Know and grow: A qualitative evaluation of a parent skills training intervention

Objective: This qualitative study examined the experience of parents of children and adolescents with eating disorders after having participated in a skills-based training intervention. Method: Participants were interviewed and transcripts were analysed using inductive thematic analysis. Results: Parent responses were organised around key themes of (1) effectiveness and acceptability of the intervention; (2) interpersonal experience of the group process; and (3) feedback on intervention content. Overall, the program was seen by parents to be highly relevant with direct application to supporting their child in home and hospital environments. Discussion: This study reports on preliminary evidence that skillsbased training is acceptable to parents and improves parent functioning including parent self-efficacy, and reduces psychological distress, anxiety, and burden. The study also demonstrated that the intervention can be delivered in a tertiary paediatric treatment setting and it may become cost-effective method for supporting parents and other carers. Future research is required on treatment efficacy and patient outcomes

Correlates of psychiatric inpatient admission in a paediatric eating disorder cohort

Objective: The prevalence and correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders were examined. Method: The sample comprised patients aged 8 to 17 years (91% female), with DSM-5 eating disorder diagnosis, categorised as with (n = 38) or without (n = 247) impending psychiatric admission, assessed between 2006 and 2013. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~ 1000), a prospective, ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. Results: Multivariate analysis of variance and discriminant function analysis were conducted to examine correlates. The prevalence of impending psychiatric admission was 13.3%. Significant group differences were found on psychological, behavioural, and situational correlates. Specifically, suicidal ideation, depressive symptoms, eating pathology, multiple methods of weight control, anxiety, purging behaviours, family functioning, and exercise for shape and weight control. Conclusions: Almost 1 in 7 young people with an eating disorder who attended assessment had a presentation needing inpatient psychiatric care, and these individuals could be differentiated from individuals not hospitalised or treated in inpatient medical settings. Implications of these findings include better identification of patients at critical psychiatric risk, earlier recognition and intervention for these patients and more focused assessment of comorbid psychiatric symptoms in specialised eating disorder triage and assessment. Adaptions at the study site to clinical and training protocols will be discussed

Rural-metropolitan health differential for young persons with eating disorders referred for specialist treatment

Objective: The aim was to explore associations between residing in a rural area and clinical characteristics of children and adolescents with eating disorders presenting to a specialist eating disorders program. Method: The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry (N ~ 1000), a prospective ongoing registry study comprising consecutive paediatric tertiary eating disorder referrals. The sample (N = 399) comprised children and adolescents presenting with a DSM-5 eating disorder, with ages ranging from 8 to 16 years (M = 14.49, 92% female). Results Consistent with the hypotheses, living in a rural area was associated with a lower body mass index z-score, and a higher likelihood of medical complications at intake assessment. Contrary to our hypothesis, eating pathology and living in a rural area were negatively associated. No relationship was observed between living in a rural area and duration of illness or greater percentage of bodyweight lost. Conclusions: The results suggest that living in a rural area and being a greater distance from specialist services is associated with more severe malnutrition and medical complications by the time the young person and their family obtain specialist care. These findings have implications for service planning and provision for rural communities. The modifications to service delivery in the study setting will be described

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: A multi-centre study

The original cognitive-behavioural (CB) model of bulimia nervosa, which provided the basis for the widely used CB therapy, proposed that specific dysfunctional cognitions and behaviours maintain the disorder. However, amongst treatment completers, only 40–50 % have a full and lasting response. The enhanced CB model (CB-E), upon which the enhanced version of the CB treatment was based, extended the original approach by including four additional maintenance factors. This study evaluated and compared both CB models in a large clinical treatment seeking sample (N = 679), applying both DSM-IV and DSM-5 criteria for bulimic-type eating disorders. Application of the DSM-5 criteria reduced the number of cases of DSM-IV bulimic-type eating disorders not otherwise specified to 29.6 %. Structural equation modelling analysis indicated that (a) although both models provided a good fit to the data, the CB-E model accounted for a greater proportion of variance in eating-disordered behaviours than the original one, (b) interpersonal problems, clinical perfectionism and low self-esteem were indirectly associated with dietary restraint through over-evaluation of shape and weight, (c) interpersonal problems and mood intolerance were directly linked to binge eating, whereas restraint only indirectly affected binge eating through mood intolerance, suggesting that factors other than restraint may play a more critical role in the maintenance of binge eating. In terms of strength of the associations, differences across DSM-5 bulimic-type eating disorder diagnostic groups were not observed. The results are discussed with reference to theory and research, including neurobiological findings and recent hypotheses

Serum Ferritin and Nutritional Status: Insights From an Eating Disorders Clinic Population

Objective: To determine the relationship between serum ferritin and malnutrition in newly assessed patients at a paediatric eating disorders clinic. Design: This was a prospectively assessed clinical cohort study. Setting: Intake assessment clinic of a tertiary eating disorders service for children and adolescents. Methods: Clinical, anthropometric and laboratory features of children and adolescents were systematically measured. The relationship of serum ferritin to other clinical, anthropometric and laboratory measures was determined using linear regression. Results: A total of 121 female patients aged 9.5–17.6 years were included, with body mass index(BMI) z score -5.7 to 1.9 (median -1.3). Using multiple regression, serum ferritin was inversely associated with BMI z score (regression coefficient (ß)=-0.234, 95% CI -0.413 to -0.055) and serum insulin-like growth factor 1 (IGF-1) (ß=-0.476, 95% CI -0.884 to -0.068) and positively associated with alanine aminotransferase (ß=0.357, 95% CI 0.055 to 0.659, controlling for age, pubertal stage and serum iron).Conclusions: In malnourished adolescents with eating disorders increased serum ferritin is associated with lower BMI z score and serum IGF-1

