Effect of brain structure and function on reward anticipation in children and adults with attention deficit hyperactivity disorder combined subtype.

Attention deficit hyperactivity disorder (ADHD) is associated with decreased ventral-striatal responsiveness during reward anticipation. However, previous research mostly focused on adults with heterogeneous ADHD subtype and divers drug treatment status while studies in children with ADHD are sparse. Moreover, it remains unclear to what degree ADHD is characterized by a delay of normal brain structure or function maturation. We therefore attempt to determine whether results from structural and functional magnetic resonance imaging (fMRI) are associated with childhood and adult ADHD combined subtype (ADHD-CT). This study used fMRI to compare VS structure and function of 30 participants with ADHD-CT (16 adults, 14 children) and 30 controls (20 adults, 10 children), using a monetary incentive delay task. Joint analyses of structural and functional imaging data were conducted with Biological Parametric Mapping. Reward anticipation elicited decreased ventral-striatal responsiveness in adults but not in children with ADHD-CT. Children and adults with ADHD showed reduced ventral-striatal volume. Taking these gray matter differences into account, the results remained the same. These results suggest that decreased ventral-striatal responsiveness during reward anticipation is present in adults but not in children with ADHD-CT, irrespective of structural characteristics. The question arises whether ventral-striatal hypoactivity is an ADHD correlate that develops during the course of illness.

Effectiveness of dialectic behavioral therapy in routine outpatient care: the Berlin Borderline Study.

BACKGROUND: Dialectical behavior therapy (DBT) has been proven to be an efficacious treatment for borderline personality disorder (BPD) in several randomized controlled trials (RCTs). However, generalizability of this outcome to the routine health care (effectiveness) has rarely been investigated to date. The aim of this study is to examine the effectiveness of DBT for BPD under the routine health care situation in Germany. METHODS: The study has a longitudinal design over a course of four years with six assessment points. In this paper, results for the first year of treatment are reported. Outcome was assessed at four times throughout an initial phase (of up to five therapy-sessions) and an additional 12 months of therapy. Overall, n =78 patients started the study, 47 patients completed one year of treatment. Dependent variables were number and duration of inpatient treatment stays, number of suicide attempts and non-suicidal self-injury, severity of borderline symptoms, depression, level of dissociation, and general psychopathology. RESULTS: Patients significantly improved regarding self-injurious behaviors, number of inpatient hospital stays, severity of borderline symptoms and psychopathology. At the end of the first treatment year, 77% of the patients no longer met criteria for BPD diagnosis. Fewer therapy discontinuations by patients were observed when therapists participated in consultation teams. CONCLUSIONS: Under routine mental health care conditions in Germany, outpatient DBT leads to positive results comparable to those reported in other effectiveness studies and in randomized controlled trials.

The role of impulsivity, inattention and comorbid ADHD in patients with bulimia nervosa.

INTRODUCTION: Little is known about the contribution of impulsivity, inattention and comorbid attention deficit/hyperactivity disorder (ADHD) in the development and maintenance of bulimia nervosa (BN). In particular, their specific contribution to disordered eating symptoms and whether they have additive effects to the general psychopathological burden remains unclear. METHODS: Fifty-seven female patients seeking treatment for BN and 40 healthy controls completed diagnostic questionnaires and interviews that investigated: a) ADHD, b) impulsivity, c) eating disorders and d) general psychopathology. Attentional processes and impulsivity were assessed by a comprehensive computer-based neuropsychological battery. RESULTS: Twenty-one percent of patients with BN met the clinical cut-off for previous childhood ADHD compared to 2.5% of healthy controls. Adult ADHD according to DSM IV was also more prevalent in patients with BN, with an odds ratio of 4.2. Patients with BN and previous childhood ADHD were more impulsive and inattentive than patients with BN alone. These patients also displayed more severely disordered eating patterns and more general psychopathological symptoms compared with those without ADHD. Severity of eating disorder symptoms was better explained by inattentiveness than by either impulsivity or hyperactivity. DISCUSSION: Our data suggest an elevated rate of former childhood and current ADHD-symptoms in treatment-seeking patients with BN. Stronger impulsivity and inattention associated with more severe neuropsychological deficits and eating disorder symptoms indicate an additive risk that is clinically relevant for these patients. Thus, clinicians should identify comorbid patients who might profit from additional ADHD-specific treatments.

[Childhood abuse in adolescents with anorexia nervosa compared to a psychiatric and healthy control group]. / Traumatische Kindheitserlebnisse bei Jugendlichen mit Anorexia nervosa im Vergleich zu einer psychiatrischen und einer gesunden Kontrollgruppe.

