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Research suggests there is an association between high levels of recreational screen time and depression among adolescents; however, mechanisms driving this association remain unknown. The present study examined appearance and weight satisfaction and disordered eating behaviors as mediators in the relationship between recreational screen time and depressive symptoms in adolescents.Longitudinal data on screen time, depressive symptoms, disordered eating behaviors, and appearance and weight satisfaction from 304 adolescents (194 females, MResults revealed appearance dissatisfaction mediated the direct effect of recreational screen time on depressive symptoms (Estimate = 0.48, SE = .18, 95% CI [0.12, 0.84]), and that recreational screen time was significantly related to lower appearance satisfaction (Estimate = -0.06, SE = .02, 95% CI [-0.10, -0.01]), which was significantly predictive of more severe depressive symptoms (Estimate = -1.49, SE = .62, 95% CI [-2.71, -0.28]).These findings suggest that modulating screen time may be an efficacious strategy to reduce appearance dissatisfaction and depressive symptoms during adolescence.

The purpose of the study was to examine the moderating role of attachment style, coping style, and perceived social support in the relationship between daily recreational screen time and depressive symptomatology over time. Complete data from 170 adolescents (106 females) from a larger research study were included at each time point. The mean age at baseline was 13.21 years (SD = 1.06) for females and 12.67 years (SD = 0.64) for males. Data related to depressive symptomatology (Children’s Depression Inventory), attachment style (Adolescent Relationship Questionnaire), coping style (Coping Inventory for Stressful Situation), perceived social support (McKnight Risk Factor Survey-IV), recreational screen time activities, and sociodemographic information were analyzed. Hierarchical linear regression models showed that daily recreational screen time at baseline (T0) predicted depressive symptomatology at T4 (4-year follow-up) (B = 0.49, p

Several psychosocial models have been proposed to explain the etiology of eating disorders (EDs) and obesity separately despite research suggesting they should be conceptualized within a shared theoretical framework. The objective of the current study was to test an integrated comprehensive model consisting of a host of common risk and protective factors (socio-environmental, psychological, and behavioral) expected to explain both eating and weight disorders simultaneously in a large school-based sample of adolescents. Data were collected from 3,043 youth (60% female, 14.00 ± 1.61) from 41 schools in the Ottawa region, Canada. Working with interested school staff, validated self-report scales in the form of a questionnaire booklet were administered to participating students to assess several understood risk and protective factors common to both eating disorders and obesity. Anthropometric measurements of weight and height were taken at the end of the questionnaire administration period by trained research staff. Structural equation modeling with cross-validation was used to test the hypothesized model. Findings demonstrated that dysregulated eating was associated with both eating disorder and weight status with diet culture and emotion dysregulation directly associated with some of these disordered eating patterns. It equally pointed to how lifestyle made up of high sedentary behaviors, low vigorous exercise and varied eating patterns contributed to both emotion dysregulation and poor body image which subsequently affected eating issues and weight status simultaneously, signaling the complex interplay of psychosocial factors that underlie these concerns. This study provides evidence for an integrated psychosocial model consisting of socio-environmental, psychological, and behavioral factors may best explain the complex interplay of risk and protective factors influencing eating disorders and obesity. It equally highlights understanding the direct and indirect effects of some of the most salient risk factors involved in eating and weight-related concerns, including the strong effects of diet culture and stressors such as weight-based teasing, providing interventionalists evidence of important risk factors to consider targeting in eating disorder and weight-based prevention efforts.

Adolescence is a developmental period that can place individuals at heightened risk of engaging in disordered eating patterns. Stress and coping have been included as etiological factors of eating pathology, yet the mechanism of this relationship in adolescent males and females remains understudied.This study investigated the role of coping as a mediator in the stress-disordered eating relationship in a sample of adolescents.Participants included 2262 grade 7-12 students from a larger cross-sectional study entitled, Research on Eating and Adolescent Lifestyles (REAL).Participants completed measures of perceived stress, life stressors, coping style, and disordered eating. Multiple mediator models of coping were analyzed to examine the extent to which coping mediated the stress-disordered eating relationship, for males and females separately.Emotion-oriented coping was a significant partial mediator in the relationship between stress (perceived stress, life stressors) and disordered eating in male and female adolescents. Findings suggest adolescents experiencing high stress tend to engage in emotion-oriented coping, which may lead to greater levels of disordered eating.Interventions targeting effective coping strategies for dealing with different stress types may prevent youth from disordered eating, thus reducing their risk of eating disorders during a vulnerable period in development.

