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Anorexia nervosa is a serious illness leading to substantial morbidity and mortality. The Anorexia Nervosa Treatment of Outpatients (ANTOP) study is the largest randomised controlled trial (RCT) globally that uses psychotherapy in outpatients with anorexia nervosa. In this Article, we report the results of the 5-year follow-up.The ANTOP study is an open-label, multicentre RCT involving 242 adult female outpatients with anorexia nervosa. Participants were recruited from ten university hospitals in Germany, had to be aged at least 18 years and female, and have a diagnosis of anorexia nervosa with a body-mass index (BMI) of 15·0-18·5 kg/mBetween May, 2007, and June, 2009, we screened 727 patients for eligibility; at baseline, 242 patients with a mean BMI of 16·7 kg/mThe long-term results of the ANTOP trial confirm the improvement in BMI of patients with anorexia nervosa in all groups; however, a substantial proportion of patients had a poor global outcome. The predictors for the long-term course of anorexia nervosa in our ANTOP study show that we need to treat patients with anorexia nervosa at an earlier stage of the disease, with a clear focus on weight gain and considering other comorbidities (especially depression).German Federal Ministry of Education and Research.

ObjectivePrevious research suggests that patients with anorexia nervosa (AN) show an impaired capacity to mentalize (reflective functioning, RF). RF is discussed as a possible predictor of outcome in psychotherapeutic processes. The study aimed to explore RF in sessions of patients with AN and its association with outcome and type of treatment.MethodsA post-hoc data analysis of selected cases from a randomized trial on outpatient psychotherapy for AN was conducted. Transcripts from 84 sessions of 28 patients (early phase, middle phase, and end of treatment) were assessed using the In-Session-Reflective-Functioning-Scale [14 cognitive-behavior therapy, enhanced (CBT-E); 14 focal psychodynamic therapy (FPT); 16 with good, 12 with poor outcome after 1 year]. Relations between the level of RF, type of treatment, and outcome were investigated using mixed linear models. Additionally, associations with depressive symptoms, weight gain, and therapeutic alliance were explored.ResultsMean in-session RF was low. It was higher in FPT when compared to CBT-E treatments. The findings point to an association between RF increase and a positive outcome. An increase in BMI in the first half of treatment was associated with higher subsequent in-session RF. There was no association between RF and depressive symptoms or the therapeutic alliance.DiscussionPatients with AN show a low capacity to mentalize in sessions, which seems to be at least partly dependent on the degree of starvation. The results suggest a possible relationship between an increase in in-session RF and outcome, which has to be replicated by further studies.

Introduction: In January 2016, 2057 refugees from civil war-torn Syria and Iraq, aged 18.0 to 24.9 years, were first-time entrants into the German unemployment register and thus potentially eligible for the labor market. Civil war and forced migration may affect individuals' mental health. Traumatic experiences in particular are assumed to represent a major barrier, e.g., to labor-market integration. This study aimed to screen the rates of posttraumatic stress disorder (PTSD). Former refugee studies have reported PTSD screening rates between 3% and 44%. Method: A total of 8.5% (N = 175 of 2057) of respondents were randomly interviewed either by telephone or web-based interviews. A total of 84 respondents (48% out of 175 respondents) were screened using the Essen Trauma Inventory (ETI) based on the DSM-IV, and 91 (52%) respondents used the Short Screening Scale for Posttraumatic Stress Disorder (SSS-PSD). All respondents were additionally questioned regarding psychological impairment (Symptom Checklist 10) and health status (Short Form 12). Results: Of the respondents, 59.4% reported at least one traumatic experience. The percentage of positive PTSD screenings obtained using the ETI was 9.5% (N = 84) and 6.6% (N = 91) using the SSS-PSD. The percentage of positive PTSD screenings obtained with both screening instruments was 8% (N = 175; 95%-CI: 3.9% to 12.1%). A total of 19.4% of the subjects were above the SCL-10 cut-off for psychiatric caseness. Discussion: The PTSD rate in this sample was in the average range compared to previous estimates from large samples of refugees. Psychiatric caseness was high. The results should be considered for planning labor-market integration programs and the design of supportive schemes. Keywords: Posttraumatic Stress Disorder, PTSD, Psychopathology, Refugee, Unemployment

