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Objective: Although the fifth Body Mass Index (BMI) percentile is the Diagnostic and Statistic Manual of Mental Disorders -5 weight cut-off criterion to diagnose anorexia nervosa (AN) in children and adolescents, its validity has not been proved, and the 10th percentile value is often applied. We aimed to investigate the diagnostic validity of these weight cut-offs. Method: We compared general and eating-disorder (ED) specific psychopathology in 380 adolescents with AN or atypical AN. They were grouped first with respect to the fifth BMI percentile and then with respect to the 10th BMI percentile and differences between groups were analysed. Network analyses on psychopathological symptoms were also conducted. Results: Adolescents with BMI above the fifth and the 10th percentile reported more severe ED specific symptomatology compared to those with BMI below these cut-offs. No significant differences emerged between groups neither in general psychopathology nor in the network structure of psychopathology. Conclusions: The fifth BMI percentile does not discriminate psychopathology severity in adolescents with AN. From the psychopathology perspective, our findings suggest that adolescents with atypical AN deserve the same clinical and research attention as those with full AN. Future studies are needed to identify a more accurate definition of underweight in adolescents.

Objective Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa. Methods Four-hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory-3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive-compulsive and post-traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters. Results Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post-traumatic stress problems, drive to thinness, low self-esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self-esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self-esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects. Discussion These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re-conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.

Introduction Studies about family functioning in adolescent anorexia nervosa (AN) are conflicting and often do not consider the possible differences between the restricting and binge/purging subtypes (AN-R and AN-B/P). Moreover, an underestimated element is the quality of the coparenting relationship, that is, the level of coordination and agreement between parents, as well as the methods of managing parental conflict. Method The study aims to explore family functioning, coparenting and conflict management in a sample of 60 adolescents with AN-R and AN-B/P and their relations with AN severity in terms of body mass index (BMI). Patients and parents completed the following questionnaires: Family Adaptability and Cohesion Evaluation Scales, Coparenting Scale-Revised, and Conflict Management Questionnaire. Results No differences are found in general family functioning between the two groups, but mothers in the AN-R group show a higher coparental conflict and a tendency to use negative-passive ways of conflict management than mothers of the AN-B/P group. Moreover, the presence of a coparental conflict is associated to lower BMI and to more dysfunctional family functioning. Discussion These findings underline the importance of increasing knowledge on specific aspects of general family functioning. In particular, it seems that the way parents manage conflict between themselves as partners can have a role in the maintenance of AN. Clinical implications of these results are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

DSM-5 describe three forms of restrictive and selective eating: Anorexia Nervosa-Restrictive (AN-R), Anorexia Nervosa-Atypical (AN-A), and Avoidant/Restrictive Food Intake Disorder (ARFID). While AN is widely studied, the psychopathological differences among these three diseases are not clear. The aim of this study was to (i) compare the clinical features of AN-R, AN-A, and ARFID, in a clinical sample recruited from a specialized EDs program within a tertiary care children’s Hospital; (ii) identifying three specific symptom profiles, to better understand if restrictive ED share a common psychopathological basis. Data were collected retrospectively. Psychometric assessment included: the Children’s Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC), the Child Behavior Checklist (CBCL), and the Eating Disorder Inventory-3 (EDI-3). A final sample of 346 children and adolescent patients were analyzed: AN-R was the most frequent subtype (55.8%), followed by ARFID (27.2%) and AN-A (17%). Patients with ARFID presented different features from AN-R and AN-A, characterized by lower weight and medical impairment, younger age at onset, and a frequent association with separation anxiety and ADHD symptoms. EDI-3 profiles showed specific different impairment for both AN groups compared to ARFID. However, no differences was detected for items: ‘Interpersonal Insecurity’, “Interoceptive Deficits”, “Emotional Dysregulation”, and “Maturity Fears”. Different ED profiles was found for the three groups, but they share the same general psychopathological vulnerability, which could be at the core of EDs in adolescence. III. Evidence obtained from case–control analytic studies.

Current guidelines for the treatment of anorexia nervosa (AN) in children and adolescents underline the central role of parents’ involvement for positive therapy outcomes. However, little is known about the influence of cooperation between the parental couple on family functioning and the maintenance of food symptoms in the anorexic child. This exploratory study reports preliminary data on coparenting and family functioning in families of adolescents with AN and their associations with food symptoms, in terms of body mass index (BMI). The sample consisted of 24 families of adolescents with AN, who had been admitted to a specialized tertiary level children’s hospital. Family coordination was evaluating using the Lausanne Trilogue Play (LTP) and coparenting style was measured using the Coparenting and Family Rating System (CFRS). Significant differences were found for different LTP functions (Friedman’s chi-square = 52.188; p

Research in patients with Eating Disorders (EDs) showed high rates of Food Addiction (FA) even in restrictive subtypes. The majority of studies were conducted on adult population. The present work aimed to describe and compared FA in adolescents diagnosed for different EDs and to evaluate its association with patients&rsquo, psychopathology. Patients aged 12&ndash, 18 y were included in the analysis. FA was assessed using the Yale Food Addiction Scale 2.0. The rate of FA was of 49.4% in the whole sample (n = 87, F = 90.8%) and of 53.7% in patients diagnosed with restrictive anorexia nervosa. No difference in FA frequency was detected between EDs. A worse psychopathological picture was found in patients diagnosed with FA. Higher age, higher score to the Eating Attitudes Test&ndash, 26 and to the Eating Disorder Inventory-3&prime, s Interoceptive Deficits scale have been detected as the major predictors of FA in our sample. FA may be considered a transnosographic construct, not linked to the subtype of ED but to patients&rsquo, personal characteristics and, in particular, to age and interoceptive deficits. A worse psychopathology might be considered a risk factor for the presence of FA in EDs.

