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Objectives In a clinical population, we estimated the frequency of mood disorders among 271 patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in comparison to a control group matched for age and gender. Method The frequency of mood disorders was measured using the Mini International Neuropsychiatric Interview (MINI), DSM-IV version. Results Mood disorders were more frequent among eating disorder (ED) patients than among controls, with a global prevalence of the order of 80% for each ED group. The majority of the mood disorders comorbid with ED were depressive disorders (MDD and dysthymia). The relative chronology of onset of these disorders was equivocal, because mood disorders in some cases preceded and in others followed the onset of the eating disorders. Limitations Our sample was characterized by patients with severe ED and high comorbidities, and thus do not represent the entire population of AN or BN. This also may have resulted in an overestimation of prevalence. Conclusion Mood disorders appear significantly more frequently in patients seeking care for ED than in controls. These results have implications for the assessment and treatment of ED patients, and for the aetio-pathogenesis of these disorders.

Objective Expressed Emotion has been called a “black box”, since little is known about contributing factors. The aim of this study was to examine which parental and which patient/illness-related characteristics contribute to maternal and paternal Expressed Emotion levels. Method Sixty adolescent girls with Anorexia Nervosa (AN) and their parents completed instruments that evaluate characteristics of the adolescent's illness and patient/parental psychological characteristics (depression; anxiety; obsession–compulsion; social anxiety and alexithymia). The following illness-related characteristics were recorded: age at AN onset, duration of illness, AN subtype (restrictive AN-R vs. purging type AN-B), current Body Mass Index (BMI) (in kg/m2), minimum lifetime BMI and number of previous hospitalizations, the Global Outcome Assessment Scale total score. Levels of Expressed Emotion were assessed for the two parents using the Five-Minute Speech Sample. Results Less than 30% of the parents in our sample expressed high levels of Critical EE and Emotional Over-Involvement. Our main findings indicate that maternal Criticism (Critical EE levels, Critical Comments, Dissatisfaction) and the sub-dimensions of maternal Emotional Over-Involvement (EOI EE) (Statement of loving Attitudes and Excessive Details about the past) were related both to the severity of the daughters' clinical state and to maternal psychological functioning. Only paternal levels of anxiety explained paternal Dissatisfaction, EOI EE and Statement of loving Attitudes. Discussion Parental psychological functioning and the severity of the daughters' clinical state have an impact on the family relationships. These elements should be targeted by individual treatment for parents where necessary, and by psycho-educational sessions about Anorexia Nervosa for parents generally.

Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22 years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12 years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

In studies on family therapy in Anorexia Nervosa, family relationships, as assessed by Expressed Emotion, have been associated with outcome. Our aim was to explore the contribution of Expressed Emotion as a predictor of 18-month outcome, above and beyond the usual predictive factors. Sixty adolescent girls suffering from Anorexia Nervosa and their parents were assessed at baseline and 18 months later. Levels of Expressed Emotion were evaluated in both parents with the Five-Minute Speech Sample. After controlling for treatment group and initial clinical status, high maternal Emotional Over-Involvement at baseline was significantly associated with better clinical state. More precisely, high maternal Emotional Over-Involvement was associated with higher nutritional status, lower eating disorder severity and fewer re-hospitalizations 18 months later. No associations were found with paternal levels of Expressed Emotion. Therefore, our study confirmed the importance of taking into account both maternal and paternal Expressed Emotion. Our results also underlined that high maternal Emotional Over-Involvement plays a positive role in the outcome of Anorexia Nervosa and needs to be explored further.

Objective: To determine whether the presence of anxiety disorders is related to depressive comorbidity in subjects with eating disorders (ED), while taking into account certain variables that may be related to depression (subjects’ age, ED duration, prior incidents of anorexia nervosa in bulimic subjects, inpatient or outpatient status, nutritional state [as measured by body mass index]). Method: We evaluated the frequency of depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview, DSM-IV version. Results: A multivariate analysis reveals that anxiety disorders do not all have the same influence in terms of risk of onset of major depressive episode in anorexics and bulimics when adjusted on variables related to depression. Conclusion: Depression in subjects with ED can be explained in part by comorbidity with obsessive-compulsive disorder, generalized anxiety, social phobia, and panic disorder. D 2006 Published by Elsevier Inc.

