ABSTRACT
Results of studies on predictive factors in eating disorders have not been very clear until now. Attention has focused primarily on the predictive value of eating behaviour, duration of illness, comorbidity, and population characteristics for groups with mixed eating disorders, but lately several studies have concentrated on the influence of psychological and personality characteristics. In this 4-year prospective follow-up study of 49 eating-disordered adolescent patients, the predictive value of psychological factors and personality characteristics for the course of eating disorders is determined and discussed. The prognostic power of psychological variables measured by means of the Eating Disorder Inventory and the Dutch Personality Questionnaire is found to be stronger than that of behavioral factors and population characteristics and is different for anorectic and bulimic patients. For restricting anorectics, strong maturity fears predict poor outcome after four years, while for bulimic anorectics a longer duration of illness is related to poor prognosis. For patients with bulimic characteristics low self-esteem at admission is predictive of poor outcome.
Subject(s)
Feeding and Eating Disorders/psychology , Personality , Adolescent , Adult , Female , Humans , Male , Prognosis , Prospective StudiesABSTRACT
BACKGROUND: Successive DSM versions struggle with the heterogeneity of the eating disorders. Criteria were mainly based on clinical impressions and on descriptive and inferential studies. METHOD: In a study of 55 eating-disordered adolescents, we investigated whether patients could be grouped on an empirical basis, using principal components analysis (PCA) with optimal scoring (scaling), i.e. PCA with no a priori assumptions. Clustering was based on Morgan-Russell subscales, each measured four times over the course of illness. RESULTS: Contrary to DSM-IV criteria, patients did not cluster primarily on the basis of anorectic symptoms; the occurrence of bulimic symptoms was more dominant. Core symptomatology (preoccupation with food, disturbed body perception and inadequate sexual behaviour) did not differ between patients, either at referral or over time. CONCLUSIONS: These results support the spectrum hypothesis of the eating disorders, which considers them as one syndrome with different manifestations.
Subject(s)
Feeding and Eating Disorders/classification , Psychiatric Status Rating Scales , Adolescent , Adult , Anorexia Nervosa/classification , Anorexia Nervosa/psychology , Bulimia/classification , Bulimia/psychology , Child , Disease Progression , Feeding Behavior , Feeding and Eating Disorders/psychology , Female , Humans , Longitudinal Studies , Prospective Studies , Sexual BehaviorABSTRACT
OBJECTIVE: This study examines whether parental Expressed Emotion (EE) ratings, based on the Camberwell Family Interview (CFI), are predictive of the course of illness in a sample of Dutch families with an adolescent eating disorder patient. Levels of EE at first assessment and at the termination of treatment are reported. METHOD: The study was designed as a prospective follow-up study and involved 49 adolescent eating disorder patients (DSM-III-R) and their parents. Patient and family assessments were conducted at intake (T1), at the termination of treatment (T2), and at follow-up (T3) 1 year later. The Morgan-Russell Outcome Assessment Schedule, which was adjusted to accommodate bulimics, yielded the average outcome score (AOS) which served as our outcome measure. RESULTS: The levels of parental EE at first assessment were low. During the treatment period the levels decreased further. We used a stepwise multiple regression analysis, with the parental EE variables as independent variables, to predict the AOS at T2 and T3. This way we showed that the mothers' Critical Comments (CC) rating explained 28 to 34% of the outcome variance. The mothers' CC rating was also the best predictor of outcome when compared to other possible predictor variables. DISCUSSION: The results underscore the importance of involving the family in the treatment of adolescent eating disorders. Specific attention should be given to the mother's thoughts, feelings, and behavior concerning her ill daughter. Helping the mother and daughter to differentiate and separate through a constructive noncritical approach to the presenting problems may be a crucial factor in breaking through the perpetuating cycle of criticism and illness.
Subject(s)
Anorexia Nervosa/therapy , Bulimia/therapy , Expressed Emotion , Family Therapy , Mother-Child Relations , Adolescent , Anorexia Nervosa/psychology , Bulimia/psychology , Female , Humans , Male , Patient Dropouts/psychology , Personality Assessment , Prognosis , Prospective Studies , Treatment OutcomeABSTRACT
In a 4-year prospective follow-up study of 25 anorectic and 24 bulimic adolescents (DSM-III-R criteria), we studied fluctuations and differences in the course of illness, using repeated measurement. Morgan & Russell general outcome categories on the Outcome Schedule were more favourable than in adult studies. Of all patients, 47% had good, 43% intermediate and 10% poor outcome scores after 4 years. The groups differed significantly as to the kind and severity of disturbed eating behaviour and its consequences, but were rather similar in mental, psychosocial and psychosexual symptoms during the course of the illness. Eight percent of the anorectic patients became bulimic. We conclude that anorexia nervosa and bulimia nervosa can be considered as different symptom patterns of one basic eating disorder, in which preoccupation with food and a disturbed body image are core symptoms.
Subject(s)
Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Adolescent , Adult , Anorexia Nervosa/psychology , Anorexia Nervosa/therapy , Body Image , Body Weight , Bulimia/psychology , Bulimia/therapy , Child , Female , Follow-Up Studies , Humans , Male , Personality Assessment/statistics & numerical data , Prospective Studies , Psychometrics , Psychosexual Development , Treatment OutcomeABSTRACT
Twenty-five adolescents referred to an outpatient clinic because of school refusal in 1985-1986 were followed up after an average of 5 years. DSM-III diagnoses and scores on the Maudsley Symptom Checklist were obtained at initial contact and a follow-up. At follow-up, information was also gathered on psychosocial adjustment, and subjects completed self-ratings of anxiety and depression. At initial contact, school refusal was associated mainly with anxiety symptoms, and to a lesser extent with depressive and somatoform disorders. No specific relationships were found between diagnoses at baseline and at follow-up. About half of the sample still had a psychiatric disorder at follow-up. Outcome was negatively associated with a history of previous psychosocial or psychiatric treatment and a small family size, and positively with a history of frequent somatic complaints.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety, Separation/diagnosis , Depressive Disorder/diagnosis , Adolescent , Anxiety Disorders/psychology , Anxiety, Separation/psychology , Depressive Disorder/psychology , Family Characteristics , Female , Follow-Up Studies , Humans , Male , Psychiatric Status Rating Scales , Somatoform Disorders/diagnosis , StudentsABSTRACT
This article examines the concurrent validity of the Five-Minute Speech Sample (FMSS) as an index of Expressed Emotion in a Dutch sample of 84 parents of adolescents suffering from anorexia or bulimia nervosa. The Camberwell Family Interview (CFI), the criterion measure of EE, and the FMSS were conducted on the same day. The levels of Expressed Emotion in these families were low when compared with the EE ratings from the schizophrenia studies. The FMSS and CFI-EE ratings showed a limited degree of overlap. Whether the limited association between the two methods is due to the low levels of criticism in our sample, to cultural differences and/or to differences in the psychopathology under study remains unclear.
