Risky business: Considerations of emotion regulation and high-risk behaviors in anxious adolescents.

A growing body of empirical literature connects anxiety symptoms and high-risk suicidal and self-harming behaviors in youth. Emotion regulation (ER) processes and deficits have been identified as important factors in the etiology, maintenance, and treatment of both youth anxiety and high-risk behaviors. The present study assessed the association between these variables using an acute, socio-demographically diverse clinical sample of youth presenting to an outpatient mental health clinic. Ninety-nine youth aged 12-20 years old completed measures of anxiety symptoms, ER difficulties, and lifetime history of high-risk behaviors including non-suicidal self-injury (NSSI) and suicide attempts. Unadjusted analyses show that more severe anxiety symptoms were associated with more ER difficulties and history of risk behavior. Multivariate linear regression models considering age, sex, race/ethnicity, and risk history show that more severe anxiety symptoms remained significantly associated with more ER difficulties (p < 0.0001) and positive suicide attempt history (p < 0.01). Findings highlight the importance of integrating considerations of ER into the case conceptualization and treatment planning of high-risk, anxious youth to inform evidenced-based care with this population. The need for targeted, ongoing risk assessment with anxious youth to identify and mitigate risk is also demonstrated.

ARFID at 10 years: A Review of Medical, Nutritional and Psychological Evaluation and Management.

PURPOSE OF REVIEW: Avoidant restrictive food intake disorder (ARFID) is a diagnostic term that was established 10 years ago to describe those patients with an eating disorder, mostly children and adolescents, who have poor nutrition that is not due to body image or weight concerns. This article reviews the diagnosis and subtypes of ARFID, as well as the medical, nutritional and psychological principles of evaluation and management of the disorder. RECENT FINDINGS: In the past 10 years, clinicians have refined their approaches to managing the two major subtypes of ARFID: (1) those patients with a longer-term restriction in the amount and/or variety of the foods they eat, and (2) those patients with a shorter-term decrease in eating because of fear of aversive consequences such as vomiting, choking, GI symptoms or an allergic reaction to food. In that same time, the field of psychology has been developing evidence-based approaches to management of ARFID in each of its manifestations. Each patient with ARFID presents with a unique set of medical, nutritional and psychological factors that requires an individualized and multi-disciplinary approach in the management of this difficult to treat disorder.