Working alliance has shown a predictive value of the outcome in different therapeutic settings but was not yet studied in a non-medical setting. The predictive value and the factor structure of the Working Alliance Inventory (WAI) [36-item client version; as reported by Horvath and Greenberg (J Couns Psychol 36:223–233, 1989)] were studied in a French primary care setting on a sample of 130 adults accessing social services. The WAI total score completed after the first meeting was positively predictive of quality of the working alliance 4 months later. An exploratory factor analysis produced two orthogonal factors which explained 45.12% of the total variance: a first factor (23 items) labelled ‘positive expectations about the usefulness of help’ and a second factor (13 items) labelled ‘absence of suspicion about the effects of help’. The WAI is shown to be applicable to primary care social work settings to measure the working alliance phenomenon and predict disruption of practitioner–client relationship.

Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxiety disorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxiety disorders significantly more frequent among women with an eating disorder than among women from the community? We assessed the frequencies of six specific anxiety disorders among 271 women with a current diagnosis of anorexia or bulimia nervosa and 271 controls, using the Mini-International Neuropsychiatric Interview, French DSM-IV version. A lifetime comorbidity with at least one anxiety disorder was found in 71% of both the anorexic and the bulimic subjects, significantly higher than the percentage of controls with an anxiety disorder. The prevalence was significantly higher in the eating disorder groups than in controls for most types of anxiety disorder, and between 41.8 and 53.3% of comorbid cases had an anxiety disorder preceding the onset of the eating disorder. Anxiety disorders are significantly more frequent in subjects with eating disorders than in volunteers from the community, a finding that has important etiological and therapeutic implications.

Sixty preschool children (31 boys, 29 girls, 5–6 years old), 60 young adults (30 men, 30 women, 20–45 years old), and 66 older adults (23 men, 43 women, 60–94 years old), bisected 11 lines of diffe...

In a sample of 807 normal preschool children aged from 3 to 6, examined eye dominance was not associated with the declared eye dominance of their parents. Forty percent of the children showed left-eyedness. Eyedness was associated with handedness and not significantly related to age group or sex. A strong relationship between the answers of the two parents concerning eye preference was observed. Two hundred forty-four children were followed-up for 2 years. The examinations were carried out once every 6 months. Two thirds of the children showed perfect stability in eye dominance. There was some evidence that stability in eye use tends to increase with age and to be lower in left-handed children with left-handed parents. There is, at present, very little evidence of a positive association between eye dominance in parents and that in their children.

This paper presents some methodological and theoretical issues based on a longitudinal study, performed in schools, on hand preference of 256 children, initially aged 3–6 years. Three phenomena are observed: (1) the well-known asymmetry of the hand preference distribution, which probably depends on biological factors; (2) a weak “towards the right” tendency with increasing age, which could be explained by environmental factors; and (3) a strong increase in the degree of hand preference with age which could be a consequence of the subject's own activity. Handedness is considered here as a possibly interesting model to delineate the respective role of biological, environmental, psychological, and pathological factors involved in a simple human behaviour.

UNLABELLED: Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in 'real world practice' in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated. OBJECTIVE: To compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT). METHOD: Sixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization. RESULTS: At 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10(th) percentile) and menstrual status. CONCLUSIONS: Adding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN. TRIAL REGISTRATION: Controlled-trials.com ISRCTN71142875.

Whereas severe relationship dysfunction in BPD is well described in adolescence, little is known about the way these patients process facial expressions of emotion. Because few data are available regarding this issue, the present study compared the sensitivity to morphed facial emotional expressions of 22 BPD female adolescents versus 22 matched controls. Participants had to identify as rapidly as possible the various emotions displayed progressively and continuously on faces. Results indicate that adolescents with BPD are less sensitive to facial expressions of anger and happiness, i.e. they require more intense facial expressions than control participants to correctly identify these two emotions. However, they did not exhibit any deficit in recognizing fully expressed emotions. These results suggest that sensitivity to facial emotions is impaired in adolescents with BPD. Theoretical and clinical implications are discussed.

Background: Bonding and expressed emotion (EE) are two concepts modeling family relationships. Two studies, with contradictory results, have explored whether these concepts and their corresponding instruments [the Parental Bonding Instrument (PBI) and the Camberwell Family Interview] do indeed measure the same aspects of family relationships. Our first objective was to compare the adolescents' perceptions of family relationships using the PBI, and the parental viewpoint using the Five-Minute Speech Sample (FMSS-EE). Secondly, we compared the PBI scores and EE levels of the parents. Sampling and Methods: Sixty adolescent girls with anorexia nervosa completed the PBI. The FMSS and a modified version of the PBI were administered to parents separately. Results: No significant link was identified between adolescent PBI scores and parental EE levels. However, a link between maternal ‘modified' PBI scores and maternal EE was observed: when mothers registered a high Final EE, they were more likely to deny their daughter's psychological autonomy compared to mothers with lower EE. Conclusions: Our empirical results do not support the hypothesis of an overlap between the two concepts. Indeed bonding and EE measure the same object, i.e. the quality of family relationships, but time scales differ and so do the perspectives (patient vs. parental viewpoint).