This study investigates the role of body image self-appraisal in predicting the outcomes of outpatient psychotherapy in patients with anorexia nervosa (AN). Multiple linear regression analyses and a path-analysis model were applied to test the study hypotheses that body image at baseline predicts treatment outcomes of outpatient psychotherapy in patients with AN at follow-up measurement. The analyses were conducted as secondary analyses in a subgroup (n = 148) of the anorexia nervosa treatment of outpatient-cohort (ANTOP-study) (N = 242) of patients with AN. The results show that Negative Evaluation of the Body at baseline predicts perceived stress during psychotherapy, which in turn predicts depressive symptoms at the end of therapy which in turn predicts the outcomes body mass index and EDI-2 sum score at 12 months follow-up. The results underline the importance of body image disturbance in the course of AN and call for body image as a central target of psychotherapeutic interventions in patients with AN.

Introduction Psychosocial resources like social support or intrapersonal coping skills play an important role in resilience and quality of life (QOL), yet research systematically investigating the availability of different resources and QOL in transgender (trans) women is missing. Aim The present study aimed to systematically investigate the existence of different psychosocial resources and QOL in trans women following gender-affirming surgery (GAS). Methods Using a cross-sectional design, 557 trans women who had received GAS at the local urological department were invited to study participation. Criteria for study inclusion were 18 years and older, diagnosis of transsexualism according to the International Classification of Disease, completion of all sessions of GAS, and given written informed consent to study participation. Main Outcome Measures Psychosocial resources were assessed using the Essen Resource Inventory (ERI), the Sense of Coherence Scale, and the Social Support Scale. QOL was assessed with the Short Form Health Survey. Data from trans women were compared to normative data of healthy non-trans women as reported in the respective test manuals. Results In total, 158 trans women responded and participated in this study. They had received GAS 4 months to 21 years ago. The total sample was divided into 3 subgroups depending on the time interval since the participants’ last GAS procedure (group 1: GAS 0.3−3 years ago (n = 48); group 2: GAS 3.1−10 years ago (n = 62); and group 3: GAS 10.1−21 years ago (n = 41)). Trans women retrospectively indicated their available resources 3 years ago (ERI 3-years) and in the last 4 weeks (ERI 4-weeks). Trans women who had received GAS within the last 3 years (group 1) showed an increase in resources when comparing ERI 3-year scores (presurgery) with ERI 4-week scores (postsurgery). No differences emerged for group 2 and group 3. Compared to normative data from non-trans women, trans women scored significantly lower on the ERI but not in measures of Social Support Scale or Sense of Coherence Scale. Compared to non-trans women, mental QOL was significantly impaired in trans women, whereas no differences in physical QOL emerged. Clinical Implications As this study hints towards reduced psychosocial resources in trans women, the offering of specialized counseling can have high beneficial potential to support the development of resources, thereby enhancing QOL. Strength & Limitations Data of a large sample of trans women is provided who were investigated up to 21 years after GAS. The study is limited by its cross-sectional design and the response rate of 42%. Conclusion This study indicates that psychosocial resources improve around the time of GAS and seem to be improved and sustained in later years following GAS. Still, compared to non-trans women, trans women have a lower availability of resources and a lower mental QOL.

ZusammenfassungDie Kunsttherapie ist eine klinisch anerkannte Therapiemethode, jedoch gibt es immer noch sehr wenige Studien, die sich mit der Wirksamkeit, Wirkfaktoren oder Wirkweisen der Kunsttherapie auseinandersetzen. Insbesondere fehlt bis zum heutigen Zeitpunkt ein speziell für die Kunsttherapie zugeschnittenes und psychometrisch überprüftes Forschungsinstrument, welches Erlebensdimensionen der Kunsttherapiegruppe aus Patientensicht misst. Ein solches Messinstrument könnte Hinweise auf deren Wirksamkeit geben, kunsttherapeutische Gruppenprozesse besser verstehen lassen und zur Qualitätssicherung dienen. Ziel der vorliegenden Untersuchung war die Entwicklung und Validierung des Fragebogens zum Erleben der Kunsttherapiegruppe aus Patientensicht (FEKTP). Dieser Fragebogen basiert auf Grawes und Yaloms Konzepten zu gruppentherapeutischen Wirkfaktoren. Es nahmen 133 Patienten an der Studie teil und beantworteten den FEKTP direkt nach der 6. Kunsttherapiesitzung. Die Patienten bearbeiteten zusätzlich etablierte Symptom- und Erfahrungsfragebögen zu Beginn und zum Ende der Behandlung. Die Faktorenanalysen ergaben eine eindeutige Faktorenstruktur des FEKTP, welche die theoretisch angenommenen Subskalen zum Großteil einordnet. Die testpsychometrischen Hauptgütekriterien des FEKTP (Reliabilität, Validität und Objektivität) lassen sich als gut bis akzeptabel einordnen. Die Kriteriumsvalidität sollte aber in zukünftigen Studien nochmals genauer überprüft werden. Somit liegt nun auch für die Kunsttherapie ein valides Instrument zur systemischen Erfassung von allgemeinen Wirkfaktoren vor. Die Anwendung empfiehlt sich im Forschungs- als auch im Versorgungskontext.