OBJECTIVES: Some studies suggest that both early sexual and early physical abuse are non-specific risk factors for the later development of eating disorders (EDs). However, only little is known about the role of emotional abuse in EDs. METHODS: The sample included 77 inpatients with Anorexia nervosa (AN-R: n = 50; AN-BP: n = 27), 26 psychiatric control participants and 44 healthy control participants, all of whom were females. The diagnosis of AN and the diagnosis of psychiatric control participants were confirmed by structured interviews (SIAB-EX, Fichter & Quadflieg, 1999; CIDI-DIA-X,Wittchen & Pfister, 1997). Childhood traumatization was assessed by a self-report questionnaire [Childhood Trauma Questionnaire (CTQ) German Version, Krischer & Sevecke, 2011]. RESULTS: The results indicated there were higher rates of sexual and physical abuse as well as physical and emotional neglect in patients with AN-BP than in patients with AN-R and in healthy control participants, with no significant differences between patients with AN-R and control participants. Furthermore, patients with AN-BP had significantly higher rates on the CTQ subscale "emotional abuse" than patients with AN-R, psychiatric control participants and healthy control participants. CONCLUSIONS: Future studies should investigate whether emotional abuse is specific to adolescents with AN-BP compared to adolescents with other psychiatric disorders.

CID: a valid incentive delay paradigm for children.

Despite several modifications and the wide use of the monetary incentive delay paradigm (MID; Knutson et al. in J Neurosci 21(16):RC159, 2001a) for assessing reward processing, evidence concerning its application in children is scarce. A first child-friendly MID modification has been introduced by Gotlib et al. (Arch Gen Psychiatry 67(4): 380-387, 2010); however, comparability in the results of different tasks and validity across different age groups remains unclear. We investigated the validity of a newly modified MID task for children (CID) using functional magnetic resonance imaging. The CID comprises the integration of a more age appropriate feedback phase. We focused on reward anticipation and their neural correlates. Twenty healthy young adults completed the MID and the CID. Additionally, 10 healthy children completed the CID. As expected, both paradigms elicited significant ventral and dorsal striatal activity in young adults during reward anticipation. No differential effects of the tasks on reaction times, accuracy rates or on the total amount of gain were observed. Furthermore, the CID elicited significant ventral striatal activity in healthy children. In conclusion, these findings demonstrate evidence for the validity of the CID paradigm. The CID can be recommended for the application in future studies on reward processing in children, adolescents, and in adults.

A randomized controlled multicentre trial on the treatment for ADHD in mothers and children: enrolment and basic characteristics of the study sample.

Parental ADHD may be a significant barrier to a successful treatment for the child's ADHD. The objective of our randomized controlled trial was to evaluate whether the treatment for maternal ADHD improves the efficacy of a behavioural parent training for children's ADHD. Patient enrolment and a description of the full analysis set (FAS) of mother-child pairs with non-missing baseline data are presented. One hundred and forty-four mother-child pairs were randomized to two treatments for maternal ADHD: cognitive behavioural group psychotherapy plus open methylphenidate treatment or control treatment (supportive counselling). After 3 months of treatment for maternal ADHD, mother-child pairs participated in a behavioural parent-child training. Assessment for eligibility included standardized instruments. After pre-screening out of 444 mother-child pairs, 206 were evaluated for trial participation and 144 were randomized. The FAS was built up by 143 dyads (children: mean age 9.4 years, 73 % males; mothers: mean age: 38.3 years). Fifty-two per cent of the children and 66 % of the mothers had combined ADHD subtype. Current axis-I co-morbidity rates were 48 % in children and 31 % in mothers. Maternal axis-II co-morbidity was 20.1 %. Fifty-seven per cent of the mothers lived together with the father of the index-child, and 29 % were single mothers. Sixty-two per cent had part-time or full-time employment. There was a selection bias excluding mothers with lack of time and effort for participation and mothers affected by coexisting mental and physical illness. Nevertheless, for our trial we were able to collect a sample comparable to routine psychiatric outpatient settings (registration: CCT-ISRCTN73911400, funding: BMBF-01GV0605).

Set shifting and working memory in adults with attention-deficit/hyperactivity disorder.