Expressed emotion (EE) measures have been created in English; adaptation into a foreign language is difficult. The aim of this study was to adapt the five minutes speech sample (FMSS), with a designed procedure ensuring optimum quality of the adaptation, and thus better trans-cultural validity. A strategy for improving inter-rater agreement comprised three phases: (1) phase of initial ratings (70 French samples), (2) experimental phase in two steps: ratings of 40 other samples in French, followed by analysis of differences between the French-language ratings and English-language ratings and (3) final rating phase of the initial 70 samples. For each phase, the κ coefficients measuring inter-rater agreement were calculated and compared using a bootstrap procedure. The improvements between these scorings were significant at p

We describe the distributions of hand skill asymmetry for the Peg-moving task and the Graphic test among 765 preschool children. A single normal component was observed for the Peg-moving task, but two normal components for the Graphic test, which corresponded primarily to the right- and left-handed children. Hand Preference and Graphic test hand skill asymmetry were age-dependent, but there was no age effect on the PMT hand skill asymmetry. Results are discussed in relation to the Annett's Right Shift theory.

In a large representative sample of young men, no clearly significant relationship between handedness and birth order or season of birth was found; the trend was opposite to that claimed by Bakan (1971) and Badian (1983) .

Objective: To identify clinical variables influencing the length of stay (LOS) of inpatient treatment for anorexia nervosa (AN). Method: We analyzed structured clinical charts of 300 consecutive hospitalizations for AN in a specialized eating disorder unit. The sample included patients from 12 to 22 years old. Factors related to the patient and events occurring during the stay were investigated as possible predictors of LOS. Results: Mean LOS was 135 days. The best model of linear regression revealed that the following factors were significantly related to LOS: duration of AN at admission, use of tube feeding during the stay, accomplishment of the therapeutic weight contract and presence of a comorbid disorder. Conclusions: The identification of factors influencing duration of stay, both at the outset and during the hospitalization, could help clinicians to optimize and individualize treatments, as well as increase patient and family compliance.

Objective: The objective of the present work is to determine whether the prevalence of depressive and anxiety disorders varies in subgroups of eating disorders (ED) according to age, ED duration, mode of care provision, and body mass index (BMI). Method: Using the Mini International Neuropsychiatric Interview (MINI), the frequency of anxiety and depressive disorders was evaluated in 271 ED participants. Their prevalence was compared in subgroups of anorexics (AN-R and AN-BN) and bulimics (BN), both before and after controlling for potential confounding variables. Results: Current or lifetime comorbidity of anxiety and depressive disorders did not differ between AN-R and AN-BN groups. Social phobia, panic disorders, and obsessive-compulsive disorder (OCD) were significantly more frequent in AN-BN and AN-R groups. Panic disorder was more frequent in the BN group. Conclusion: Several confounding factors, in particular those identified in the present study, may explain previous conflicting results on the frequency of anxiety and depressive disorders in ED. Nevertheless, the study confirmed that OCD is more frequent in AN, even after controlling for confounding factors. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006; 39:772–778

Objective: The goal of the current study was to test whether the Five-Minute Speech Sample (FMSS) assessments of expressed emotion (EE) in families with a daughter with anorexia nervosa (AN) are valid in comparison to the Camberwell Family Interview (CFI). Method: The sample included parents of hospitalized patients with AN. Assessments were conducted at the time of patients' discharge from the hospital. The participants (n = 40) were assessed individually with the FMSS and then the CFI. FMSS-EE ratings were classified as high or low for Emotional Overinvolvement (EOI), Critical EE, and Final EE (overall rating). For the CFI, average EE scores were computed on the same subscales. Results: Comparisons of FMSS subgroups on the CFI mean scores revealed that parents rated high EE on the FMSS subscales (EOI and Final EE) had significantly greater mean scores on the CFI than parents rated low EE on the FMSS (EOI: p = .02; Final EE: p = .04). Furthermore, FMSS-EE ratings were positively correlated to CFI-EE ratings for EOI EE (r = .38, p = .01), Critical EE (r = .31, p = .05), and Final EE (r = .29, p = .07). Conclusion: The FMSS can reliably measure EE in reference to the CFI in terms of Final EE and EOI EE. For the Critical EE subgroup, further investigation is needed with a bigger sample size. © 2006 Wiley Periodicals, Inc., Int J Eat Disord, 2006