Objectives: The purpose of this study is to examine the use of assistive technology, social support in everyday life and psychological existential orientation for individuals with physical disabilities. Methods: Forty-six elderly persons with physical disabilities (aged 73.7±10.6 years, range 53-93 years) were examined with regard to the use of assistive technology, social support in everyday life and psychological existential orientation by an extensive questionnaire set (questionnaire for assistive technology (AT-24), questionnaire for social support (F-SOZU-K-22) and Brief Symptom Inventory (BSI)). Results: The subjects stated that they needed aid and social support in order to carry out their daily indoor/outdoor activities (for e.g. dressing, having a bath / shower, using toilet, eating, going up / down the stairs, shopping, or going out). The most commonly used mobility aid was the walking frame that accounted for 61.9%, followed by the walking stick with 40.5% and a bathtub lift with 21.4%. The results also showed the psychopathological symptoms in the sample. Discussion: Assistive technologies together with the support of relatives and care services help people to cope with a variety of activities in their daily lives with fewer restrictions. The effectiveness of the aids differs between participants because it depends on several factors such as health, knowledge, and information about aids, as well as the appropriate selection of aids.

Die Lebensqualitat von Menschen mit psychischen Storungen ist in der Regel stark reduziert und sollte wahrend der Behandlung mit berucksichtigt werden. Der vorliegende Beitrag bietet eine Ubersicht uber Studien zur Effektivitat von psychotherapeutischen Interventionen zur Verbesserung der Lebensqualitat von Betroffenen mit Essstorungen. Eine umfassende elektronische Literaturrecherche ergab 10 Studien, die den Ein- und Ausschlusskriterien unserer Arbeit entsprachen und integriert wurden, 3 davon waren randomisierte Kontrollstudien. Die Art der Interventionen sowie die Messinstrumente zur Erfassung der Lebensqualitat unterschieden sich stark zwischen den Studien. Insgesamt zeigte sich eine signifikante Verbesserung der Lebensqualitat durch psychotherapeutische Behandlung. Jedoch besteht weiterhin die Frage, welche Faktoren in der Psychotherapie zur Verbesserung der Lebensqualitat beitragen. Die Durchfuhrung weiterer randomisierter Kontrollstudien mit standardisierten methodischen Messverfahren wird empfohlen, auch um den Langzeiteffekt von Psychotherapie auf die Lebensqualitat bei Essstorungen zu untersuchen.

Das Ziel dieser Arbeit war der Vergleich von Psychotherapiepatienten im Kindes- und Jugendalter mit Schülern bezüglich der Prävalenz potentiell traumatischer Ereignisse, der posttraumatischen Symptomatik und der psychischen Belastung. Zudem wurden der Einfluss kumulativer Traumata auf posttraumatisches Erleben und mögliche Prädiktoren einer PTBS untersucht. Mit Hilfe des Essener Trauma-Inventars für Kinder und Jugendliche (ETI-KJ) und der Symptom Check-Liste 27 (SCL-27) wurden 96 Therapiepatienten mit 99 Schülern im Alter von 12 bis 17 verglichen. Hinsichtlich der Prävalenz potentiell traumatischer Ereignisse konnte kein Unterschied zwischen den Gruppen festgestellt werden. Patienten berichteten häufiger von interpersonellen Traumata und waren von einer höheren Anzahl persönlich erlebter Traumata betroffen. Für beide Gruppen erwiesen sich Alter, weibliches Geschlecht, die Anzahl traumatischer Erlebnisse sowie sexueller Missbrauch als signifikante Prädiktoren für die PTBS-Symptomatik. Kumulative und interpersonelle Traumata führen zu schweren psychosozialen Folgen bei Kindern und Jugendlichen. Daher gilt es diese standardmäßig zu eruieren und die Chronifizierung einer PTBS zu vermeiden.

BackgroundAnorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive–behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.MethodThe analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost–utility and assumptions underlying the base case were investigated in exploratory analyses.ResultsCosts of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained ConclusionsDepending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study

Body image disturbance represents a central characteristic of anorexia nervosa (AN). Depression and anxiety are the most common mental comorbidities in patients with AN. This study aims to investigate the relationship of body image with symptoms of depression and anxiety during outpatient psychotherapy in AN. Analyses were conducted using the data set of the Anorexia Nervosa Treatment Outpatient Study (ANTOP) randomized controlled trial. The ANTOP study included N = 242 females with AN between 18 and 56 years of age. The trial was designed to compare enhanced cognitive behavioral therapy (CBT-E) and focal psychodynamic therapy (FPT) with optimized treatment as usual (TAU-O) for patients with AN. The analyses on body image dimensions were conducted using measures of correlations and multiple linear regression analyses to assess the relationship and longitudinal prediction of symptoms of depression and anxiety by body image dimensions. Results showed that body image perceptions were significantly associated with symptoms of depression and anxiety in patients with AN at all treatment stages. In addition, body image dimensions at early treatment stages predict depression and anxiety in follow-up measurements. The correlation of symptoms of depression and anxiety by body image perceptions increased along treatment course. The persistence of body image disturbance, while body mass index increases under treatment (persistency effect), may constitute a relevant factor contributing to the course of the most common affective comorbidities of depression and anxiety in patients with AN. Body image disturbances in patients with AN should therefore be explicitly targeted within the specialized psychotherapy of affected patients. (PsycINFO Database Record

The aim of the present prospective-naturalistic study was the evaluation of psychosomatic inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN). 128 patients with eating disorders (n=59 AN and n=69 BN) were investigated on admission and discharge using the following standardized questionnaires: eating disorder symptoms (EDI), general psychopathology (BSI), quality of life (SF-12), and personal resources (SOC-13, SWE). Moderate to large effect sizes were achieved for the eating disorder symptoms; in addition, general psychopathology was substantially reduced at the end of treatment, and quality of life as well as personal resources were enhanced. Personal resources were found to be the strongest predictors for therapy outcome. Based on our data, important insights and recommendations may be gained for the inpatient treatment of eating disorders, especially with regard to the potential influence of personal resources.

It was analysed if the weight course in the first half of a four-step psychosomatic treatment program for inpatients with Anorexia nervosa (AN) was useful to predict premature termination of treatment. The weight courses, sociodemographic and disorder-related data of 121 female adult inpatients were investigated. 39% of the studied patients did not reach their target weight (not completers). 61% of the patients completed all four steps of treatment (completers). The not completers showed significant more time with weight losses in the first step and had more and bigger weight losses in the second step of treatment than the completers. Furthermore, they had fewer comorbid depression. In contrast to the sociodemografic and disorder-related data, the weight courses in the first treatment half were very useful to predict premature termination of treatment for inpatients with AN.

Anliegen Wir untersuchten den Zusammenhang zwischen dem Ausmas der religiosen Bindung, der allgemeinen psychischen Symptombelastung und unterschiedlichen Aspekten der Integration bei turkischen / kurdischen Migranten in der Primarversorgung. Methode Es wurde ein Vergleich der Migrantengruppe (n = 179, Alter M = 39,4 Jahre, 65,0 % weiblich) mit deutschen dermatologischen Patienten (n = 184, Alter M = 43,1 Jahre, 60,9 % weiblich) bezuglich der Religiositat hergestellt. Ergebnisse Im Durchschnitt lebten die Migranten seit 24,98 Jahren (SD = 8,90) in der BRD. Im Vergleich zur deutschen Vergleichsgruppe schatzten sich die Migranten hochsignifikant religioser ein (p

