Come play with me : an argument to link autism spectrum disorders and anorexia nervosa through early childhood pretend play

This article builds on the argument of a link between behaviours observed in persons with autism spectrum disorders and persons with anorexia nervosa. In describing these behaviours, a link is made between deficits in social cognition, lack of flexible and creative thinking, theory of mind, and deficits in early pretend play ability. Early pretend play ability is a strong avenue to the development and strengthening of social cognition, problem solving, language, logical sequential thought, and understanding social situations. Currently, there is no literature on the pretend play ability of persons who develop anorexia nervosa. This article argues for research into this area which may potentially contribute to developments in new intervention strategies for these persons.

An exploratory evaluation of the family meal intervention for adolescent anorexia nervosa

Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty-three AN adolescents aged 12-20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6-month duration. Their outcome was compared at the end of treatment (EOT) and at a 6-month posttreatment follow-up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.

Inside anorexia : the experiences of girls and their families

An accessible resource for anyone who wants a better understanding of anorexia nervosa. An informative guide for health professionals as well as for people with anorexia and their families.

Looking after well siblings of adolescent girls with anorexia : an important parental role

Background Research has suggested that well siblings of children with chronic and life-threatening illnesses are at risk for negative outcomes and that parents’ responses to the illnesses can influence the adaptation of well siblings. Yet, parents’ efforts to look after well siblings in the context of illness are rarely considered in literature about sibling adaptation. The importance of attending to the needs of well siblings was a major theme to emerge from a qualitative analysis of the experiences of parents of adolescent girls with anorexia nervosa.

Methods In-depth interviews were conducted with 24 parents of adolescent girls with anorexia and analysed using grounded theory method.

Results The data indicated that parents viewed caring for well siblings in the context of anorexia as an important role and responsibility. Parents reported making conscious and active efforts to look after well siblings by: maintaining normality; compensating for changes to routines; protecting siblings; providing emotional support; and managing the consequences.

Conclusions This paper provides a picture of the actions parents take to help well siblings adapt to anorexia in the family. Further research is needed to develop and expand this understanding to families experiencing a wide range of chronic and life-threatening illnesses. The findings underline the importance of clinical attention and further research into the critical parental role of caring for well siblings.

Parents dealing with anorexia : actions and meanings

This paper examines parents’ actions in response to anorexia nervosa, and how these are shaped by the ways they construct or understand the eating disorder. The findings indicate that parents try to influence their daughters by searching for help, providing practical support, avoiding confrontation, complying with special requirements, persuading, explaining, and pressuring, using ploys and force, providing emotional support, and mediating interactions. Parents’ actions are influenced by how they construct anorexia, such as whether they see it as an eating issue, an illness, a psychological problem, a choice, or a mystery. Understanding parents’ actions and constructions can help clinicians develop collaborative partnerships with parents.

Support for parents of children with anorexia : what parents want

Parents' encounters with health professionals can influence their ability to cope with having a daughter with anorexia nervosa. Using qualitative analysis of in-depth interviews with 24 parents, we examine the question “What support do parents of teenage girls with anorexia want from clinicians?” The analysis shows that parents wanted clinicians to include them in treatment, support and guide them in their daughters' care, and demonstrate positive attitudes toward them. The implications for clinicians are discussed, including being sensitive to parents' vulnerability, ensuring congruence between clinicians' and parents' expectations about treatment, and strengthening formal channels of communication.

The paradox of virtue : (re)thinking deviance, anorexia and schooling

In this paper we posit a radical retheorization of anorexia as a form of deviance. We examine how the disciplinary practices and moral technologies typical of contemporary secondary schooling signify and enter into the articulation of three ‘virtue discourses’ (discipline, achievement and healthism), and tease out how these ‘virtue discourses’ play into the formation of the ‘anorexic’ subject. Informed by Foucauldian theory, our analysis draws on our life history interview study with teenage girls diagnosed with anorexia nervosa and their parents. We argue that anorexia can be understood not as a form of deviance but as a ‘paradox of virtue’ involving zealous compliance with and taking up of socially and culturally sanctioned ‘virtue discourses’ that are immanent in schooling and wider society.

Body image and self-concept in adolescent girls [R]

Anorexia Nervosa has been recently recognized as one of the most common chronic illnesses that affects the female adolescent population today. Although there has been an abundance of research into eating disorders in a variety of fields, significant limitations within the research still exist. Since very early descriptions of the disorder, self-concept and body image have been identified as core components of the anorexia nervosa. However, research has been somewhat limited in that there have not been any consistent theoretical underpinnings for self-concept and body image within the eating disorders field. Furthermore, researchers have tended to adopt traditional inferential statistics and multivariate methods to assess the role of self-concept and body image. As a result there has been very little consistency in research results. The current paper summarizes the significant findings from a doctoral thesis that attempted to address current limitations in self-concept and body image literature within the field of eating disorders.