Poor treatment outcomes are available for anorexia nervosa (AN) and treatment innovations are urgently needed. Recently, non-invasive neuromodulation tools have suggested to have potential for reducing an symptomatology targeting brain alterations. The objective of the study was to verify whether left anodal/right cathodal prefrontal cortex transcranial direct current stimulation (tDCS), may aid in altering/resetting inter-hemispheric balance in patients with AN, re-establishing control over eating behaviors. Twenty-three adolescents with an underwent a treatment as usual (AU), including nutritional, pharmacological, and psychoeducational treatment, plus 18 sessions of tDCS (TDCS+AU = n11; mean age = 13.9, SD = 1.8 years) or a family based therapy (FBT+AU = n12, mean age = 15.1, SD = 1.5 years). Psychopathological scales and the body mass index (BMI) were assessed before and after treatment. After 6 weeks of treatment, the BMI values increased only in the tDCS group, even at 1-month follow-up. Independently of the treatment, all participants improved in several psychopathological measures, included AN psychopathology and mood and anxiety symptoms. Our results demonstrated for the first time a specific effect of the left anodal/right cathodal tDCS treatment protocol on stable weight gain and a superiority compared to an active control treatment for adolescents with AN. Results were interpreted as a possible direct/indirect effect of tDCS in into some pathophysiological mechanisms of AN, involving the mesocortical dopaminergic pathways and the promotion of food intake. This pilot study opens new perspectives in the treatment of an in adolescence, supporting the targeted and beneficial effects of a brain-based treatment.

This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive-compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups. Of the 30 AN participants, only three scored above the conventional ADOS-2 threshold for ASD. The AN participants were similar to their controls on autistic trait measures, and to the ASD group on obsessive-compulsive measures, and on theory of mind ability and affect recognition measures. Further longitudinal studies are needed in order to determine the association between these conditions.

The current guidelines for treatment of Anorexia Nervosa (AN) in children and adolescents recommend an integrated multidisciplinary approach as the elective intervention for this disorder. Nevertheless, there is insufficient evidence on the results of an integrated approach for the treatment of AN adolescent patients, especially in a Hospital setting. This study aims to analyze clinical and psychological changes occurring in adolescent patients after completion of a Day-Hospital Multifocal Integrated Treatment (MIT) for Anorexia Nervosa. The sample consisted of 60 adolescents with AN or Eating Disorder Not Otherwise Specified (EDNOS) restrictive type, aged 11 to 18 years, and their parents. Clinical course was evaluated at 3, 6 and 12-month follow-up periods. Our results showed clinical remission in a good percentage of patients. In general, we found a significant reduction of the eating psychopathology, whereas we did not detect any significant improvement in body dissatisfaction, perfectionism, and relational difficulties. This positive trend was confirmed at 3, 6, and 12-month follow-up, despite the increase of drop-outs. These results suggest that the proposed treatment is reasonably effective, because it aims to contain and reduce the acute phase of the disease in a limited time and in a hospital setting, but it is necessary to continue the treatment with targeted psychotherapeutic interventions to address the deeper psychological discomfort underlying the eating disorder.

IntroductionAnorexia nervosa (AN) is characterized eating behaviors and body image disturbances. Given poor treatment outcomes are available for AN, treatment innovations are urgently needed. Recently, non-invasive neuromodulation tools have suggested having potential for reducing AN symptomatology targeting brain alterations.ObjectivesThe objective was to verify whether an excitatory transcranial direct current stimulation (tDCS) over the left prefrontal cortex may aid in altering/resetting inter-hemispheric balance in AN patients, re-establishing control over eating behaviors.AimsResearch is aimed to evaluate the potential of tDCS treatment in determining a more rapid improvement compared to classical treatments in adolescents with AN.MethodsTwenty-two adolescents with AN, underwent the treatment as usual (AU) plus the tDCS treatment (TDCS + AU: n = 8, age M 13.7 ± 1.9 years) or a family therapy (FT + AU: n = 14, age M 15.1 ± 1.75 years), for six weeks. Psychopathological scales (EDI-III, EAT 26, BUT, MASC, CDI) and anthropometric indicator of nutritional status (BMI) were assessed before and after treatment.ResultsBMI improved only in the TDCS + AU group (P < 0.01). Mean BMI percentage of improvement was 14.43% + 10.8 in the TDCS + AU and 4.83% ± 5.4 in the FT + AU. Both groups improved in the total scores of the EDI, EAT-26, MASC and CDI scales (all P < 0.01).ConclusionstDCS treatment improved BMI values more than classical treatment and determined comparable to the classical treatment improvement in the psychopathological scales. This results may be an important starting point to further explore the beneficial effect of brain based treatments for AN.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patterns of adaptation to conflict in anorexia nervosa were assessed with the Serial Color-Word Test. A group of teenage girls with anorexia nervosa ( n = 34) was compared with an age-matched group of normal girls ( n = 54). Measures of linear and nonlinear change of reading times during each of the five consecutive trials of the test were compared between groups by means of a multivariate model with doubly repeated measures. Multivariate testing indicated statistically significant main effects of group and time, as well as a group × time interaction. The groups did not differ on linear change, while anorexia patients had higher scores of nonlinear change. When the same analysis was performed covarying for total reading times, the main effect of group remained significant and anorexia patients had higher scores on linear change. The anorexia group seemed less able to master the conflict situation over time, a tendency which could be related to treatment outcomes.