Compared to the high number of studies that investigated executive functions (EF) in children with attention-deficit/hyperactivity disorder (ADHD), a little is known about the EF performance of adults with ADHD. This study compared 37 adults with ADHD (ADHD(total)) and 32 control participants who were equivalent in age, intelligence quotient (IQ), sex, and years of education, in two domains of EF--set shifting and working memory. Additionally, the ADHD(total) group was subdivided into two subgroups: ADHD patients without comorbidity (ADHD(-), n = 19) and patients with at least one comorbid disorder (ADHD(+), n = 18). Participants fulfilled two measures for set shifting (i.e., the trail making test, TMT and a computerized card sorting test, CKV) and one measure for working memory (i.e., digit span test, DS). Compared to the control group the ADHD(total) group displayed deficits in set shifting and working memory. The differences between the groups were of medium-to-large effect size (TMT: d = 0.48; DS: d = 0.51; CKV: d = 0.74). The subgroup comparison of the ADHD(+) group and the ADHD(-) group revealed a poorer performance in general information processing speed for the ADHD(+) group. With regard to set shifting and working memory, no significant differences could be found between the two subgroups. These results suggest that the deficits of the ADHD(total) group are attributable to ADHD rather than to comorbidity. An influence of comorbidity, however, could not be completely ruled out as there was a trend of a poorer performance in the ADHD(+) group on some of the outcome measures.

Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery.

Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12-17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.

Etiological role of childhood emotional trauma and neglect in adolescent anorexia nervosa: a cross-sectional questionnaire analysis.

BACKGROUND: Most studies on the relationship between childhood trauma and anorexia nervosa (AN) have focused on the role of childhood sexual and physical trauma in adult patients. Little is known about the role of emotional trauma and eating disorders. The aim of the present study was to examine childhood sexual, physical, and emotional traumatization in adolescents with anorexia nervosa restricting type (AN-R) in comparison to those with anorexia nervosa binge-eating/purging type (AN-BP) and a healthy control group. SAMPLING AND METHODS: The sample included 50 patients with AN-R (mean age = 15.8 ± 1.6 years), 27 with AN-BP (mean age = 16.1 ± 1.1 years), and 44 healthy female control participants (mean age = 15.7 ± 1.3 years). AN diagnosis was confirmed by the Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-EX). Childhood sexual, physical, and emotional traumatization was assessed by a self-report questionnaire (Childhood Trauma Questionnaire; CTQ). RESULTS: The results indicated higher rates of sexual, physical, and emotional abuse and physical and emotional neglect in patients with AN-BP than in patients with AN-R and healthy control participants. No significant differences in childhood traumatization were found between patients with AN-R and control participants. CONCLUSIONS: Our results underline the importance of detecting the full range of possible childhood traumatic experiences in adolescents with AN, rather than focusing simply on childhood sexual traumatization. Sexual, physical, and emotional childhood traumatization are particularly important in the history of adolescent patients with AN-BP, in contrast to patients with AN-R, and should be screened for in the diagnosis and therapy of eating disorders.

Severe affective and behavioural dysregulation is associated with significant psychosocial adversity and impairment.

BACKGROUND: Recently, a highly heritable behavioral phenotype of simultaneous deviance on the Anxious/Depressed, Attention Problems, and Aggressive Behavior syndrome scales has been identified on the Child Behavior Checklist (CBCL-Dysregulation Profile, CBCL-DP). This study aims to investigate psychosocial adversity and impairment of the CBCL-DP. METHODS: A total of 9024 patients aged 4-18 years were assessed using the CBCL, and the axes V and VI of ICD-10. RESULTS: ANOVA revealed significant differences regarding psychosocial adversity and impairment between patients with CBCL-DP phenotype and the clinical control group, patients with attention problems, and patients with attention problems and additional anxious/depressed symptoms as assessed by the CBCL. Patients with CBCL-DP showed significant psychosocial adversity and impairment. However, in most cases patients with aggressive behavior showed equal psychosocial adversity as patients with CBCL-DP. CONCLUSIONS: Findings suggest the CBCL-DP phenotype to be associated with significant psychosocial adversity and impairment either as a cause or an effect of the syndrome. Clinicians should carefully address psychosocial adversity and impairment with particular attention to the adversity and impairment of adolescents with CBCL-DP.

[Personality disorders in adolescent patients with anorexia and bulimia nervosa]. / Persönlichkeitsstörungen bei jugendlichen Patientinnen mit Anorexia und Bulimia nervosa.

