Presentations in 2007

This study compared patients with typical age onset for EDNOS* (11-19) to those with older age of onset (20 plus). Older age of onset was associated with more pathological scores on self-esteem, ineffectiveness, interpersonal problems and physical functioning, plus trends toward greater depression and personal alienation. These differences suggest treatment should be tailored to age of onset.

Background: Several outcome studies assessing eating disorders found that certain factors (age of onset, duration of illness …) are associated with poorer outcomes and prognoses. For instance, lower weight at admission helped predict number of relapses and other poor outcomes.
Current study: 40 eating disorders patients (97.1 percent Caucasian; average age 28.9) treated between 1995 and 2005 were examined to determine the association between low admission BMI*, and long-term outcomes and related psychopathology. Participants with an admission BMI below 18.5 were in the low BMI group; all other participants were in the average BMI group. As part of a larger study, participants completed an intake evaluation and behavioral, cognitive and psychological outcomes.
Results: Study results indicated that the low BMI scored more favorably on mental health components and had lower depression levels. In addition, the low BMI group had:

• lower measures on anxiety within the areas of state and trait anxiety*
• more dietary restraint
• fewer eating concerns
• better body image

No differences were found between the two groups on measures of self-esteem, shape or weight concerns, normative eating and physical health. Nor within quality of life subscales that included psychological, physical, cognitive and financial components, plus those including work and school.
Conclusion: These results indicate that lower admission BMI is associated with more favorable mental health outcomes related to depression and anxiety. These patients also have fewer eating and mental health concerns, less dietary restraint and increased self-efficacy for body image. These findings may help eating disorders researchers further understand how different factors can influence success levels for patients in various treatment programs.

Purpose: To describe changes in mood, self-esteem and ED*-related concerns during eating disorders treatment.
Methods: From a larger study, 50 females (98.0 percent Caucasian; mean age 23.1; mean BMI* 22.5; 24.0 percent AN*; 26 percent BN*; 50 percent EDNOS*) seeking treatment for an ED at a large multidisciplinary treatment facility completed measures (BDI-2*, STAI*, EDE-Q* and EDI-3*) at intake assessment and three- to six- month follow-up.
Results: Results showed reduced depression and anxiety scores, and lower measures of concerns related to eating disorders. Lower scores was most predominant between three- and six-month follow-up. Improvements occurred earlier in treatment, and continued between the three- and six-month follow-up.
Discussion: During the course of ED* treatment, improvements in broader psychological functioning with nutritional rehabilitation, plus healthier skills, developed during the course of treatment. Future research should seek to identify interventions that provide the greatest improvements in the shortest period of time.

Purpose: To examine differences between eating disorder patients who have and have not used laxatives for weight control on treatment factors at intake assessment and follow-up.
Methods: 202 females (98.4 percent Caucasian; average age 26.1) completed intake evaluation and behavioral, cognitive and psychological follow-up. A total of 81 (43.8 percent) reported ever using laxatives.
Results: Laxative use was significantly associated with the higher BMI* and older age at intake assessment. At follow-up, laxative users scored significantly lower on measures of self-esteem, mental health functioning and self-efficacy for body image and normative eating and higher scores on measures of depression, trait anxiety*, dietary restraint and eating and weight and shape concerns. Laxative users reported more pathological scores on psychological and physical or cognitive factors related to quality of life, eating disorder behaviors and related characteristics than nonlaxative users.
Discussion: Laxative users have poorer outcomes than their nonusing peers on many behavioral, cognitive and psychological factors. Due to severe medical complications encountered during treatment (dehydration, electrolyte imbalance, abnormal bowel motility and peripheral edema), future research should address the clinical implications of treating those who use laxatives, and evaluate the longer-term impact of laxative use on overall health.