Suicidal ideation is a serious mental health concern reported by adolescents. Despite understanding of increased suicidal ideation in patients with eating disorders (EDs) and obesity, few studies have compared how disordered eating (bingeing, vomiting and over exercising) is associated with suicidal ideation in clinical and non-clinical samples of youth across the ED and weight spectrum. The present study aimed to 1) comparatively examine rates of suicidal ideation and disordered eating behaviors in clinical samples of youth with EDs, complex obesity, or from the community, and 2) examine whether disordered eating was associated with suicidal ideation above and beyond age, body mass index, diagnosis, treatment-seeking status, and depressive symptoms in large samples of males vs. females in an attempt to understand whether these behaviors should lead to concern regarding suicidal ideation. Data from charts on treatment-seeking adolescents diagnosed with either an ED (N = 315), severe complex obesity (N = 212), and from the community (N = 3036) were pooled together for comparative purposes. Results showed that suicidal ideation was higher in youth seeking treatment for an ED (50.2%) and obesity (23.7%) as compared to youth from the community (13%). Binary logistic regression analyses revealed that vomiting (OR = 1.73 for females, 8.17 for males) and over-exercising (OR = 1.47 for females, 1.68 for males) was significantly associated with suicidal ideation in both males and females. Findings underscore the importance of screening for suicidal ideation in youth who report vomiting or over-exercising despite diagnostic presentation, age, weight, or treatment setting.

Weight teasing is associated with body dissatisfaction, but no study has examined the differential impact of the teasing source’s gender. This study examined whether the longitudinal relationship between weight teasing (by peers), weight-related comments (by parents) and body esteem differed by the teasing sources’ gender, and whether these relationships were moderated by victims’ weight status and demographic factors. A school-based sample (N = 1197 at Time 1; 60% female) of adolescents completed surveys over approximately 2 years (Time 1-Time 3). Multilevel modeling showed that teasing from a male peer had a stronger, negative association with appearance esteem for female victims than males. Although weight teasing was more prevalent among youth with overweight/obesity, teasing from female peers had a stronger negative association with weight esteem for adolescents of average weight. Results suggest the weight teasing sources’ gender may differentially impact the victims’ body esteem, and highlights the need to consider these factors in weight teasing prevention strategies.

The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive–compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.

Objective:This study investigated whether the duration and type of screen time (ST) (TV viewing, recreational computer use, video gaming) is longitudinally associated with z-BMI and if these relationships are mediated by disordered eating (emotional, restrained).Design:At baseline, participants were n 1197 (T1; 60 % female) adolescents (mean age = 13·51 years) who completed surveys over 2 years. ST was assessed by a self-reported measure created by the investigative team, while emotional and restrained eating was measured by the Dutch Eating Behaviour Questionnaire (DEB-Q). Height and weight were objectively measured to quantify z-BMI.Setting:Thirty-one public and two private schools from the region of Ottawa, Canada.Participants:Students in grades 7–12.Results:Parallel multiple mediation analyses revealed that more time spent watching TV at baseline is associated with higher z-BMI at T3 (total effect; B = 0·19, se = 0·07, P = 0·01, 95 % CI 0·05, 0·34), but no relationships were observed for total ST exposure or other types of ST and z-BMI. Disordered eating did not mediate the positive association between baseline TV viewing and z-BMI at T3.Conclusions:TV viewing was longitudinally associated with higher z-BMI in a community-based sample of adolescents, but disordered eating behaviours did not mediate this relationship. However, other non-pathological eating behaviours may mediate the association between ST and obesity and warrant further investigation. Finding suggests that targeting reduction in youth’s TV viewing may be an effective component in the prevention of childhood obesity.

