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Abstract: Objective: The aim of the study was to compare the DSM‐IV, DSM‐5, and ICD‐10 eating disorders (ED) nomenclatures to assess their value in the classification of pediatric eating disorders. We investigated the prevalence of the disorders in accordance with each system's diagnostic criteria, diagnostic concordance between the systems, and interrater reliability. Method: Participants were 1062 children and adolescents assessed at intake to a specialist Eating Disorders Program (91.6% female, mean age 14.5 years, SD = 1.75). Measures were collected from routine intake assessments. Results: DSM‐5 categorization led to a lower prevalence of unspecified EDs when compared with DSM‐IV. There was almost complete overlap for specified EDs. Kappa values indicated almost excellent agreement between the two coders on all three diagnostic systems, although there was higher interrater reliability for DSM‐5 and ICD‐10 when compared with DSM‐IV. Discussion: DSM‐5 nomenclature is useful in classifying eating disorders in pediatric clinical samples. [ABSTRACT FROM AUTHOR]

Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise. [ABSTRACT FROM AUTHOR]

Objective: The factor structure of the eating disorder examination (EDE) has never been tested in a clinical pediatric sample, and no normative data exist. Method: The factor structure of an adapted EDE was examined in a clinical sample of 665 females aged 9-17 years with anorexia nervosa spectrum (70%), bulimia nervosa spectrum (12%), purging disorder (3%), and unspecified feeding and eating disorders (15%). Results: The original four-factor model was a good fit in a confirmatory factor analysis as well a higher order model with three dimensions of restraint, eating concern, and combined weight concern/ shape concern. Normative data are reported for clinicians to identify the percentiles in which their patients' score. Discussion: The findings support dimensions of restraint, eating concern, weight concern, and shape concern in a clinical pediatric sample. This supports the factorial validity of the EDE, and the norms may assist clinicians to evaluate symptoms in females under 18 years. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective Given the importance of assessing depressive symptoms and suicidal ideation in adolescents with eating disorders (EDs), the aim was to provide normative data on the Children's Depression Inventory (CDI) for female adolescents presenting for treatment of an ED. Method The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project registry ( N = 1000), a prospective, ongoing registry study comprising consecutive pediatric tertiary ED referrals. Females ( N = 256; 12-17 years) with DSM-5 EDs completed the CDI at intake. Results Results on the CDI revealed a pattern of increasing depressive scores with age and higher scores among patients with anorexic spectrum disorders. The prevalence of suicidal ideation was high and had the same pattern as CDI scores. The mean score on the CDI in the sample was higher than community samples and clinical samples of adolescents with post-traumatic stress disorder, obsessive compulsive disorder, and other clinical disorders. Discussion Females adolescents with EDs are at high-risk of depression and suicidal ideation. These data provide information about variation in CDI scores to guide clinicians in interpretation of scores. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:666-670) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To provide normative data on the Multidimensional Anxiety Scale for Children (MASC) for female adolescents presenting for eating disorder (ED) treatment. Method This study is part of the Helping to Outline Paediatric Eating Disorders Project registry ( N ∼ 1,000), a prospective ongoing registry study comprising consecutive pediatric tertiary ED referrals. Female adolescents ( N = 278; 13-17 years) with EDs completed the MASC at intake. Results Summary data including percentiles are given for the MASC total and subscales. MASC scores were higher than community norms as expected and increased with age ( p <.001) and an anorexic spectrum diagnosis ( p < .001). Discussion The norms reported will aid clinicians in the understanding and interpretation of individual MASC scores among female adolescents with EDs and could assist future research to better understand the role of anxiety in the onset and maintenance of EDs. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:471-474) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To examine child and adolescent differences in the clinical presentation of eating disorders (EDs) at referral to a specialist pediatric program. Method This study compared cognitive, behavioral, and physical and medical features of children (≤12 years) and adolescents (13-18 years) with EDs presenting to a state-wide specialist pediatric ED service over two decades ( N = 656; 8-18 years; 94% female). Results Significant differences were found between the groups. Children were more commonly male ( p < .001), had lower eating pathology scores ( p < .001), were less likely to binge eat ( p = .02), purge ( p < .001) or exercise for shape and weight control ( p < .001), and lost weight at a faster rate than adolescents ( p = .009), whereas adolescents were more likely to present with bulimia nervosa spectrum disorders ( p = .004). Children and adolescents did not differ significantly on mean body mass index z-score, percentage of body weight lost, or indicators of medical compromise ( p > .05). Discussion The clinical presentation of EDs differs among children and adolescents, with eating pathology and behavioral symptoms less prominent among children. Frontline health professionals require knowledge of these differences to assist with early detection, diagnosis, and prognosis. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:47-53) [ABSTRACT FROM AUTHOR]