An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders

Objective: Perfectionism is a transdiagnostic factor across eating disorders, anxiety, and depression. Previous research has shown anxiety mediates the relationship between perfectionism and eating disorders in adults. The aim of this study was to investigate the relationships between anxiety/depression, perfectionism and eating disorder symptoms in children and adolescents with eating disorders. Method: Structural equation modeling was used to investigate three models in a clinical sample of children and adolescents (N = 231, M age = 14.5, 100% female): (1) anxiety and depression as mediators of the relationship between perfectionism and eating disorder symptoms, (2) eating disorder symptoms as a mediator of the relationship between perfectionism and anxiety and/or depression, and (3) perfectionism as a mediator of the relationship between anxiety/depression and eating disorders. Results: Results indicated that both models 1 and 2 fit the data well, while model 3 provided a poor fit. These findings suggest that in clinical populations of children and adolescents, anxiety and depression mediate the relationship between perfectionism and eating disorder symptoms, and there is also a reciprocal relationship whereby eating disorders mediate the association between perfectionism, and anxiety and/or depression. Discussion: The results highlight the importance of further research to determine whether targeting perfectionism is helpful in the treatment of eating disorders and comorbid anxiety and depression in young people. It would be useful for clinicians to consider assessing for and treating perfectionism directly when it is elevated in children and adolescents with eating disorders

Brief report: Correlates of inpatient psychiatric admission in children and adolescents with eating disorders

Objective: To examine the prevalence and importance of psychological, behavioural, and situational correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders. Method: The sample consisted of 285 patients (8-17 years, M=14.4, SD=1.49) with DSM-5 eating disorders assessed between 2006 and 2013 from the Helping to Outline Pediatric Eating Disorders (HOPE) Project. The sample was split into two groups, those with (n=38) and without (n=247) impending psychiatric admission; Discriminant function analysis was used to examine correlates. Results: The prevalence of impending psychiatric admission was 13.3%. Suicidal ideation provided the greatest discriminating power, followed by eating pathology, depressive symptoms, anxiety, multiple methods of weight control, binge eating, and family functioning. Conclusions: Earlier recognition of comorbid symptoms in eating disorders in the community may reduce the number of young people with eating disorders who present needing critical psychiatric care

Consensus-based perspectives of pediatric inpatient eating disorder services

© 2018 Wiley Periodicals, Inc. Objective: There are few evidence-based guidelines for inpatient pediatric eating disorders. The aim was to gain perspectives from those providing and receiving inpatient pediatric eating disorder care on the essential components treatment. Method: A modified Delphi technique was used to develop consensus-based opinions. Participants (N=74) were recruited for three panels: clinicians (n=24), carers (n=31), and patients (n=19), who endorsed three rounds of statements online. Results: A total of 167 statements were rated, 79 were accepted and reached a consensus level of at least 75% across all panels, and 87 were rejected. All agreed that families should be involved in treatment, and thatpsychological therapy be offered in specialist inpatient units. Areas of disagreement included that patients expressed a desire for autonomy in sessions being available without carers, and that weight gain should be gradual and admissions longer, in contrast to carers and clinicians. Carers endorsed that legal frameworks should be used to retain patients if required, and that inpatients are supervised at all times, in contrast to patients and clinicians. Clinicians endorsed that food access should be restricted outside meal times, in contrast to patients and carers. Discussion: The findings indicate areas of consensus in admission criteria, and that families should be involved in treatment, family involvement in treatment, while there was disagreement across groups on topics including weight goals and nutrition management. Perspectives from patients, carers, and clinicians may be useful to consider during future revisions of best practice guidelines

Clinical presentation of eating disorders in young males at a tertiary setting

Abstract Background Young males with eating disorders are a neglected study population in eating disorders. The aim of this study was to provide knowledge about the clinical presentation of eating disorders in young males. Methods The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project (N ~ 1000), a prospective, ongoing registry comprising consecutive paediatric (<18 years) tertiary eating disorder referrals. Young males with DSM-5 eating disorders (n = 53) were compared with young females with eating disorders (n = 704). Results There was no significant difference in the prevalence of diagnosis of bulimia nervosa (2 % vs 11 %, p = 0.26) among sexes. Males had comparable duration of illness (9 months; p = 0.28) and a significantly earlier age of onset (M = 12 years; p <0.001). Shape concern (2.39 vs 3.57, p <0.001) and weight concern (1.97 vs 3.09, p <0.001) were lower in males, and body mass index z score (−1.61 vs −1.42, p = 0.29) and medical compromise (odds ratio [OR] = 0.64, 95 % CI: 0.36, 1.12) were comparable. Males had a two-folder higher odds of being diagnosed with unspecified feeding or eating disorders (40 % vs 22 % for females, p = 0.004). Driven exercise to control weight and shape was common and comparable in prevalence among males and females (51 % vs 47 %, p = 0.79) and males were less likely to present with self-induced vomiting (OR = 0.23, 95 % CI: 0.09, 0.59). Conclusion Boys with eating disorders are an understudied group with similarities and differences in clinical presentation from girls with eating disorders. Parents and physicians are encouraged to consider changes in weight, disturbed vital signs, and driven, frequent exercise for the purposes of controlling weight or shape, as possible signs of eating disorders among male children. Diagnostic classification, assessment instruments, conceptualisation, and treatment methods need to be refined to improve application to young males