OBJECTIVE The aim of the current study was to examine the occurrence of sense of coherence (SOC) and the relationship between SOC and anxiety, depression, somatoform complaints and life satisfaction in female bulimia nervosa (BN) outpatients. METHODS In a consecutive cross-sectional study 73 BN outpatients (age 26.9 years, SD 7.8) were assesssed with the Sense of Coherence Scale (SOC-13), the Hospital Anxiety and Depression Scale (HADS-D), and the Screening for Somatoform Disorders (SOMS-2). RESULTS The BN outpatients showed highly reduced SOC in comparison to the reference group (M = 45.09 vs. M = 71.23; p < or = 0.001). SOC significantly correlated inversely with depression and somatoform complaints. Additionally, there was a positive correlation between SOC and life satisfaction (r = 0.467; p < or = 0.001). Interestingly, SOC was not significantly correlated with anxiety. CONCLUSIONS The results support the thesis that female BN outpatients could benefit from an enhancement of SOC particularly with regard to depression and somatoform complaints.

In a consecutive cross-sectional study 195 Turkish/Kurdish patients from seven general practices (40.5 +/- 13.3 years, 63.6 % female) were examined with regard to traumatisation and psychological distress with the Essen Trauma Inventory (ETI) and Hospital Anxiety and Depression Scale (HADS). In mean the average duration of living in Germany was 25,3 years (SD = 8.9). 53.3 % reported at least one traumatic event in their life. Of those who experienced a traumatic event, 19.6 % met testpsychometric a positive diagnosis of PTSD. In general, patients with PTSD were more likely to report more about doctor visits (p

We present results of an investigation dealing with psychological strain in soldiers following a foreign assignment. There are few studies in German-speaking countries concerned with prevalence of traumatic events and posttraumatic stress disorder in soldiers. A total of 118 soldiers were questioned (age: 20 - 46; 2,6 % female). The following questionnaires were used in the survey: Essener Trauma Inventory (ETI), Posttraumatic Symptom Scale (PTSS-10), Impact of Event Scale-Revised (IES-R), Symptom Check List 27 (SCL-27), Patient Health Questionnaire (PHQ-D) and Breslau's short screening scale for PTSD. Prevalence of Posttraumatic Stress Disorder (PTSD) in soldiers following foreign assignment ranged from 0.8 % to 2.5 % depending on the Scale used. 19.5 % had symptoms of depression or dysthymia. 15 % had an alcohol syndrome according to den PHQ-D. Contrary to our expectations the PTSD prevalence was lower than in the general population or other military samples.

This study aimed to determine predictors of BMI and recovery for outpatients with anorexia nervosa (AN). Patients were participants of the ANTOP (Anorexia Nervosa Treatment of Out-Patients) trial and randomized to focal psychodynamic therapy (FPT), enhanced cognitive behavior therapy (CBT-E), or optimized treatment as usual (TAU-O). N=169 patients participated in the one-year follow-up (T4). Outcomes were the BMI and global outcome (recovery/partial syndrome/full syndrome) at T4. We examined the following baseline variables as possible predictors: age, BMI, duration of illness, subtype of AN, various axis I diagnoses, quality of life, self-esteem, and psychological characteristics relevant to AN. Linear and logistic regression analyses were conducted to identify the predictors of the BMI and global outcome. The strongest positive predictor for BMI and recovery at T4 was a higher baseline BMI of the patients. Negative predictors for BMI and recovery were a duration of illness >6 years and a lifetime depression diagnosis at baseline. Additionally, higher bodily pain was significantly associated with a lower BMI and self-esteem was a positive predictor for recovery at T4. A higher baseline BMI and shorter illness duration led to a better outcome. Further research is necessary to investigate whether or not AN patients with lifetime depression, higher bodily pain, and lower self-esteem may benefit from specific treatment approaches.

Hintergrund: Das Ziel der vorliegenden Arbeit war die Validierung des Essener Lebensqualitats-Index (ELI), eines kurzen storungsspezifischen Fragebogens zur Erfassung der Lebensqualitat bei Personen mit Essstorungen. Die Gesamtstichprobe setzte sich aus n=182 aktuellen und ehemaligen Essstorungspatientinnen sowie n=87 gesunden Kontrollpersonen zusammen. Alle Probandinnen beantworteten den ELI sowie andere testtheoretisch gut abgesicherte Instrumente (EDQOL, SF-12, EDI-2, FKB-20, SEED, BSI, IIP-D und SOC-13). Zusatzlich wurde eine Teilstichprobe von n=46 Essstorungspatientinnen nach Beendigung der Therapie erneut mit den genannten Instrumenten untersucht. Fur die Gesamtstichprobe zeigte sich ein sehr guter Reliabilitatskennwert von α=0,96. Erwartungskonform ergab sich ein Hauptfaktor mit einer hohen Varianzaufklarung von 71,25%. Es zeigten sich Hinweise auf eine sehr gute Konstruktvaliditat und Veranderungssensitivitat. Der ELI kann somit als okonomischer, reliabler und valider Fragebogen zur Messung der storungsspezifischen Lebensqualitat von Betroffenen mit Essstorungen eingesetzt werden. Seine Anwendung empfiehlt sich sowohl im Forschungs- als auch im Versorgungskontext.