OBJECTIVE Research on body esteem (weight and appearance esteem) and weight suggests that having a positive body esteem may be associated with more stable weight trajectories during adolescence, and adolescents with higher weight report lower levels of body esteem. However, bidirectional relationships between body esteem and weight have not yet been examined. This 3-year longitudinal study examined (1) bidirectional relationships between body esteem and body mass index (BMI) and (2) how BMI and body esteem changed together throughout adolescence. METHODS Participants (N = 1163 adolescents, at time 1 [T1] baseline; 60.3% female) from a school-based community sample completed surveys approximately annually for 3 years. RESULTS Latent growth modeling revealed that (a) among boys and girls, appearance and weight esteem scores decreased over time, (b) higher initial BMI scores were associated with slower decreases in appearance esteem over time. However, evidence for bidirectionality was not found, in which baseline appearance and weight esteem did not predict changes in BMI over time and vice versa. CONCLUSION Results suggest that changes in BMI and body esteem are co-occurring (rather than predictive) throughout adolescence. The decreasing trajectory of body esteem over time suggests the need for prevention efforts to improve body esteem throughout adolescence.

International audience; Marine was a fourteen and a half-year-old adolescent female hospitalized for an eating disorder (ED) of the anorexic type with purging behaviors. She has had a complicated life course, made up of disruptions and discontinuities, both family and school. Since the age of five, Marine had been intermittently treated in psychiatry for a diagnosis of oppositional defiant disorder. The current illness started with spontaneous and induced vomiting associated with major weight loss (body mass index, 15.27 kg m−2). The diagnosis of anorexia nervosa was established after several opinions from professionals in five Parisian university pediatric departments, where additional investigations were carried out without any somatic cause being identified. In this context, Marine was transferred to a child psychiatry unit. There, she had acute dyspnea during the insertion of a nasogastric tube. As a result, a new specialized opinion was sought from a pediatric gastroenterologist and further explorations were performed (oeso-gastroduodenal transit and manometry), leading to the conclusion to an oesophageal achalasia requiring surgical treatment. This case report highlights that the exclusion of any organic disorder should be a priority in the diagnostic assessment of an ED. Oesophageal achalasia is a rare differential diagnosis and should be considered in case of swallowing difficulties or dysphagia. Health care professionals should take care to provide appropriate somatic follow-up for patients with psychiatric disorders.

This study explores the relationship between self-silencing, sociocultural attitudes toward appearance and negative body esteem in a large community-based sample of male youth, to better understand the interrelationship among these socioemotional characteristics and their effects on body esteem. A cross-sectional study of 1,253 males in Grades 7 to 12 asked participants to complete self-report measures of body esteem, sociocultural attitudes toward appearance, and self-silencing as part of a larger study, and also took anthropometric measurements of weight and height. Results revealed that increased body mass index, greater engagement in self-silencing behaviors and higher levels of internalization of the masculine body ideal all contributed to poor body esteem in male youth. Findings from this study demonstrate that males, like females, are vulnerable to low body esteem when they rely on an externalized view of self-perception and allow themselves to take care of others needs before attending to their own, leaving little room for their voice to be heard. It was also found that greater endorsement of the mostly unattainable masculine beauty ideal as a personal standard and higher body mass index both contributed to lower body esteem, most likely influencing each other in various ways. Prevention efforts geared toward media literacy, promoting positive body image and fostering authenticity in one's relationships may be helpful at reducing poor body esteem in male youth.

Objective To develop a concise screening tool that allows for early identification of disordered eating in youth. Study design In this 2-step classification accuracy study, questions for the Ottawa Disordered Eating Screen–Youth, a 2-question screening tool (index test), were conceptualized by clinician-scientists from tertiary care pediatric eating disorder and weight-related clinics, and was validated using retrospective data (2004-2010) from a community-based study, the Research on Eating and Adolescent Lifestyles (REAL) study. Results Analyses of contrast between the index test and the reference standard using data from 2892 (1714 females) students between grade 7 and grade 12 revealed classification statistics of 67.1% for sensitivity, 85.9% for specificity, 4.7 for positive likelihood ratio, 0.38 for negative likelihood ratio, 50.6% for positive predictive value, and 92.4% for negative predictive value for females and 61.1% for sensitivity, 93.9% for specificity, and 9.9 for positive likelihood ratio, 0.41 for negative likelihood ratio, 32.3% for positive predictive value, and 98.0% for negative predictive value for males. Conclusions Our findings suggest that the index test has utility as a short and accurate screening tool for earlier detection of disordered eating thoughts and behaviors in youth. Additional research is needed to best determine how the index test can be administered to youth across various health care, school, public health, and surveillance settings in clinically sensitive pragmatic ways.

