior. An investigation of behavioral disturbances with respect to conditions, trigger mechanisms, causes, as well as functions and effects on the patient is necessary.

[Life-threatening complications and death in anorexia nervosa]. / Lebensbedrohung und Tod bei Anorexia nervosa.

The medical complications of anorexia nervosa may endanger the patient in several ways; the severity of somatic complications may be underestimated; medical findings may be assigned to other diagnoses than anorexia nervosa or complications may indicate an emergency, leading to therapeutic activities which may result in a life-threatening situation for the patient. There are some indications that phosphate depletion is involved in medical complications in anorexia nervosa, even in those cases with fatal outcome. Acute hypophosphatemia may be induced by hyperalimentation.

[Disorders of the maturation process and psychosexual development of anorexic patients]. / Störungen im Reifungsprozess und in der psychosexuellen Entwicklung Magersüchtiger.

In a therapy outcome-study with 51 female anorectic patients most of them showed a delay in maturation, deviations in sexual behaviour and in attitudes towards sexuality. The interpretation of our data shows that family factors play a major role in the development of sexual disturbances. To interpret anorexia nervosa only as a rejection of the female role means to simplify the complex processes in this multidetermined illness.

[Stealing in anorexia nervosa and bulimia nervosa]. / Stehlen bei Anorexia nervosa und Bulimia nervosa.

Only recently stealing behaviour has been noticed as a symptom of anorexia nervosa and bulimia nervosa. Reviewing our sample of 63 patients we discuss the incidence and motivation of kleptomania. In 24% of our patients stealing behaviour was reported which is a definitely high rate compared to literature. Among the intentions for stealing behaviour we found: Stealing as conversion of revenge, self-assertiveness compensation of binge-eating or stealing as achievement. The differential motivation of stealing should be considered in legal consequences.

Anorectic behavior, mood, and metabolic and endocrine adaptation to starvation in anorexia nervosa during inpatient treatment.

Twenty-two patients with anorexia nervosa were studied at 2-week intervals during treatment on psychiatric wards. In order to characterize the metabolic situation in starvation, levels of free fatty acids, beta-hydroxybutyric acid, and acetoacetate were measured. The endocrine adaptation to starvation was studied by measuring triiodothyronine, noradrenaline, and cortisol. Anorectic symptoms were assessed by the Anorexia Nervosa Inventory Scale (ANIS) and mood changes on the basis of a "Befindlichkeits" Scale (BF). Only half of the patients showed metabolic and endocrine signs of starvation on admission to the hospital, despite low body weight. This group had significantly more severe anorectic symptoms (ANIS) and gained weight at a lesser rate. Metabolic signs of starvation disappeared during the first 4 weeks of therapy in most of the patients. The endocrine indicators for starvation normalized much more slowly, with noradrenaline having the slowest pace. "Bulimics" and "restricters" could not be distinguished from one another by metabolic or endocrine observations. The "bulimics," however, showed more severe anorectic symptoms (ANIS) and a more depressed mood.