OBJECTIVE: The present study aimed to ascertain the occurrence of personality disorders (PD) in adolescent patients with anorexia (AN) and bulimia nervosa (BN) by means of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). METHOD: 99 female adolescent patients (57 AN - restrictive type, 17 AN - binge-purging type, 25 BN; M(age) = 16.3 +/- 1.6) were consecutively assessed by means of SCID-II. Furthermore, the influence of age, axis-I-comorbidities, and type of treatment according to PD were examined. RESULTS: 30.3% of the patients met the criteria for PD according to SCID-II. AN patients of the binge-purging type showed higher prevalences of PD and higher dimensional scores than the other eating disorder groups. Moreover, our findings indicate that age and axis-I-comorbidities are associated with the development of PD. CONCLUSION: Significant differences in the occurrence of PD in the three eating disorder groups were found. Patients of the AN binge-purging type are more often affected than restricting AN or BN patients are. This, and also the influence of age and axis-I-comorbidities, should be taken into account in the treatment of patients with eating disorders.

Preproenkephalin expression in peripheral blood mononuclear cells of acutely underweight and recovered patients with anorexia nervosa.

BACKGROUND: The prohormone preproenkephalin (ppE) and its derived peptides are involved in leukocyte functioning as well as in the regulation of hunger and satiety. Various abnormalities of the immune and endocrine systems have been described in states of malnutrition such as anorexia nervosa (AN). We hypothesized that ppE expression in AN patients may vary depending on the state of the disorder and the extent of malnutrition. METHODS: Expression of ppE mRNA was analysed in peripheral blood mononuclear cells of 29 underweight and 29 weight-recovered patients with AN and compared to that in 29 healthy control women. The extent of malnutrition was characterized by BMI and plasma leptin. Psychological distress and eating disorder specific-psychopathology was determined with the Symptom Checklist-90-Revised and the Eating Disorders Inventory-2. RESULTS: ppE gene expression was similar in all 3 groups and was not related to nutritional status or eating disorder symptoms. However, a significant negative correlation was found between ppE expression and obsessive-compulsive, depressive and anxious symptoms. In addition, ppE expression was higher in smokers compared to non-smokers. CONCLUSION: Although malnutrition and hypoleptinaemia as seen in patients with AN were not related to peripheral ppE expression, we demonstrated reduced ppE expression in patients with elevated psychological distress. Similar associations have been shown in animal models of stress. It remains speculative if psychological symptoms and/or stress may augment immune abnormalities in AN patients via a pathway that is independent of nutritional status and involves ppE.

[Psychiatric disorders among parents of patients with anorexia nervosa and bulimia nervosa]. / Psychiatrische Störungen bei Eltern essgestörter Patientinnen.

Family diseases represent a risk factor in the multifactorial etiology model regarding the genesis of eating disorders. In German-speaking countries only a few studies give attention to this topic. The aim of this study is to investigate the occurrence frequency of psychiatric disorders and personality styles among parents of juvenile patients with eating disorders. Furthermore a comparison between parents of patients with restrictive anorexia nervosa (AN-R) and parents of patients with bulimia nervosa (BN) is carried out. Psychiatric disorders listed on Axis I and Axis II of DSM-IV (American Psychiatric Association (APA), 1994) and personality styles were assessed in 73 mothers and fathers of 27 patients with AN-R and 13 patients with BN. The results show a high psychiatric strain among parents of patients with AN-R and BN. However the overall psychiatric strain does not differ among the parents of patients with AN-R and BN. Depressive disorders were more frequently observed among mothers of patients with AN-R. Parents of patients with BN showed higher occurrences of paranoid and schizotypal personality styles. A vulnerability of psychiatric disorders is indicated among parents of patients with eating disorders in general but nonspecific for AN-R or BN.

[Psychometric properties of the Eating Disorder Inventory (EDI-2) in adolescents]. / Psychometrische Gütekriterien des Eating Disorder Inventory (EDI-2) bei Jugendlichen.

The present study examines the psychometric properties of the German version of the Eating Disorder Inventory EDI-2 (1997) in 371 adolescents aged 13 to 18 years. Internal consistency, convergent and divergent validity were examined and a confirmatory factor analysis was conducted. Internal consistency was high for the group of patients and satisfactory for both control groups. Associations with other clinical instruments point in the expected direction and support the external validity of the EDI-2. The EDI-2 differentiated very well between the group of eating disorder patients (n=71) and the female (n=150) and male control groups (n=150). A discriminant analysis demonstrated that 86.0% of the cases were correctly classified, and a confirmatory factor analysis largely supported the six-factor structure generated by the German version of the EDI-2 (Thiel et al., 1997).