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.

The authors conducted a pilot study on the effects of a mindfulness-based stress reduction (MBSR) educational intervention on mental health professionals' self-compassion, perceived stress, burnout, and quality of life. Data were obtained from 22 female mental healthcare workers between the ages of 24 and 69 years who were enrolled in one of four separate 8-week MBSR courses. Pre- and post-assessment measures consisted of the Self-Compassion Scale (SCS), Maslach Burnout Inventory, and Quality of Life Inventory. The changes on the SCS total score proved significant with a p-value of .003. Within the SCS, changes were significant on four out of the six subscales. The study is unique in its use of the eight-week MBSR intervention to target mental health professionals currently working in the field, and in the examination of the specific facets of self-compassion enhanced by this type of intervention.

The purpose of this study was to explore clinical changes observed in suicidal adolescents treated with an adapted form of Dialectical Behavior Therapy for adolescents (A-DBT-A) in a tertiary care setting. We conducted an open-label naturalistic study including 61 adolescents with self-injurious thoughts and behaviors and associated features of borderline personality disorder, who underwent a 15-week course of A-DBT-A. Pre- and post-treatment measures were administered, the primary outcome being the total score on the Suicidal Ideas Questionnaire. Self-harm, symptoms of borderline personality disorder, resiliency measures, predictors of response, and predictors of attrition were also explored. Among participants who completed post-treatment measures, we found a significant reduction in suicidal ideation (n = 31, p < 0.001). Secondary outcomes also suggested improvement. Baseline substance use predicted attrition (HR 2.51; 95% CI 1.03-6.14; p < 0.05), as did baseline impulsivity score on the Life Problems Inventory (HR 1.03; 95% CI 1.004-1.06; p < 0.05). Overall, we observed clinical improvements in adolescents receiving A-DBT-A.

This study examined the relationships between screen time and symptoms of depression and anxiety in a large community sample of Canadian youth.Participants were 2482 English-speaking grade 7 to 12 students. Cross-sectional data collected between 2006 and 2010 as part of the Research on Eating and Adolescent Lifestyles (REAL) study were used. Mental health status was assessed using the Children's Depression Inventory and the Multidimensional Anxiety Scale for Children-10. Screen time (hours/day of TV, video games, and computer) was assessed using the Leisure-Time Sedentary Activities questionnaire.Linear multiple regressions indicated that after controlling for age, sex, ethnicity, parental education, geographic area, physical activity, and BMI, duration of screen time was associated with severity of depression (β=0.23, p0.001) and anxiety (β=0.07, p0.01). Video game playing (β=0.13, p.001) and computer use (β=0.17, p0.001) but not TV viewing were associated with more severe depressive symptoms. Video game playing (β=0.11, p0.001) was associated with severity of anxiety.Screen time may represent a risk factor or marker of anxiety and depression in adolescents. Future research is needed to determine if reducing screen time aids the prevention and treatment of these psychiatric disorders in youth.

Objectives DSM-5 changes for eating disorders (EDs) aimed to reduce preponderance of non-specified cases and increase validity of specific diagnoses. The objectives were to estimate the combined effect of changes on prevalence of EDs in adolescents and examine validity of diagnostic groupings. Method A total of 3043 adolescents (1254 boys and 1789 girls, Mage = 14.19 years, SD = 1.61) completed self-report questionnaires including the Eating Disorder Diagnostic Scale. Results Prevalence of full-threshold EDs increased from 1.8% (DSM-IV) to 3.7% (DSM-5), with a higher prevalence of bulimia nervosa (1.6%) and the addition of the diagnosis of purging disorder (1.4%); prevalence of binge eating disorder was unchanged (0.5%), and non-specified cases decreased from 5.1% (DSM-IV) to 3.4% (DSM-5). Validation analyses demonstrated that DSM-5 ED subgroups better captured variance in psychopathology than DSM-IV subgroups. Discussion Findings extend results from previous prevalence and validation studies into the adolescent age range. Improved diagnostic categories should facilitate identification of EDs and indicate targeted treatments. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