Purpose: To compare long-term outcomes across ED* diagnoses using varying definitions of recovery as suggested by Couturier & Lock (2006).
Methods: 205 females (98.4 percent Caucasian; average age 20.3) completed an outcomes study one to 10 years after intake assessment. Intake diagnoses were 42.0 percent AN-R*, 8.8 percent AN-P*, 12.2 percent BN*, and 37.1 percent EDNOS*. “Good outcome” was assessed in four ways: a) BMI* greater than 18.5; b) no diagnosis on the EDDS*; c) within 1 SD of norms on the EDE-Q*; or d) within 1 SD of norms on the EDRSQ*.  Chi-squares* and ANOVAs* were used to evaluate differences across diagnosis.
Results: Fewer AN-R (75 percent) and AN-P (50 percent) patients had achieved a BMI of 18.5 or greater at follow-up than BN (91.3 percent) or EDNOS (81.5 percent) patients (p less than .002). According to EDDS, the majority of individuals with AN-R (68.6 percent) and EDNOS (71.1 percent) did not meet any full or subthreshold ED diagnosis at follow-up, compared to only 38.9 percent of AN-P and 44 percent of BN patients (p less than .001). Only results for the Weight Concerns subscale of EDE-Q approached significance across diagnostic categories (p = .052). No significant results registered on the EDRSQ.
Discussion: Recovery rates vary greatly by definition used. The ED field could benefit from developing consistently-used criteria for evaluating a good outcome.

Purpose: The current study sought to determine if age of onset of an eating disorder affected the treatment outcome among individuals diagnosed with EDNOS* at intake.
Methods: From a larger sample of 100 people who received partial or inpatient hospitalization within the past 11 years, we compared individuals diagnosed with EDNOS whose age of eating disorder onset was typical (ages 11-19; n = 29) to those with older onset (age 20 or older; n = 6) on measures of outcome at follow-up.
Results: Overall, there were no differences between groups on race, BMI* at intake, BMI at follow-up, number of years since intake, or eating disorder diagnosis at follow-up.  As expected, those diagnosed with EDNOS who were older at onset were more likely than those with a typical age of onset to report lower self-esteem, greater feelings of ineffectiveness and greater concerns about interpersonal problems and physical functioning. In addition, there were trends for older onset patients to report, at follow-up, greater depression and personal alienation than typical onset patients.
Discussion: EDNOS clients who were older at the onset of eating disorder symptoms may present with a poorer outcome, particularly for a broader set of psychological concerns. These patients may benefit from special clinical interventions tailored to their unique situation.

Objective: The purpose of the study was to differentiate between athletes and nonathlete patients presenting for eating disorder treatment.
Method: The study design was a retrospective chart review. A sample of 255 patients was drawn from the population of females ages 13 to 24 presenting for an initial eating disorder assessment. Patients were grouped as follows: endurance, aesthetic and ball sport athletes, or nonathletes. Age of onset, age at presentation, BMI, menstrual status, duration of eating disorder, EDI-2* subscales scores, and STAI* scores were analyzed for between-group differences.
Results: Nonathletes had an eating disorder longer, and were older than athletes at presentation. Endurance athletes exhibited a significantly higher percentage with interrupted menses when compared with the other groups. No other significant group differences were found.
Conclusion: Athletes and nonathletes present for eating disorder treatment with similar levels of body dissatisfaction, interoceptive* awareness, perfectionism, drive for thinness and state or trait anxiety*.

Objective: To determine the relationship between clinical factors associated with eating disorders and age of onset.
Method: 208 females, ages 8 to 21 were drawn from the inpatient population of a large Midwestern eating disorder clinic. Diagnoses included AN*, BN*, and EDNOS*. Measures taken from a retrospective chart review included diagnosis, symptoms, EDI-2* subscale scores, diagnosis of depression, STAI* scores and Rosenberg self-esteem scores.
Results: Participants ages 8 to 12 had higher maturity fears, lower body dissatisfaction, lower social insecurity, lower anxiety (state and trait*) and higher self-esteem than those ages 13 to 21.
Conclusion: The differences in clinical factors between patients with onset between ages 8 to 12 and ages 13 to 21 indicate that age of onset should be taken into account when treating eating disorder patients, particularly preadolescents.