Background: The lifetime prevalence of DSM-IV traumatic events and posttraumatic stress disorder (PTSD) was assessed in outpatients of a tertiary referral mental health center; differences in psychopathology and service utilization between PTSD and non-PTSD patients were evaluated. Methods: Five hundred eighty-three outpatients (35.3 years, S.D.=12.5; 74.3% women and 25.7% men), who had been initially examined by clinically experienced medical and psychological psychotherapists, were investigated by means of standardized trauma-specific questionnaires. Results: Of the patients, 61.1% reported at least one traumatic event during their lifetime, but only 34.3% of the total sample met the DSM-IV (A1 and A2) criteria. The lifetime prevalence of PTSD-positive screening was 10.1%. In 2.7% of these patients, PTSD had been diagnosed in clinical routine (ICD-10: F43.1); 6.6% of the men and 11.3% of the women met the diagnostic criteria for lifetime prevalence of PTSD. All in all, patients with PTSD had higher levels of depression and anxiety and lower levels of sense of coherence (P

In a cross-sectional study, 483 patients (age: 35.8 +/- 13.2 years) of an outpatient psychosomatic university clinic were investigated using a standardized disorder-specific set of tests. 63.1 % of the patients reported to have experienced at least one traumatic event in their life. Test-psychometrically, a posttraumatic stress disorder (PTSD) could be assumed in 10.1 %. Compared to non-traumatized patients, patients with a PTSD reported significantly more frequently somatoform symptoms; even the comparison of traumatized patients with and without PTSD demonstrated a pronounced tendency to somatize in PTSD patients. Neurologic, gastrointestinal and cardiopulmonary symptoms, as well as pain sensations and sexual dysfunctioning were predominantly reported as somatoform complaints. The results emphasize the close connection between somatization and PTSD symptoms; this should be increasingly taken into consideration in the diagnostic process within psychotraumatology.

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.

The gastrointestinal peptide hormone ghrelin promotes food intake and increases body weight and adiposity through activation of the growth hormone secretagogue receptor (GHSR1a). To promote its biological action ghrelin is acylated at its serine 3 residue by the recently discovered ghrelin O-acyltransferase (GOAT, a.k.a. membrane-bound O-acyltransferase 4, MBOAT4). Plasma levels of total and acyl-ghrelin are negatively correlated with body-mass-index (BMI); as lower the BMI as higher plasma levels of total and acylated ghrelin and vice versa. Accordingly, plasma levels of total and acyl-ghrelin are elevated in patients with anorexia nervosa (AN) and decline upon weight regain. The importance of the endogenous Goat/ghrelin system in the neuroendocrine adaptation to fasting was recently highlighted by the observation that acyl-ghrelin mediated elevation of growth hormone (GH) release prevents starvation induced hypoglycemia in Goat(-/-) mice. The aim of this study was to test if genetic variation of GOAT is implicated in the etiology of AN. We therefore assessed association of 6 tagging single nucleotide polymorphisms (tagSNPs), which were predicted to cover 96% the common genetic variability of GOAT plus 50 kb of the 5' and 3' flanking region, in 543 German patients with AN and 612 German normal and underweight healthy controls. Based on a recessive mode of inheritance we observed some evidence for association of the G/G genotype at SNP rs10096097 with AN (nominal two-sided p = 0.031). Based on our results we conclude that genetic variation in GOAT might be implicated in the etiology of AN.