BackgroundThe high rate of depression among children of depressed mothers is well known. Suggestions that improvement in maternal acute depression has a positive effect on the child have emerged. However, data on the mechanisms of change have been sparse. The aim was to understand how remission and relapse in the mother might explain the changes in the child's outcome.MethodParticipants were 76 depressed mothers who entered into a medication clinical trial for depression and 135 of their eligible offspring ages 7–17 years. The mothers and children were assessed at baseline and periodically over 9 months by independent teams to understand the relationship between changes in children's symptoms and functioning and maternal remission or relapse. The main outcome measures were, for mothers, the Hamilton Depression Rating Scale (HAMD), the Social Adjustment Scale (SAS) and the Parental Bonding Instrument (PBI) and, for children, the Children's Depression Inventory (CDI), the Columbia Impairment Scale (CIS), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Global Assessment Scale (CGAS).ResultsMaternal remission was associated with a decrease in the child's depressive symptoms. The mother's subsequent relapse was associated with an increase in the child's symptoms over 9 months. The effect of maternal remission on the child's improvement was partially explained by an improvement in the mother's parenting, particularly the change in the mother's ability to listen and talk to her child, but also reflected in her improvement in parental bonding. These findings could not be explained by the child's treatment.ConclusionsA depressed mother's remission is associated with her improvement in parenting and a decrease in her child's symptoms. Her relapse is associated with an increase in her child's symptoms.

Objective Obesity and overweight are associated with many negative health outcomes. Attachment style has been implicated in the development of obesity in youth. The present study examined if disordered eating behaviors mediate the relationship between attachment style and body mass index (BMI) in a large community sample of Canadian youth. Method A total of 3,043 participants (1,254 males and 1,789 females, Mage = 14.20 years) completed self-report questionnaires including the Relationship Questionnaire and the Dutch Eating Behavior Questionnaire, and BMI was objectively measured. Disordered eating behaviors (restrained, emotional, and external) were examined as possible mediating mechanisms in the relationship between attachment style and BMI z-score, using a multiple mediation model using bootstrapping while controlling for socio-demographic covariates. Results Insecure attachment was significantly associated with higher BMI, and disordered eating mediated this relationship. Restrained eating was the strongest mediator of this pathway. Conclusion Results suggest that it may be important to take attachment history and restrained eating into account when designing treatment and prevention strategies for obesity in youth.

A partial hospitalization program was developed for youth with moderate to severe psychiatric disorders. The objectives of this study were to prospectively assess changes from admission to discharge in the participants' clinical symptoms and psychosocial functioning, as well as the maintenance of any treatment gains at 3-month follow-up. In this naturalistic treatment study, 55 youth completed both the youth partial hospitalization program and the study. Diagnosis at admission was established by a psychiatrist based on a clinical assessment and a structured diagnostic interview. Clinician-rated and self-report measures of symptoms and psychosocial functioning were administered at admission, discharge, and follow-up to track changes over time. Clinically and statistically significant improvements were found in both symptoms and psychosocial functioning from admission to discharge on all study measures. Furthermore, these gains were maintained at 3-month follow-up. The results suggest that partial hospitalization programs can be an effective modality in treating youth with moderate to severe psychiatric disorders.

The goal of the study was to explore the content of on-line and off-line peer interactions among shy and non-shy adolescents. Participants were 148 ten-to-eighteen year old adolescents in Rome, Italy (n=98) and Ottawa, Canada (n=50). Participants completed self reports of shyness and loneliness and web logs of their interactions with friends both in person and on-line. Among the results, there was little general difference in the general content and emotion expressed during the two modalities of interaction with friends, both of which were used in a wide variety of ways. Importantly, shy participants used the on-line modality more extensively than their non-shy counterparts to express negative emotions and to convey content regarding negative exchanges with peers. Such use of electronic communication may be an important contributor to their loneliness.

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

OBJECTIVE: This paper describes the creation and demonstrates the internal consistency of the Attitudes and Patterns of Eating (APE) Questionnaire, English version, which assesses adolescent food beliefs and eating habits and can be used for comparative studies on various cultures and lifestyles. The questionnaire is intended for use in a study comparing French and U.S. adolescents, the details of which will be presented in a future article. METHOD: A research team composed of French and American researchers observed eating behaviors in community samples from each country and reviewed previous studies comparing Europe and North America regarding eating attitudes/practices. Common eating-related themes were identified and corresponding questionnaire items were constructed, then a group of U.S. high school students (N=1230) was administered the questionnaire. RESULTS: A principal components analysis (PCA) identified 5 components: “Eating Diet/Light Foods,” “Unhealthy/Increased Eating,” “Homemade Meals,” “Skipping Meals” and “Healthy Eating”. DISCUSSION: The testing and factor analysis of the APE (English) Questionnaire demonstrated its internal consistency. Further validity and reliability studies will be needed to complete the global validation process for both the French and English versions.

