We explored associations between lifetime eating disorder (ED) diagnoses and behaviors and menstr... more We explored associations between lifetime eating disorder (ED) diagnoses and behaviors and menstrual dysfunction using logistic regression models. Body mass index (BMI) fully explained differences in the odds of secondary amenorrhea (SA) across diagnoses. Women with dieting behaviors had borderline significantly higher odds of SA than those without after accounting for BMI. We suggest the presence of a strong association between BMI and SA and that dieting might represent a risk factor for SA regardless of BMI and ED diagnosis.
To examine a new socio-family risk model of eating disorders using path-analyses. The sample comp... more To examine a new socio-family risk model of eating disorders using path-analyses. The sample comprised 1,264 (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. 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. 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.
European eating disorders review : the journal of the Eating Disorders Association, Jan 26, 2015
The objective of this study was to investigate the prevalence of eating disorder (ED) risk as wel... more The objective of this study was to investigate the prevalence of eating disorder (ED) risk as well as associated psychopathology and health-related quality of life (HrQoL) in a large population sample of Austrian adolescents. A sample of 3610 adolescents aged 10-18 years was recruited from 261 schools representative for the Austrian population. The SCOFF questionnaire was used to identify participants at risk for EDs, and the Youth Self-Report and KIDSCREEN were used to assess general psychopathology and HrQoL. In total, 30.9% of girls and 14.6% of boys were screened at risk for EDs. SCOFF scores were significantly associated with internalising and externalising behavioural problems as well as HrQoL after controlling for sex, age and body mass index. The SCOFF score further turned out to be an independent predictor of HrQoL. The high prevalence of ED risk among Austrian adolescents points out the need for prevention in this field. Variables indicating eating pathology should be incl...
their unaffected sisters. Conclusions: Traits of childhood overeating were more common in bulimic... more their unaffected sisters. Conclusions: Traits of childhood overeating were more common in bulimic women compared to their unaffected siblings. Subjects with AN did not differ from their sisters on eating variables. The increased risk of BN due to childhood overweight suggests that prevention strategies for childhood obesity and overweight may therefore be applicable in BN.
This study examines retrospective correlates of nonshared family environment prior to onset of di... more This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.
No epidemiological data on prevalence rates of mental disorders based on a representative sample ... more No epidemiological data on prevalence rates of mental disorders based on a representative sample are available for Austrian adolescents up to now. However, the knowledge of psychiatric disorders, related risk and protective factors is of great significance for treatment and prevention. The purpose of the MHAT-Study (Mental Health in Austrian Teenagers), the first epidemiological study on mental health in Austria, is to obtain prevalence rates of mental disorders and to examine risk factors, protective factors and quality of life in a representative sample of adolescents aged 10-18. Aims of this pilot study were to evaluate the feasibility and acceptability of the screening instruments, pre-estimate the frequency of mental health problems and estimate possible non-responder bias. Twenty-one schools in eastern Austria were asked to participate. Data on mental health problems were derived from self-rating questionnaires containing standardized screening measures (Youth Self-Report, measuring emotional and behavioral problems and the SCOFF, indicating eating problems. Quality of life as well as related risk and protective factors were also obtained. Four hundred and eight adolescents of five schools were recruited. The prevalence of mental health problems was 18.9 % [CI 95 %: 14.9-22.7]. Moreover, emotional and behavioral problems were highly correlated with quality of life measures. A Non-Responder Analysis indicated that non-responders (16.7 %) differ from responders with regard of school related problems. The results demonstrate that mental health problems affect approximately one fifth of the adolescents. A Non-Responder Analysis suggests that the prevalence of behavioral and emotional problems is underestimated.
European eating disorders review : the journal of the Eating Disorders Association, 2014
Technology assisted guided self-help has been proven to be effective in the treatment of bulimia ... more Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable. One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered. Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline. Techn...