Objectives: The purpose of this study was to determine whether subjects suffering from anorexia nervosa (AN) or bulimia nervosa (BN) would demonstrate more severe social disability than a control group; and whether social disability could be best explained as a function of the eating disorder itself or as a function of comorbid anxiety or depressive disorders. Method: Subjects were166 AN subjects, 105 BN subjects and 271 control subjects matched for age, sex and socio-economic status. Prevalence of anxiety or depressive disorders was assessed (through the Mini International Neuropsychiatric Interview), and social functioning was measured (through the Groningen scale). Results: The majority of AN and BN subjects demonstrated social disability in the “social role” (leisure time, time spent with friends) and the “occupational role” (work or educational activities). A regression analysis was employed to uncover predictive factors of social disability. Eating disorders (AN and BN), anxiety disorders and depression accounted for a large portion of social disability. Discussion: Anxiety and depressive disorders appear to play an important role in the type of social disability demonstrated in eating disorder patients. Therapeutic implications are discussed.

Some studies suggest that inaccuracy in recognizing and describing emotional states, combined with a highly descriptive mode of expression, as in alexithymia, may influence the immune response. We therefore investigated in healthy women the relationship between alexithymia and circulating levels of IL-1, IL-2 and IL-4.Seventeen mentally and physically healthy women aged between 20 and 25 years completed psychological questionnaires to assess alexithymia (Toronto Alexithymia Scale: TAS) and depressed mood (Hospital Anxiety and Depression Scale: HAD). Serum concentrations of IL-1, IL-2 and IL-4 were measured by ELISA.We found a significant positive correlation between serum levels of IL-4 and TAS score (r = 0.55; p = 0.021) and between factor 1 of the TAS (difficulty in identifying feelings) and IL-4 (r = 0.57; p = 0.017) while serum IL-1 and IL-2 were not detected in ten and six patients, respectively. Although there was a significant correlation between age and IL-4 levels, a linear regression with BMI, age, depressed mood and TAS as independent variables showed that only alexithymia could predict significantly increased levels of IL-4.Alexithymia and difficulty in identifying feelings could be associated with increased levels of IL-4 which may result in chronic impairment of pro/anti-inflammatory cytokine balance with psychological and somatic consequences. Nevertheless, these intriguing findings would deserve replication and extension in a larger sample of subjects.

A total of 1022 children aged 3 to 6 years were examined in their preschools and 27% of them were followed up for 2 years. A computerised version of the peg-moving task was used repeatedly to assess hand skill of the dominant and the nondominant hand. Cognitive performance was repeatedly evaluated by tasks involving speech, vocabulary, phonological memory, and visual-spatial skills. Results showed that: (i) age, sex, and handedness effects on hand skill asymmetry generally confirmed previous reports, especially by Annett (2002); (ii) visual-spatial and vocabulary tasks were significantly related to hand skill but speech and phonological memory tasks were not, and the role of the dominant and nondominant hand were similar; (iii) overall, manual laterality indexes were only weakly associated to some cognitive abilities; (iv) early manual skill was more strongly associated to cognitive tasks than later manual skill. These results fit the assumption of a significant role of early manual behaviour in aspects of cognitive development not relying exclusively on phonology, and raise questions about cognitive development and rehabilitation of children with early occurring manual deficiencies.

A stepwise analysis of the Cronbach Alpha Coefficient (CAC) was performed on five large samples of adults and young children, in order to choose the ''minimum'' set of items of a handedness scale which gives the maximum reliability. In adults, a handedness scale with 12 items has nearly the same or even a better CAC than other scales with more items; so, a choice of 10 to 12 items seems to be adequate. For children, a scale with eight items seems to be quite reliable but it is not impossible that a scale including more items would lead to a slight increase of CAC. The controversial usefulness of a precise assessment of the ''general handedness factor'' (the first principal component) generated by handedness questionnaires and its J-shaped distribution in the general population are discussed.

Hand preference and hand skill in 1150 normal children between 3 and 6 years of age and hand preference of their parents were assessed to study the effect of parental hand preference on different dimensionsl of manual asymmetry in children. Children hand skill was measured with a computerized version of the Peg Moving Task which allowed us to split the overall performance into two components, a “transport time” and a “search time.” Paternal and maternal left-handedness was significantly related to child left-handedness. Both components of hand skill asymmetry were reduced with mother's left-handedness and one component (search time) with father's left-handedness. A significant impact of parental hand preference on child hand skill asymmetry, after controlling for child hand preference, was observed. When this analysis was limited to strong right-handed children, a greater paternal effect on child hand skill emerged. These results show the usefulness of performance tasks in detecting parent-child associations concerning manual functional asymmetry.