Agreement between youth-reported and parent-reported psychopathology in a referred sample.

OBJECTIVE: The study examined parent-youth agreement regarding reports on psychopathology among adolescents suffering from psychiatric disorders. METHOD: A total of 1,718 patients between the age of 11 and 18, as well as their parents, were assessed using the child behavior checklist (CBCL), and the youth self-report (YSR). RESULTS: Poor to low agreement between parent- and adolescent-reported problem behavior on the internalizing scale, the total problem scale and moderate agreement concerning the externalizing scale of the CBCL and the YSR were found. Independent from the amount of psychiatric diagnoses, adolescents reported significantly less behavioral problems than their parents. Concerning externalizing problems, parent-youth disagreement was stronger for patients suffering from comorbid psychiatric disorders, than for adolescents displaying only one psychiatric disorder. CONCLUSION: In clinically referred children, parents are likely to emphasize the severity of the difficulties, whereas adolescents' under-report symptoms.

The German version of the Anorectic Behavior Observation Scale (ABOS).

OBJECTIVE: To assess the performance of the German version of the Anorectic Behavior Observation Scale (ABOS) as a parent-report screening instrument for eating disorders (ED) in their children. METHODS: Parents of 101 ED female patients (80 with Anorexia Nervosa; 21 with Bulimia Nervosa) and of 121 age- and socioeconomic status (SES)-matched female controls completed the ABOS. RESULTS: Confirmatory factor analysis supported the original three-factor structure model of the ABOS. Cronbach's alpha coefficients indicated good internal consistency for the three factors and the total score in the total sample. The best cut-off point (100% sensitivity and specificity) in the German version was >or=23. CONCLUSION: The ABOS may be a useful additional instrument for assessing ED.

Correspondence between self-reported and parent-reported psychopathology in adolescents with eating disorders.

BACKGROUND: This study examined parent/youth self-report agreement on emotional and behavioral symptoms among adolescents with eating disorders (ED). SAMPLING AND METHODS: Eighty-three parent-adolescent pairs participated. All adolescents (age 11-18 years) were females and met diagnostic criteria according to the DSM-IV for anorexia nervosa restricting type (n = 53) or bulimia nervosa (n = 30). Diagnoses were confirmed using the Structured Inventory for Anorectic and Bulimic Syndromes. Parents completed the Child Behaviour Checklist, and the adolescents completed the corresponding Youth Self-Report. RESULTS: Results of the interclass correlation provide very poor coefficients between parents and adolescents, especially for the internalizing subscale. Analyses of variance of repeated measures revealed significant differences in the total problem score and the internalizing subscore between parents and adolescents. Parents reported significantly more internalizing problems than adolescents. CONCLUSIONS: Agreement between parents and adolescents regarding the presence and severity of psychiatric symptoms in adolescents with ED is low. In contrast to previous studies in non-ED samples, adolescents with ED reported lower levels of internalizing problems than their parents. Denial and minimization may be underlying reasons for our findings and represent obstacles in the psychological assessment of adolescents with ED.

Psychiatric comorbidities among female adolescents with anorexia nervosa.

This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN.

Psychopathology in elite rhythmic gymnasts and anorexia nervosa patients.

This study investigates current psychopathology and psychological distress in elite rhythmic gymnasts. Due to a strong emphasis on leanness in aesthetic sports and the controversial findings in literature regarding the role of anorexia nervosa (AN) in such sports, we compared elite rhythmic gymnasts (n=51) to inpatients with AN (n=55) as a disease control group and to high school students (n=53) as a "normal" control group. We assessed psychopathology using the Symptom Checklist (SCL-90-R). Moreover, body height, weight, Body Mass Index (BMI) and the presence of amenorrhea were assessed. Regarding physical aspects, the rhythmic gymnasts showed an intermediate position between the two other groups. In terms of psychopathology, significant differences were found between the gymnasts and the AN patients, while no differences were detected between the gymnasts and the "normal" control group. Depression discriminated best between the three groups. Elite rhythmic gymnasts may show a lean, almost anorexic-like physique. Nevertheless, no psychological distress comparable to that of AN patients was found. Therefore, even though analogies to AN might seem obvious in elite rhythmic gymnasts, this study is putting emphasis on the importance of a careful consideration of psychological distress and psychopathology.

Body image and attitudinal aspects of eating disorders in rhythmic gymnasts.

BACKGROUND: Aesthetic sports, especially on a competitive level, are often considered as a risk factor for the development of an eating disorder. A few studies have examined this issue in rhythmic gymnasts, but no reports on body image disturbance exist for these athletes compared to anorectic patients. SAMPLING AND METHODS: Fifty elite rhythmic gymnasts (average age 14.8 years) including the German national team, 58 female patients with anorexia nervosa (AN; average age 15.5 years), and 56 high school girls (average age 14.9 years) completed the Eating Disorder Inventory-2 and the Test for Detecting Body Image Distortion in Children and Adolescents (Test zur Erfassung der Körperbildstörung bei Kindern und Jugendlichen). Furthermore, body weight and height, body mass index, presence of amenorrhea and frequency of exercise were surveyed. RESULTS: Body mass index was significantly lower in the elite rhythmic gymnasts than in the high school students, and significantly higher than in the AN patients. Both the elite rhythmic gymnasts and the AN patients were significantly smaller than the high school students. The elite rhythmic gymnasts trained significantly more frequently compared with the AN group and the high school group. Regarding the Eating Disorder Inventory-2 and the Test for Detecting Body Image Distortion in Children and Adolescents, AN patients scored significantly higher on all explored subscales than both the elite rhythmic gymnasts and the high school students. CONCLUSIONS: Even though some physical similarities were found for the elite rhythmic gymnasts and the AN patients, contrary to previous studies, no noticeable problems related to attitudinal aspects of eating disorders were detected in the elite rhythmic gymnasts. A mildly distorted body image of the abdomen was identified in elite rhythmic gymnasts, while AN patients expressed a broad body image distortion and students expressed no body image distortion. Our data do not allow us to draw conclusions regarding prevalence rates, long-term effects or male athletes.

[Dialectical behavior therapy for adolescents with anorexia and bulimia nervosa (DBT-AN/ BN)--a pilot study]. / Dialektisch-behaviorale Therapie für jugendliche Patientinnen mit Anorexia und Bulimia nervosa (DBT-AN/BN) - eine Pilotstudie.

Dialectical behavior therapy (DBT) was originally developed by Linehan (1993a, b) and modified by Miller et al. (1997) for suicidal adolescents with borderline personality features. Meanwhile, this therapy has also successfully applied in other adult clinical groups. The prior aim of the study is to evaluate the effectiveness of DBT for inpatient adolescents with anorexia and bulimia nervosa. In this pilot study (n=31) the efficacy of this treatment will be evaluated in a pre-post comparison. Different instruments will be used (SIAB, EDI-2, SCL-90-R, FBB). The first results are promising and we must hope that this new approach will improve the future treatment.