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 2002
Zusammenfassung: Fragestellung: Familienbeziehungen bei Essstörungen sind in den letzten Jahrzehn... more Zusammenfassung: Fragestellung: Familienbeziehungen bei Essstörungen sind in den letzten Jahrzehnten intensiv beforscht worden. Subjektive Wahrnehmungen von familiären Beziehungen mittels des «Subjektiven Familienbildes», einem Instrument, das dazu entwickelt wurde, die unterschiedlichen Wahrnehmungen der Familienmitglieder bezüglich der entwicklungspsycho(patho)logisch relevanten Faktoren Autonomie und Verbundenheit in ihrer subjektiven Wertigkeit zu erfassen, wurden bei Adoleszenten mit Essstörungen allerdings nur in wenigen kleinen Gruppen untersucht. Methode: Unsere Studie hatte daher zum Ziel, (1) die subjektiven Wahrnehmungen von Familienbeziehungen in einer größeren klinischen Gruppe (n = 118) von weiblichen adoleszenten Patientinnen mit Magersucht beider Subtypen und Bulimie zu untersuchen, mit einer gesunden Kontrollgruppe (n = 96) zu vergleichen und (2) innerfamiliäre Unterschiede der Wahrnehmung des Familienbildes zu erfassen. Ergebnisse: Die Hauptergebnisse waren, dass Adoleszente mit Bulimia nervosa geringere Autonomie und geringere emotionale Verbundenheit in der Familie erlebten als alle anderen Gruppen. Die Adoleszenten mit Bulimie erlebten geringere Autonomie und emotionale Verbundenheit als ihre Väter dies wahrnahmen, und Adoleszente mit restriktiver Anorexie erlebten höhere emotionale Verbundenheit in den Familien als ihre Väter. Die Relevanz der Ergebnisse für das Verständnis der Familiendynamik wird diskutiert.
Background: Celiac disease (CD), treated by a gluten-free diet, may represent a nonspecific trigg... more Background: Celiac disease (CD), treated by a gluten-free diet, may represent a nonspecific trigger for the development of eating pathology, particularly in adolescence. Objective: The authors sought to perform a systematic study on eating pathology in CD. Method: CD patients were assessed for eating disorders by questionnaire, and body mass index was recorded. Results: There was a higher rate of eating pathology in CD patients than would be expected, especially, a higher rate of bulimia nervosa. This subgroup reported more noncompliance with the gluten-free diet and had higher scores on most eating-related questionnaires. In most cases, diagnosis of CD preceded the onset of eating pathology. Conclusion: The authors recommend asking earlyadolescent CD patients whether they are also dieting for aesthetic reasons.
Psychology and Psychotherapy: Theory, Research and Practice, 2010
Objectives. Pathology of the regulative mechanisms of self seems to be connected with eating diso... more Objectives. Pathology of the regulative mechanisms of self seems to be connected with eating disorders (EDs). The present study aimed to explore the hypothesis that there are differences in self-regulation in adolescent girls with Type 1 diabetes with and without EDs.
The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatr... more The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
We explored associations between lifetime eating disorder (ED) diagnoses and behaviors and menstr... more We explored associations between lifetime eating disorder (ED) diagnoses and behaviors and menstrual dysfunction using logistic regression models. Body mass index (BMI) fully explained differences in the odds of secondary amenorrhea (SA) across diagnoses. Women with dieting behaviors had borderline significantly higher odds of SA than those without after accounting for BMI. We suggest the presence of a strong association between BMI and SA and that dieting might represent a risk factor for SA regardless of BMI and ED diagnosis.
To examine a new socio-family risk model of eating disorders using path-analyses. The sample comp... more To examine a new socio-family risk model of eating disorders using path-analyses. The sample comprised 1,264 (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. 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. 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.