This study investigates body esteem factors (weight-esteem and appearance-esteem) as mediators of the relationship between 'internalization of the ideal body figure' and disordered eating behaviors (restrained, emotional and external eating) in a community sample of adolescent males (n=810) and females (n=1137) from the Ontario Research on Eating and Adolescent Lifestyles (REAL) study. Mediation models were examined using a bootstrapping approach to test indirect effects and indirect contrasts. In males, weight-esteem partially mediated the relationship between muscular ideal and restrained eating; appearance-esteem partially mediated effects in the emotional and external eating regressions. In females, both weight-esteem and appearance-esteem partially mediated the relationship between thin ideal and all three forms of disordered eating; weight-esteem was a stronger mediator for restrained eating, and appearance-esteem a stronger mediator for emotional and external eating. Body esteem is important to consider for prevention and treatment of disordered eating in both genders.

Family meals have been identified as a protective factor against obesity among youth. However, gender specificities with respect to the relationship between the frequency of family meals and body mass index (BMI) have not been investigated. The purpose of this study was to examine the relationship between the frequency of family meals and BMI in male and female adolescents, while controlling for potential confounding factors associated with BMI, such as parental education, adolescent’s age, and snack-food eating. Research participants were 734 male and 1030 female students (mean age, 14.12 years, SD = 1.62) recruited from middle schools and high schools in the capital region of Canada. Participants completed validated, self-report measures to assess the frequency of family meals and the risk factors associated with increased BMI, which was derived from objective measures of height and weight. After controlling for proposed confounding variables, a higher frequency of family meals was associated with lower BMI in females, but not in males. A Z-transformation test of the homogeneity of adjusted correlation coefficients showed a significant trend (p = 0.06), indicating that the relationship between family meals and BMI is stronger in females than males, consistent with our regression analyses. Our findings suggest that eating together as a family may be a protective factor against obesity in female adolescents, but not in male adolescents. Findings from this study have important implications for parents and health care practitioners advocating for more frequent family meals as part of a comprehensive obesity prevention and treatment program for female adolescents.

The goal of the present study was to explore patterns of communication between adolescents and their friends across both “online” and “in-person” contexts. The participants were adolescents (n = 727) aged 11–16 years attending middle schools in urban and rural areas of Italy. Participants completed daily logs of their in-person and online contacts with friends for 20 consecutive school days. Girls reported more total contacts with their friends than did boys as well as friendships that were closer and more intimate. However, boys indicated more contact than girls via electronic communication and online. Contacts with peers in general were less frequent among the older participants, perhaps because of increasing academic demands. Participants who complemented in-person contact with friends with electronic contact were less lonely than their counterparts who were less versatile in accessing different modalities of making contact with friends.

The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.

Objective:To examine the association between volume and intensity of physical activity (PA) and depressive symptoms, anxiety, and body image in a large sample of adolescents in Ottawa and surrounding region.Methods:A total of 1259 (n = 746 girls and n = 513 boys) students responded to surveys on leisure time PA, depressive symptoms, anxiety, and body image.Results:A dose response effect of intensity of PA and psychological distress was observed whereby those who performed greater bouts of vigorous PA exhibited better psychological adjustment than adolescents engaging in mild to moderate intensity activity. Gender impacted the results as vigorous PA was associated with reduced depression but not anxiety in boys, and reduced anxiety but not depression in girls. The positive association between total volume of PA and psychological functioning in the overall sample was no longer significant when gender was considered, except for reduced anxiety in girls.Conclusions:Vigorous PA was associated with reductions in depressive symptoms, anxiety and improvements in body esteem in adolescents, but these associations were differentially influenced by gender. Future research is needed to elucidate the efficacy of vigorous PA as a treatment for mental health problems in male and female adolescents.