Educational and mental health implications of the multidimensional model of the self-concept for adolescent girls : comparison of clinical and non-clinical samples

The importance of a positive self-concept as an educational outcome and a facilitator of other desirable outcomes are well established within the education research field. Although the multidimensional and hierarchical model of the self-concept is widely accepted within the educational psychology, this perspective is not widely used within the mental health research. Hence, the purpose of the present investigation is to compare the psychometric properties of the short version of the Self-Description Questionnaire (SDQII-S) based on responses by a large sample of female adolescent high school students (N= 829) and a clinical sample of adolescent girls who have been diagnosed with anorexia nervosa (N= 75). The well-established psychometric properties of the longer version of the SDQII generalise well to both samples of adolescent girls, and analyses provided good support for the invariance of the factor structure across the two samples. Furthermore, analyses employing new structural equation modelling approaches to comparing the latent mean differences indicated that there were differences (although surprisingly small) between the two groups that were generally consistent with a priori predictions. The important educational and clinical implications of these results are discussed.

Actual/ideal body images of high school girls and how it affects their self-esteem : implications for educational and clinical institutions

Given that adolescence is a critical period for the development of a positive self-concept and body image, it is imperative that educators have an understanding of adolescent students' body image and their dieting practises and behaviours. Negative body image is an issue that is rife within the adolescent student population in Australia and around the world, and is a factor that is commonly associated with and linked to disturbed eating behaviours and chronic eating disorders like Anorexia Nervosa (AN). Despite the intuitive appeal and importance of investigating adolescents' body image in terms of what adolescents would like to look like and what they think that they look like now, very little research has investigated these concepts. Furthermore, very little research has explored whether there is a difference between these two constructs how this may affect adolescents' self-esteem. This study therefore aimed to explore the actual and ideal body images of adolescent high school girls aged between 12 and 18 years in two samples of adolescents, one with eating disorders (n=76, clinical sample) and one without (n=823 high school sample). Additionally, this study investigates these constructs in relation to self-esteem levels. The results of this study have important implications for educators and clinicians within educational and clinical settings.

Childhood sexual abuse and adolescent eating disorder : findings from the Victorian Adolescent Health Cohort study

Objective: To examine the relationship between childhood sexual abuse (CSA) before the age of 16 years and later onset of bulimia and anorexia nervosa symptoms in females.

Design: A longitudinal cohort study of adolescents observed from August 1992 to March 2003. The cohort was defined in a 2-stage cluster sample using 44 Australian schools in Victoria.

Setting: Population based.

Participants: A total of 1936 persons participated at least once and survived to the age of 24 years, including 999 females. The mean (SD) age of females at the start of follow- up was 14.91 (0.39) years; and at completion, 24.03 (0.55) years.

Main Exposure: Self-reported CSA before the age of 16 years was ascertained retrospectively at the age of 24 years.

Outcome Measures: Incident Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–defined partial syndromes of anorexia and bulimia nervosa were identified between waves 4 (mean age, 16.3 years) and 6 (mean age, 17.4 years) using the Branched Eating Disorder Test.

Results: The incidence of bulimic syndrome during adolescence was 2.5 (95% confidence interval, 0.80-8.0) times higher among those who reported 1 episode of CSA and 4.9 (95% confidence interval, 1.9-12.7) times higher among those who reported 2 or more episodes of CSA, compared with females reporting no episodes, adjusted for age and background factors. The association persisted after adjusting for possible confounders or mediators measured 6 months earlier, including psychiatric morbidity and dieting behavior. There was little evidence of an association between CSA and partial syndromes of incident anorexia nervosa.

Conclusion: Childhood sexual abuse seems to be a risk factor for the development of bulimic syndromes, not necessarily mediated by psychiatric morbidity or severe dieting.

A new social-family model for eating disorders: A European multicentre project using a case-control design

OBJECTIVE: To examine a new socio-family risk model of Eating Disorders (EDs) using path-analyses. METHOD: The sample comprised 1264 (ED patients = 653; Healthy Controls = 611) participants, recruited into a multicentre European project. Socio-family factors assessed included: perceived maternal and parental parenting styles, family, peer and media influences, and body dissatisfaction. Two types of path-analyses were run to assess the socio-family model: 1.) a multinomial logistic path-model including ED sub-types [Anorexia Nervosa-Restrictive (AN-R), AN-Binge-Purging (AN-BP), Bulimia Nervosa (BN) and EDNOS)] as the key polychotomous categorical outcome and 2.) a path-model assessing whether the socio-family model differed across ED sub-types and healthy controls using body dissatisfaction as the outcome variable. RESULTS: The first path-analyses suggested that family and media (but not peers) were directly and indirectly associated (through body dissatisfaction) with all ED sub-types. There was a weak effect of perceived parenting directly on ED sub-types and indirectly through family influences and body dissatisfaction. For the second path-analyses, the socio-family model varied substantially across ED sub-types. Family and media influences were related to body dissatisfaction in the EDNOS and control sample, whereas perceived abusive parenting was related to AN-BP and BN. DISCUSSION: This is the first study providing support for this new socio-family model, which differed across ED sub-types. This suggests that prevention and early intervention might need to be tailored to diagnosis-specific ED profiles.