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January 2011



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First Published Friday, 27 March 2009

Anorexia Hurts

According to a leading expert, severe cases of anorexia may be the result of undetected autism in women.

Professor Christopher Gillberg, of the University of Strathclyde, says that autism, characterised by defects in communication and social interaction, also makes many anorexic patients unresponsive to traditional treatments and may be responsible for anorexia’s low recovery rates.

Professor Gillberg believes that although autism is thought to be predominately a male problem, affecting up to four times more boys than girls, the disorder has been overlooked in women because their autistic traits present themselves differently.

For example an obsession with counting calories may be an outward sign of autism.

He says their research has shown that a small but important minority of all teenage girls, with anorexia nervosa in the general population, meet the diagnostic criteria for autistic disorder, Asperger syndrome or atypical autism.

He has apparently seen quite a number of cases where the anorexia has become completely entrenched because people have not understood that underlying the eating disorder is autism.

Professor Gillberg says anorexic patients with autism tend to be severe cases because traditional treatment for eating disorders proved ineffective.

A good example is family therapy, a popular psychotherapy in which family members discuss eating with the sufferer which is all but useless for autistic patients.

People with an autism spectrum disorder have great difficulty even understanding basic concepts about other people’s thoughts and feelings, which means that anything said in a family-therapy session is likely to be misconstrued by the affected individual who will not grasp what is going on in that particular context.

They need far more concrete, one-to-one interventions.

A spokesman for the Eating Disorder Association welcomed the research and said it could help develop more effective treatments for eating disorders.

About 5 per cent of anorexic patients die from complications of the disorder and only 40 per cent make a full recovery.

Ten per cent of the 1.1 million reported anorexia cases in the UK are in men, and Professor Gillberg says autism is behind the majority of male anorexia cases.

He says his clinical impression over the past 30 years has been that males struck by anorexia nervosa very often have autism spectrum disorders.

Judith Gould, director of the National Autistic Society’s Diagnostic Centre, agrees with the study’s findings, and feels autism in girls is being missed because it often manifests itself in females in different ways.

She agrees that anorexia, which is predominantly diagnosed in girls, could be linked to autism in an unknown proportion of cases.

About 500,000 people in the UK are thought to have some form of autism.

Source:   http://www.opposingviews.com/articles/research-undetected-autism-in-women-manifests-as-anorexia-nervosa


Psychiatric Disorders Are Common In Adults Who Have Had Anorexia

ScienceDaily (Mar. 26, 2009) — The study was initiated in 1985. A total of 51 teenagers with anorexia nervosa were studied, together with an equally large control group of healthy persons. The groups have been investigated and compared several times as the years have passed.

“This study is unique in an international perspective. It is the only study in the world that reflects the natural course of anorexia nervosa in the population”, says Elisabet Wentz, Associate Professor in Child and Adolescent Psychiatry at the Sahlgrenska Academy.

The research group has published new results from the study in two scientific journals: the British Journal of Psychiatry and the International Journal of Eating Disorders.

Three women have still not recovered from anorexia, 18 years after the start of the study. Thirteen people, or around 25%, are on disability benefit or have been signed off sick for more than six months due to an eating disorder or other psychiatric disorder.. Thirty-nine percent have at least one other psychiatric disorder, in addition to the eating disorder. The most common of these is obsessive compulsive disorder.

But the results also contain some positive surprises.

“Previous studies have shown that anorexia is a diagnosis with a very poor prognosis, with as many as one in five patients dying as a result of the disease. In contrast, we have not had a single death among the subjects of our study”, says Elisabet Wentz.

Other studies have also shown that infertility is a common complication for adult women who have had anorexia, as are increased risks of giving birth prematurely and of post-natal depression. The women in the two groups in this study have had essentially the same number of children, but the women who have had anorexia were younger when they had their first child. Such children had a lower birth weight than children of women in the control group.

“None of the women who had had children still suffered from an eating disorder, but it is still more common that they worry about whether their babies are putting on weight”, says Elisabet Wentz.

Brief Facts: Anorexia Nervosa

Anorexia nervosa is one of the most common psychiatric disorders among young women, and 1% of all teenage girls suffer from the condition. The figure for boys is 0.1%. The most common age range for being diagnosed with anorexia is 14-17 years, and the condition can continue for a very long time.

Journal references:

  1. 1. Wentz E, Gillberg IC, Anckarsäter H, Gillberg C, Råstam M. Adolescent-onset anorexia nervosa: 18-year outcome. The British Journal of Psychiatry, 2009; 194 (2): 168 DOI: 10.1192/bjp.bp.107.048686
  2. 2. Wentz et al. Reproduction and offspring status 18 years after teenage-onset anorexia nervosa-A controlled community-based study. International Journal of Eating Disorders, 2009; DOI: 10.1002/eat.20664

Source:  http://www.sciencedaily.com/releases/2009/03/090326134012.htm

New Family Approach Uses Milkshakes for Anorexia

By Rick Nauert, Ph.D.
Senior News Editor

Reviewed by John M. Grohol, Psy.D. on April 3, 2009

Friday, Apr 3 (Psych Central) —

Getting your teenager to drink a chocolate milkshake isn’t something most parents need to worry about. But this is just the approach used in one treatment for anorexia nervosa.