European eating disorders review : the journal of the Eating Disorders Association, Jan 26, 2015
The objective of this study was to investigate the prevalence of eating disorder (ED) risk as wel... more The objective of this study was to investigate the prevalence of eating disorder (ED) risk as well as associated psychopathology and health-related quality of life (HrQoL) in a large population sample of Austrian adolescents. A sample of 3610 adolescents aged 10-18 years was recruited from 261 schools representative for the Austrian population. The SCOFF questionnaire was used to identify participants at risk for EDs, and the Youth Self-Report and KIDSCREEN were used to assess general psychopathology and HrQoL. In total, 30.9% of girls and 14.6% of boys were screened at risk for EDs. SCOFF scores were significantly associated with internalising and externalising behavioural problems as well as HrQoL after controlling for sex, age and body mass index. The SCOFF score further turned out to be an independent predictor of HrQoL. The high prevalence of ED risk among Austrian adolescents points out the need for prevention in this field. Variables indicating eating pathology should be incl...
their unaffected sisters. Conclusions: Traits of childhood overeating were more common in bulimic... more their unaffected sisters. Conclusions: Traits of childhood overeating were more common in bulimic women compared to their unaffected siblings. Subjects with AN did not differ from their sisters on eating variables. The increased risk of BN due to childhood overweight suggests that prevention strategies for childhood obesity and overweight may therefore be applicable in BN.
This study examines retrospective correlates of nonshared family environment prior to onset of di... more This study examines retrospective correlates of nonshared family environment prior to onset of disease, by means of multiple familial informants, among anorexia and bulimia nervosa patients. A total of 332 participants was included (anorexia nervosa, restrictive type (AN-R): n = 41 plus families); bulimic patients (anorexia nervosa, binge-purging type; bulimia nervosa: n = 59 plus families). The EATAET Lifetime Diagnostic Interview was used to establish the diagnosis; the Subjective Family Image Test was used to derive emotional connectedness (EC) and individual autonomy (IA). Bulimic and AN-R patients perceived significantly lower EC prior to onset of disease compared to their healthy sisters. Bulimic patients perceived significantly lower EC prior to onset of disease compared to AN-R patients and compared to their mothers and fathers. A low family sum - sister pairs sum comparison - of EC had a significant influence on the risk of developing bulimia nervosa. Contrary to expectations, AN-R patients did not perceive significantly lower levels of IA compared to their sisters, prior to onset of disease. Findings of low IA in currently ill AN-R patients may represent a disease consequence, not a risk factor. Developmental child psychiatrists should direct their attention to disturbances of EC, which may be present prior to the onset of the disease.
No epidemiological data on prevalence rates of mental disorders based on a representative sample ... more No epidemiological data on prevalence rates of mental disorders based on a representative sample are available for Austrian adolescents up to now. However, the knowledge of psychiatric disorders, related risk and protective factors is of great significance for treatment and prevention. The purpose of the MHAT-Study (Mental Health in Austrian Teenagers), the first epidemiological study on mental health in Austria, is to obtain prevalence rates of mental disorders and to examine risk factors, protective factors and quality of life in a representative sample of adolescents aged 10-18. Aims of this pilot study were to evaluate the feasibility and acceptability of the screening instruments, pre-estimate the frequency of mental health problems and estimate possible non-responder bias. Twenty-one schools in eastern Austria were asked to participate. Data on mental health problems were derived from self-rating questionnaires containing standardized screening measures (Youth Self-Report, measuring emotional and behavioral problems and the SCOFF, indicating eating problems. Quality of life as well as related risk and protective factors were also obtained. Four hundred and eight adolescents of five schools were recruited. The prevalence of mental health problems was 18.9 % [CI 95 %: 14.9-22.7]. Moreover, emotional and behavioral problems were highly correlated with quality of life measures. A Non-Responder Analysis indicated that non-responders (16.7 %) differ from responders with regard of school related problems. The results demonstrate that mental health problems affect approximately one fifth of the adolescents. A Non-Responder Analysis suggests that the prevalence of behavioral and emotional problems is underestimated.