Fragestellung: Angesichts der klinischen und wissenschaftlichen Bedeutung traumatischer Ereignisse und posttraumatischer Störungen hatte unsere Studie die Entwicklung und Überprüfung des Essener Trauma-Inventars für Kinder und Jugendliche (ETI-KJ) zum Ziel. Das neue Instrument erfasst ein breites Spektrum an potenziell traumatischen Ereignissen und soll ein geeignetes Screeningverfahren zur Identifikation der beiden Traumafolgestörungen Akute Belastungsstörung und Posttraumatische Belastungsstörung nach DSM-IV darstellen. Methodik: Das ETI-KJ wurde an einer Stichprobe von 276 Kindern und Jugendlichen zwischen 12 und 17 Jahren im Hinblick auf seine psychometrischen Kennwerte an klinischen und nicht klinischen Gruppen überprüft. Ergebnisse: Es fanden sich gute bis sehr gute Reliabilitätskennwerte, insbesondere für die Gesamtskala des ETI-KJ ergab sich eine sehr hohe interne Konsistenz. Die a priori angenommene Vier-Faktoren-Struktur (Intrusion, Vermeidung, Hyperarousal, Dissoziation) fand empirische Bestätigung. Hinweise auf eine sehr gute Konstruktvalidität zeigten sich durch signifikante Korrelationen des ETI-KJ mit weiteren Traumaskalen, Maßen der psychischen Befindlichkeit und der Ressourcenausstattung. Schlussfolgerungen: Mit dem ETI-KJ liegt im deutschen Sprachraum erstmals ein ökonomisches, reliables und valides Screeninginstrument zur differenzierten Erfassung traumatischer Ereignisse und posttraumatischer Störungen vor, dessen Einsatz sich sowohl im Forschungs- als auch im klinischen Kontext empfiehlt.

The aim of the study was the translation and validation of a disease-specific questionnaire (Eating Disorders Quality of Life, EDQOL) to measure the health-related quality of life of eating-disordered patients. 195 patients with eating disorders and 109 healthy controls were examined by EDQOL and other instruments (SF-12, EDI, FKB-20, SEED, BSI, IIP-D and SOC-13). The EDQOL total score proved to have a high internal consistency. The four factorial structure of the original version was confirmed. There were indications of very good construct validity and a good sensitivity for change. For the first time, in the German-speaking part there is an economic, reliable and valid instrument that assesses the specific health-related quality of life for patients with eating disorders which is recommended for use in research as well as in clinical settings.

Objective The central aim of the study was to assess the frequency of traumatic events and comorbid posttraumatic stress disorder (PTSD) in women with eating disorders (EDs). In addition, the frequency of somatoform complaints was investigated in patients with PTSD compared to those without PTSD. Method 101 ED patients (26.4 years, SD = 7.4) from an outpatient department were investigated by means of standardized questionnaires. Results 63.3% of the anorexic and 57.7% of the bulimic patients had experienced at least one trauma in their life. 10% of the anorexic and 14.1% of the bulimic patients fulfilled the study definition for a current diagnosis of PTSD. Patients with a comorbid PTSD reported somatoform symptoms more frequently than patients without PTSD (p

The controlled study examined the distortion of hunger und satiation in 12 patients with restrictive AN (BMI = 14.0; SD: 1.78; age 27.4 years; SD = 10.5) and 13 healthy and not eating-disordered normalweight controls (BMI = 21.3; age 25.3 years; SD = 3.4) by visual confrontation with food stimuli in different states of nutrition. During fasting patients with AN describe less hunger-feelings. In contrast to healthy women pictures of food and the anticipation of the consumption of hot chocolate are not experienced enjoyable, but aversive. Visual confrontation of food has a satiable effect on anorexic patients. Healthy women, however, indicate a moderate decrease in hunger feelings. After eating ad libitum satiety of healthy women reach a plateau instead of further eating. Anorexic patients initially feel hungry, a stable level of satiety, however, cannot be obtained. The visual confrontation with food is experienced aversively and satiably. These results leads us to assume a cognitive allocation of satiation ratings. The dysfunctional cognitive allocation of satiation ratings may represent a mean to maintain a food-avoidance.

Objective The aim of the present study was to find factors that predict the short-term outcome of inpatients with anorexia nervosa (AN). Method Female inpatients with AN (N = 100) were divided into treatment completers (N = 50) and drop-outs (N = 50). Using stepwise linear regression the relationship of demographic data, illness history and patterns of weight gain to BMI gain up to discharge were analysed. Results Among drop-outs, 69% of the variance in BMI gain up to discharge was explained by length of the first half of treatment (FHT), average weekly BMI gain and average weight loss during FHT. Among completers, 52% of the variance in BMI gain up to discharge was explained by BMI at admission and average weekly BMI gain during the second half of treatment (SHT). Discussion Weight curves offer important information about short-term outcome for patients with AN. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.