The technique, known as Behavioral Family Therapy, or the Maudsley Approach, calls for parents to supervise the eating habits of their anorexic child, feeding them high-calorie meals like milkshakes and macaroni and cheese until they regain a healthy weight.

For the first time, the Maudsley Approach is being compared with a more established treatment known as Family Systems Therapy as part of an ongoing National Institutes of Health (NIH)-funded treatment study at New York-Presbyterian Hospital/Westchester Division and five other centers nationally. Both are outpatient therapies for adolescents, aged 12 to 18.

“Anorexia is a life-threatening condition. Treating it early is very important since it is during the teenage years that this disorder usually takes hold,” says Dr. Katherine Halmi, founder of the Eating Disorders Program at New York-Presbyterian Hospital/Westchester Division and professor of psychiatry at Weill Cornell Medical College.

“Traditionally, patients with anorexia have been treated in a hospital setting or through one-on-one outpatient therapy. While inpatient treatment is still appropriate in acute cases, we have increasingly seen the value of family-oriented outpatient therapy for adolescents.”

The current study is designed to compare two different therapeutic approaches that involve the family — one is a behavioral therapy initially focused on weight gain, and the other examines various underlying issues in the family dynamic.

In the Maudsley Approach, named after the hospital in London where it was developed in the 1980s, the anorexic teenager attends therapy sessions together with parents and siblings. Parents work with the Maudsley therapist to develop ways in which they can monitor their child’s intake, choosing the amounts and types of foods necessary for them to regain to a healthy weight.

Siblings are encouraged to act as a support system for their sister or brother. Once patients achieve a healthy weight, they graduate toward taking more responsibility for their intake. At this point, family and developmental issues relevant to the patient maintaining a healthy weight are addressed.

In Family Systems Therapy, families also attend regular therapy sessions, but discussions do not necessarily focus on eating. Instead, family members are free to broadly explore and challenge any problematic communication patterns or stressors within the family unit.

“In Maudsley, food is medicine that restores the body and mind. When the body is starving, the mind also weakens, becoming more susceptible to anorexia’s rigid, often obsessive logic. Supervised feeding helps to break this vicious cycle. With the anorexia in charge, the adolescent really cannot regain the weight on his or her own. Nutritional rehabilitation gives the brain the nutrition it needs to re-establish healthy eating habits,” says Dr. Dara Bellace, a clinical psychologist at New York-Presbyterian Hospital/Westchester Division and an instructor of psychology in psychiatry at Weill Cornell Medical College.

“This approach does not blame parents, but rather calls on their ability to nurse their child back to health. It requires a strong commitment to be with them for every meal — something that can mean rearranging schedules and taking a tag-team approach to sharing the responsibility,” adds Dr. Bellace.

“The adolescent must also dedicate themselves to the therapy, understanding that, until they regain the weight, their parents will be feeding them much as they did when they were younger, deciding what and how much they eat and making sure they finish.”

Previous research has shown the Maudsley Approach successfully prevented hospitalization and helped adolescents recover their normal weights, with at least 75 percent of patients maintaining their recovery after five years.

A total of 240 adolescents aged 12 to 18 are being recruited for the study at six centers: New York-Presbyterian/Westchester; Stanford University in Palo Alto, Calif.; Sheppard Pratt in Baltimore, Md.; University of California at San Diego; University of Toronto; and Washington University in St. Louis.

Those eligible must be medically stable individuals ages 12 to 18 with a body weight between 75 percent and 87 percent of its healthy range. Families are randomized to receive either the Maudsley Approach or Family Systems Therapy. In each family treatment, they attend 16 one-hour sessions over the course of nine months. Sessions are held weekly for the first seven to eight weeks, bimonthly for the next six sessions, and monthly for the remaining sessions.

Anorexia nervosa is an eating disorder characterized by extreme low body weight and body image distortion with an obsessive fear of gaining weight. The condition largely affects adolescent females, who make up more than 40 percent of all cases. As much as 3 percent of American girls and women are anorexic. Contributing causes may include genetics, personality type, hormones, stress and societal pressures.

Anorexia carries the highest mortality rate of any psychiatric condition. Previous research by Dr. Halmi found that 7 percent of affected women died within 10 years. In a Swedish study that followed patients for 30 years, 18 percent to 20 percent of the women died. Even when anorexia is not fatal, it can cause long-term complications, including damage to the heart and bones.

For more information, eligible participants can e-mail the study coordinator, Samantha Berthod, at sab2024@med.cornell.edu.

Source:Cornell University


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