Denial of symptoms and psychopathology in adolescent anorexia nervosa.

OBJECTIVE: To evaluate the psychopathological status and denial of symptoms in a sample of 38 consecutively admitted adolescents with anorexia nervosa (AN). METHOD: The Schedule for Affective Disorders and Schizophrenia for School-Aged Children was used to determine the categorical diagnosis of eating disorder. The anorexic adolescents completed the EAT-40 (Eating Attitude Test) and, on the basis of its score, the sample was dichotomized in a false-negative group (FNG) scoring under 30 and a positive group (PG) scoring over 30. We compared these two subgroups in terms of clinical variables (age of onset and admission, duration of illness prior to admission, diagnosis, BMI) and psychopathology assessed by the CBCL (Child Behaviour Checklist) and the YSR (Youth Self-Report). In order to evaluate the possible role of diagnosis and BMI on the EAT score we also dichotomized the sample with respect to the diagnosis (full vs. partial AN) and to the mean female BMI (< or = 15 vs. > 15). RESULTS: A significant difference was found in terms of duration of illness prior to admission, which was briefer in the FNG. Higher CBCL and YSR values were found in the PG with significant differences in terms of YSR internalizing symptoms. A large amount of significantly positive Pearson's correlations were found between the CBCL and YSR values in the FNG. No significant Pearson's correlations were found between EAT, BMI and diagnosis. CONCLUSIONS: The lower CBCL and YSR values in the FNG seem to point out a tendency of this group to deny anxiety and depression as well as an eating pathology; the longer duration of illness prior to admission in the PG seems to support the hypothesis that the PG may be considered to be not so much more disturbed as more aware of its eating attitudes and psychopathology. The nature of denial in anorexic adolescents is discussed.

Internalizing and externalizing conditions in adolescent anorexia.

OBJECTIVE: To identify the prevalence of internalizing and externalizing conditions in referred anorexic adolescents. METHOD: Child Behavior CheckList (CBCL) and Youth Self Report (YSR) were used to assess psychopathology: (a) in the global sample (43 adolescents); (b) in different subtypes of anorexia; (c) considering the timing of admission after the onset of the disease. RESULTS: A high percentage of patients were found in the internalizing clinical range both at CBCL and YSR. Higher mean values were found in full syndromes both at CBCL and YSR, and in the binge-eating subtype only at the YSR. Subjects arrived within the first year of illness showed a less severe psychopathology. CONCLUSIONS: Adolescents with anorexia have high rates of internalizing psychopathology. The less severe psychopathology in adolescents arrived within the first year of illness shed light on discontinuity between anorexia and internalizing condition. On the basis of the psychopathological severity, three types of adolescent anorexia are proposed which could be of interest for therapeutic decisions.

A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children.

OBJECTIVE: To evaluate short- and long-term effects of time-limited psychodynamic psychotherapy (PP) for children with internalizing disorders. METHOD: Fifty-eight outpatient children (6.3-10.9 years old), seen in a process of routine care and meeting criteria for depressive or anxiety disorder, were assigned to either active treatment or community services. Subjects were measured at baseline, after 6 months, and at a 2-year follow-up, by Children's Global Assessment Scale (C-GAS) and Child Behavior Checklist (CBCL). RESULTS: Major improvements in the experimental group were found in C-GAS and CBCL. These differences are noted at different times, with the C-GAS findings seen at 6 months and the CBCL findings at 2-year follow-up. Significant differences were found also for externalizing syndrome scales. CONCLUSIONS: PP is effective in treating internalizing disorders in routine outpatient care. The benefits of treatment are manifest both immediately and with delayed onset (sleeper effect). The finding that PP patients sought mental health services at a significantly lower rate than comparison conditions represents an important economic impact of PP.

Efficacy of brief dynamic psychotherapy for children with emotional disorders.

BACKGROUND: Child psychiatry has enjoyed a long tradition of using brief psychotherapy with children, but research on its efficacy and effectiveness in the setting of routine clinical care is remarkably sparse; the aim of this study was to evaluate the efficacy of an original model of brief psychodynamic psychotherapy (BPP) for children with emotional disorders in a clinical outpatient setting. METHODS: A sample of 30 subjects (6.3-10.9 years old) was divided into an experimental BPP group and a control group. Each subject was evaluated at the beginning, after 6 months and at an 18-months follow-up. Outcome measures were Children's Global Assessment Scale and Child Behavior Check-List. Statistical and clinical significance of change were evaluated. RESULTS: At the first evaluation, the experimental group showed a better improvement in global functioning; at follow-up, the two groups improved to a comparable degree, but only the mean of the experimental group moved to a functional range. The experimental group showed a significant reduction in total behavioral problems and externalizing problems at the follow-up. CONCLUSIONS: The better improvement of the experimental group in two outcome measures suggests that BPP is efficient in emotional disorders. The hypothesis that BPP introduces changes at long term (sleeper effects) is suggested. The improvement in global functioning of the two groups is discussed in relation to specific characteristics of emotional disorders. Finally, limitations of the study are discussed and in particular the bias introduced by lack of randomization.