Fragestellung: Im Rahmen einer Studie zur Versorgungsforschung untersuchten wir (1) die Haufigkeit traumatischer Ereignisse und posttraumatischer Belastungsstorung (PTSD) der grosstadtischen Inanspruchnahmeklientel einer psychosomatisch-psychotherapeutischen Ambulanz einer Universitatsklinik mit regionalem Versorgungsauftrag und (2) in welcher Beziehung Traumata und PTSD mit Somatisierung, Depressivitat, Angst und dem Koharenzgefuhl stehen. Methodik: In einer konsekutiven Querschnittsstudie wurden 583 ambulante Patienten (Altersmittelwert 35,3 Jahre, SD 12,5) mit der Posttraumatic Diagnostic Scale (PDS), der Impact of Event Scale (IES-R), der Hospital Anxiety and Depression Scale (HADS-D), dem Screening fur somatoforme Storungen (SOMS) und dem Fragebogen zum Sense of Coherence (SOC) untersucht. Ergebnisse: 63,1% der Patienten gaben zwar an, mindestens ein traumatisches Erlebnis in ihrem Leben gehabt zu haben, jedoch nur 34,3% der Gesamtstichprobe erfullten das Traumakriterium nach DSM-IV. Frauen und Manner unterschieden sich nicht im Hinblick auf Trauma- und PTSD-Pravalenz voneinander. 10,1% der Patienten waren PTSD-positiv. Patienten mit PTSD-positivem Screening zeigten gegenuber Traumatisierten ohne PTSD und Nicht-Traumatisierten die hochsten Werte in Somatisierung (p

Hintergrund und Ziele: Fur Erkrankungen, die nicht durch eine erhohte Mortalitat gekennzeichnet sind, ist die gesundheitsbezogene Lebensqualitat (HRQOL) ein wichtiger Indikator der Schwere der Erkrankung. Ziel war die Untersuchung der Bedeutung der HRQOL adjustiert nach Angst und Depression bei Patienten mit funktioneller Dyspepsie (FD) oder chronischer Lebererkrankung (CLD). Methodik: 100 konsekutive Patienten mit FD und 195 Patienten mit CLD wurden an zwei tertiaren Versorgungszentren untersucht. FD wurde anhand der gultigen Rom-II-Kriterien diagnostiziert. CLD wurde klinisch und histologisch diagnostiziert und klassifiziert (53,6% mit Zirrhose, 21,4% Child-Pugh A, 14,8% Child-Pugh B, 17,3% Child-Pugh C). Der Short Form Health Survey (SF-36) zur Erfassung der HRQOL und die Hospital Anxiety and Depression Scale (HADS) zur Erfassung von Angst und Depression wurden benutzt. Ergebnisse: Es gab keine signifikanten Unterschiede bezuglich Depression, aber FD-Patienten waren deutlich angstlicher als CLD-Patienten (9,6–2,6 vs. 7,0–4,7, p≤0,0001). FD-Patienten hatten eine bessere Korperfunktion (75,8–21,8 vs. 59,5–29,7, p≤0,0001), aber deutlich hohere Schmerzscores als CLD-Patienten (39,5–24,0 vs. 56,1–31,5, p≤0,0001). Soziale Rollenfunktion (56,6–26,7 vs. 67,0–30,4, p≤0,004) und mentaler Gesundheitsstatus (52,3–19,4 vs. 61,7–21,7, p≤0,0001) lagen bei FD- deutlich unterhalb der CLD-Patienten. Der mentale Gesamtscore war bei FD- im Vergleich zu CLD-Patienten deutlich reduziert (38,8–11,8 vs. 43,0–12,1, p≤0,0007). Diese Scores lagen bei FD- noch unterhalb derjenigen von Child-C-CLD Patienten. Diese Unterschiede blieben auch nach Adjustierung fur Alter, Geschlecht und HADS deutlich signifikant. Schlussfolgerung: Die HRQOL ist bei FD- im Vergleich zu CLD-Patienten, auch im fortgeschrittenen Erkrankungsstadium, deutlich reduziert. Angst scheint unabhangig mit FD assoziiert zu sein.