European eating disorders review : the journal of the Eating Disorders Association, 2014
Technology assisted guided self-help has been proven to be effective in the treatment of bulimia ... more Technology assisted guided self-help has been proven to be effective in the treatment of bulimia nervosa (BN). The aim of this study was to determine predictors of good long-term outcome as well as drop-out, in order to identify patients for whom these interventions are most suitable. One hundred and fifty six patients with BN were assigned to either 7 months internet-based guided self-help (INT-GSH) or to conventional guided bibliotherapy (BIB-GSH), both guided by e-mail support. Evaluations were taken at baseline, after 4, 7, and 18 months. As potential predictors, psychiatric comorbidity, personality features, and eating disorder psychopathology were considered. Higher motivation, lower frequency of binge eating, and lower body dissatisfaction at baseline predicted good outcome after the end of treatment. Lower frequency of binge eating predicted good outcome at long-term follow-up. Factors prediciting drop-out were higher depression and lower self-directedness at baseline. Techn...
Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 2002
Zusammenfassung: Fragestellung: Familienbeziehungen bei Essstörungen sind in den letzten Jahrzehn... more Zusammenfassung: Fragestellung: Familienbeziehungen bei Essstörungen sind in den letzten Jahrzehnten intensiv beforscht worden. Subjektive Wahrnehmungen von familiären Beziehungen mittels des «Subjektiven Familienbildes», einem Instrument, das dazu entwickelt wurde, die unterschiedlichen Wahrnehmungen der Familienmitglieder bezüglich der entwicklungspsycho(patho)logisch relevanten Faktoren Autonomie und Verbundenheit in ihrer subjektiven Wertigkeit zu erfassen, wurden bei Adoleszenten mit Essstörungen allerdings nur in wenigen kleinen Gruppen untersucht. Methode: Unsere Studie hatte daher zum Ziel, (1) die subjektiven Wahrnehmungen von Familienbeziehungen in einer größeren klinischen Gruppe (n = 118) von weiblichen adoleszenten Patientinnen mit Magersucht beider Subtypen und Bulimie zu untersuchen, mit einer gesunden Kontrollgruppe (n = 96) zu vergleichen und (2) innerfamiliäre Unterschiede der Wahrnehmung des Familienbildes zu erfassen. Ergebnisse: Die Hauptergebnisse waren, dass Adoleszente mit Bulimia nervosa geringere Autonomie und geringere emotionale Verbundenheit in der Familie erlebten als alle anderen Gruppen. Die Adoleszenten mit Bulimie erlebten geringere Autonomie und emotionale Verbundenheit als ihre Väter dies wahrnahmen, und Adoleszente mit restriktiver Anorexie erlebten höhere emotionale Verbundenheit in den Familien als ihre Väter. Die Relevanz der Ergebnisse für das Verständnis der Familiendynamik wird diskutiert.
Background: Celiac disease (CD), treated by a gluten-free diet, may represent a nonspecific trigg... more Background: Celiac disease (CD), treated by a gluten-free diet, may represent a nonspecific trigger for the development of eating pathology, particularly in adolescence. Objective: The authors sought to perform a systematic study on eating pathology in CD. Method: CD patients were assessed for eating disorders by questionnaire, and body mass index was recorded. Results: There was a higher rate of eating pathology in CD patients than would be expected, especially, a higher rate of bulimia nervosa. This subgroup reported more noncompliance with the gluten-free diet and had higher scores on most eating-related questionnaires. In most cases, diagnosis of CD preceded the onset of eating pathology. Conclusion: The authors recommend asking earlyadolescent CD patients whether they are also dieting for aesthetic reasons.
Psychology and Psychotherapy: Theory, Research and Practice, 2010
Objectives. Pathology of the regulative mechanisms of self seems to be connected with eating diso... more Objectives. Pathology of the regulative mechanisms of self seems to be connected with eating disorders (EDs). The present study aimed to explore the hypothesis that there are differences in self-regulation in adolescent girls with Type 1 diabetes with and without EDs.
The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatr... more The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
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