Background Among adults, personality traits have been implicated in the development and maintenance of eating disorders ( EDs); whether these findings extend to youth is unknown. The aim of this study was to investigate personality traits of adolescents with EDs. Methods A case-control approach was performed by comparing a clinical group of female adolescents with EDs ( n = 23) to a control group of adolescents in the general community ( n = 26) on personality traits of inhibited, self-demeaning, and borderline tendency. Controls were frequency-matched to cases on age and sex, were drawn from a similar geographic catchment area, and observed in the same year as clinical cases. Results The clinical group demonstrated significantly higher scores on self-demeaning ( F(1,47) = 41.39, p < .001, η2 = .075), borderline ( F(1,47) = 24.50, p < .001, η2 = .093), and inhibited ( F(1,47) = 13.33, p = .001, η2 = .014) personality styles. Adjustment for affective symptomatology diminished the strength of these relationships, but personality pathology still demarcated the group with clinical EDs. Conclusions The well-established link between personality pathology and EDs in adults generalised to adolescents. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The aim of this study was to examine parent-youth concordance in reporting of eating disorder pathology, as assessed by the Eating Disorder Examination (EDE) in a clinical pediatric sample. Method The sample comprised 619 parent-youth dyads of youth (8-18 years) presenting for treatment at a specialist eating disorder clinic. A cross-sectional correlational design was used to examine the association between parent and youth symptom reports. Results On the whole, parent-youth inter-rater agreement was poor to moderate. Agreement was acceptable for the presence of behavioral symptoms, with the exception of excessive exercise (PAK = 0.48-0.98). There was poor inter-rater agreement on frequency of behavioral symptoms, with parents providing lower estimates than youth (ICC = 0.07-0.52). Although we predicted that inter-rater agreement on cognitive symptoms would by higher with adolescents than children, both groups were discordant with parent reports. Younger children identified less severe eating disorder cognitions than parents and the opposite occurred for adolescents. An anorexia nervosa presentation and lower malnutrition were not associated with lower inter-rater agreement, as might have been expected through ego syntonicity. Youth with bulimia nervosa presentations reported significantly higher severity of cognitive symptoms and more frequent disordered eating behaviors compared with their parents. Discussion Results support the utility of parent-youth assessment via the EDE to obtain a wider clinical picture of eating disorder psychopathology in children and adolescents, particularly for younger children. Clinical implications pertinent to administration of the EDE and parent literacy regarding eating disorder symptoms are discussed. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:617-625) [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the factor structure, validity, and reliability of the Compulsive Exercise Test (CET) in an adolescent clinical eating disorder population. The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project, a prospective ongoing registry study comprising consecutive pediatric tertiary eating disorder referrals. Adolescents ( N = 104; 12–17 years) with eating disorders completed the CET and other measures. Factor structure, convergent validity, and internal consistency were evaluated. Despite failing to identify a factor structure, the study provided clear evidence of the multidimensionality of the measure. The total score correlated significantly with measures of eating pathology, perfectionism, and frequency of exercise for shape and weight control ( r = 0.32–0.70, p s < 0.05). More research into the multidimensional nature of compulsive exercise in clinical populations is needed. Further, research into compulsive exercise offers promise as an addition to existing cognitive behavioral models and treatments for eating disorders. [ABSTRACT FROM AUTHOR]

Perfectionism is a risk factor for the development and maintenance of eating disorders. The objective of this study was to examine the efficacy of unguided Internet cognitive behaviour therapy for perfectionism (ICBT-P) as a treatment and prevention for perfectionism and symptoms of eating disorders, anxiety, depression and self-esteem in female adolescents. Young women (N = 94, 14–19 years) who self-identified as having difficulties with perfectionism but did not have a clinical eating disorder diagnosis were recruited. Participants were randomly allocated into one of three groups: unguided ICBT-P, unguided ICBT for nonspecific stress management (ICBT-S), or waitlist control. All analyses were intent-to-treat. ICBT-P resulted in the most favorable outcomes at post-treatment and 3- and 6-months follow-up. ICBT-P was superior to control on all outcome measures at 3- and 6-months and superior to ICBT-S on all outcomes over most time points (d s = 0.13–0.94). Clinical significance analysis demonstrated that the treatment prevented symptom increases over 6-month follow-up, with ICBT-P superior to ICBT-S in prevention of clinical perfectionism and depressive symptoms, and ICBT-P superior to waitlist control in prevention of eating disorder symptoms. There was relatively high attrition, although there were no differences in attrition between the groups at 3- and 6-month follow-up and rates were commensurate with other Internet interventions. The findings support unguided ICBT-P as a useful target for preventing eating disorder and associated symptoms in female youth who self-identify as perfectionistic. ACTRN12615001098527. • Perfectionistic female adolescents with no eating disorder diagnosis participated. • Participants were randomized to three conditions. • Unguided Internet cognitive behaviour therapy for perfectionism (ICBT-P). • Unguided Internet stress management (ICBT-S) or waitlist control. • ICBT-P was superior to control on all outcome measures at 3- and 6-months. [ABSTRACT FROM AUTHOR]

Objective: The link between perfectionism and eating disorders is well established in adults, however little research has been conducted in children and adolescents. The aim was to examine if perfectionism was a predictor of eating disorder symptoms at intake assessment, and 6 and 12 month review.Method: There were 175 children and adolescents aged 10-17 years (M = 14.47 years, SD = 1.31) who were assessed using the Eating Disorders Inventory-3 perfectionism subscale and the child adapted Eating Disorders Examination at intake, 6 and 12 months review.Results: There was a significant association between perfectionism and symptoms of eating disorders at intake assessment and at 6 and 12 month review. Higher perfectionism at intake predicted a lower likelihood of remission at 12 months.Discussion: The findings suggest that similar to adult samples, perfectionism is significantly associated with eating disorder symptoms in children and adolescents. Further research is required to examine the impact of perfectionism on eating disorder symptoms in longitudinal research with children and adolescents with eating disorders. [ABSTRACT FROM AUTHOR]