[Subjective evaluation of DBT treatment by adolescent patients with eating disorders and the correlation with evaluations by their parents and psychotherapists]. / Subjektive Therapiebeurteilung jugendlicher Patientinnen mit Essstörungen und deren Ubereinstimmung mit Eltern- und Therapeutenbeurteilungen.

OBJECTIVE: The subjective evaluation of a psychotherapeutic treatment may be an essential aspect of the recovery from an eating disorder. Our study investigates the subjective treatment evaluation by patients with eating disorders and the accordance with their parents' and psychotherapist's evaluation. METHOD: In a sample of 41 eating-disorder patients (M(Age) = 16.3; SD = 1.26), their parents and psychotherapists, we used a questionnaire (FBB) to assess satisfaction with Dialectical Behavioral Therapy treatment. RESULTS: Our results show good ratings, as well as good correlations between patients and parents. CONCLUSIONS: The findings implicate the importance of assessing a subjective therapy rating in addition to objective parameters.

Comparison of body size estimation in adolescents with different types of eating disorders.

OBJECTIVE: To examine differences in body size estimation in adolescents with different types of eating disorders. METHOD: A total of 129 patients with eating disorders (M(age) = 16.0 +/- 1.8) and 354 healthy control participants (CP) (M(age) = 15.2 +/- 2.1) completed the EDI-2 and were asked to estimate the circumference of selected body parts by using string (BID-CA). RESULTS: CP showed an average overestimation of 8-16%, depending on the estimated body part. Eating disorder patients overestimated their body parts on average by about 30%. Thigh and waist estimations were the best variables for discriminating between patients with eating disorders and CP. No significant differences were found between bulimia nervosa and anorexia nervosa patients. CONCLUSIONS: Body image distortion plays an important role in both anorexia nervosa and bulimia nervosa. The BID-CA is well suited to discriminate between healthy and disordered overestimation of body parts.

Serum brain-derived neurotrophic factor and peripheral indicators of the serotonin system in underweight and weight-recovered adolescent girls and women with anorexia nervosa.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) mutant mice show hyperphagia and hyperleptinemia. Animal and cell-culture experiments suggest multiple interrelations between BDNF and the serotonin (5-HT) system. We studied serum BDNF in patients with anorexia nervosa and its associations with peripheral indicators of the 5-HT system. To control for secondary effects of acute malnutrition, we assessed acutely underweight patients with anorexia nervosa (acAN) in comparison to long-term weight-recovered patients with the disorder (recAN) and healthy controls. METHODS: We determined serum BDNF, platelet 5-HT content and platelet 5-HT uptake in 33 patients in the acAN group, 20 patients in the recAN group and 33 controls. Plasma leptin served as an indicator of malnutrition. RESULTS: Patients in the acAN group were aged 14-29 years and had a mean body mass index (BMI) of 14.9 (standard deviation [SD] 1.4) kg/m(2). Those in the recAN group were aged 15-29 years and had a mean BMI of 20.5 (SD 1.3) kg/m(2) and the controls were aged 15-26 years and had a BMI of 21.4 (SD 2.1) kg/m(2). The mean serum BDNF levels were significantly increased in the recAN group compared with the acAN group (8820, SD 3074 v. 6161, SD 2885 pg/mL, U = 154.5, p = 0.001). There were no significant associations between BDNF and either platelet 5-HT content or platelet 5-HT uptake. Among patients with anorexia nervosa, we found significant positive linear relations between BDNF and BMI (r = 0.312, p = 0.023) and between BDNF and leptin (r = 0.365, p = 0.016). LIMITATIONS: We measured the signal proteins under study in peripheral blood. CONCLUSION: Serum BDNF levels in patients with anorexia nervosa depend on the state of illness and the degree of hypoleptinemia. Upregulation of BDNF in weight-recovered patients with anorexia nervosa could be part of a regenerative process after biochemical and molecular neuronal injury due to prolonged malnutrition. Associations between the BDNF and the 5-HT system in humans remain to be established.

Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study.

The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN) and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3) admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year after being discharged. Assessments were made at the beginning and at the end of the inpatient treatment as well as at the 1-year follow-up. Self-rating data and expert-rating interview data were obtained. Adequate data for 55 (96.5%) cases allowed for the assignment of an outcome category. A total of 28.1% of the patients' cases showed a good outcome, meaning the patients fully recovered, and 8.8% had an intermediate outcome, and 59.6% of the patients' cases had a poor outcome. Significant predictors of poor outcome included the patient's BMI at the beginning of the treatment as well as psychiatric comorbidity, and purging behavior. Adolescent AN is a severe disorder with a poor outcome in a substantial amount of adolescents.

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.