BACKGROUND: Adolescence may be a crucial period for developing obesity and associated mental health problems. This study examined the relationship of weight status on body image, eating behavior, and depressive symptoms in youth. METHODS: A survey was conducted on 1490 youth attending grades 7–12. Participants completed questionnaires on body image, eating behavior, and mood and were measured for height and weight to calculate body mass index (BMI). Weight classification was based on the International Obesity Task Force guidelines, whereby youth at or above the 95th BMI percentile for age and sex were classified as obese, those between 85th and 94th BMI percentile as overweight, and those between 5th and 84th BMI percentile as normal weight. Several multivariate analyses of variance (MANOVAs) were conducted to examine these relationships. RESULTS: Clear relationships emerged between body image and weight classification. Obese youth reported higher body dissatisfaction than overweight youth, who reported more body dissatisfaction than normal weight youth. These effects were independent of age and gender. A relationship was also found for dietary restraint and weight status whereby higher restraint scores were associated with greater adiposity. Similarly, obese youth reported greater depressive symptoms, including anhedonia, negative self-esteem, and higher overall depression scores compared with overweight and normal-weight youth. CONCLUSIONS: Psychopathology in obese youth is well known in clinical samples but this study suggests that obese youth in the community may be at increased risk of developing body dissatisfaction, dietary restraint, and depressive symptoms compared with overweight or normal weight youth.

Background: Child and adolescent mental health problems are prevalent and require adequate interventions. Despite several evidence-based interventions for these problems described in the literature, few studies addressed strategies to diffuse efficacious interventions for child mental disorders especially in developing countries. Methods: An extensive but not systematic review of the literature was performed aiming to identify evidence-based interventions for children and adolescents with mental disorders, professionals to target in disseminating these interventions, and the available strategies to diffuse information. Results: Substantial evidence-based information is available to guide preventive, psychosocial and psychopharmacological interventions. The effectiveness of treatments in real-world settings and the cost-effectiveness of interventions are rarely tested. Professionals at different levels (teachers, school counselors, social workers, general practitioners, pediatricians, child psychologists and psychiatrists) should be targeted in diffusing efficacious interventions for child mental health problems worldwide. Telepsychiatry and the internet seem to be the most promising strategies to diffuse knowledge with lower costs. Conclusions: Medical and allied professionals must incorporate child and adolescent mental health issues in their under- and postgraduate curricula, and be better prepared to critically evaluate available information. Professionals need to disseminate evidence-based programs to guide parents and teachers in developing countries to deal with child and adolescent difficulties. Countries need to explore internet solutions for dissemination of medical information.

Obsessive-compulsive disorder (OCD) experienced in childhood or adolescence is often a chronic disorder with high subjective distress and impairment of family and social functioning. An early comprehensive intervention schedule can have a profound effect on outcome in later years. The clinical manifestations of OCD among children and adolescents do not seem to be inherently different from those of adult patients. In younger subjects, the clinical picture tends to be dominated by compulsions, and insight can be poor, with little recognition of the symptoms as a problem.There is often a shift in symptoms over time, with some symptoms being replaced by others, while in adults, the core obsessions and compulsions tend to be more stable. In addition to depression and anxiety disorders, the spectrum of comorbid psychopathology seen in pediatric OCD patients includes tic, disruptive behavior, and specific developmental disorders. The treatment of childhood and adolescent OCD relies on cognitive-behavioral techniques of psychotherapy and pharmacotherapeutic interventions similar to those recommended in adults. The efficacy of exposure and response prevention in pediatric OCD has been shown in numerous open studies, and four controlled trials. Pharmacotherapy relies on serotonergic medication, and all have been demonstrated to be significantly superior to placebo, as reported in a recently published meta-analysis. Current concerns with the use of SSRIs in children and adolescents were explored as regards OCD and anxiety disorders, and there is no evidence for an increase in suicide or related behaviors.

More physical activity (PA) and less screen time (ST) are positively associated with mental health in adolescents; however, research is limited by short-term designs and the exclusion of ST when examining PA. We examined: (a) changes in PA, ST, symptoms of depression, and symptoms of anxiety over four assessments spanning 11years, and (b) bidirectional relationships between initial PA, ST, and symptoms of depression and anxiety as predictors of change in each other during adolescence. Between 2006 and 2010, participants from Ottawa Canada (Time1; N=1160, Mean age=13.54years) completed questionnaires at four points covering the ages from 10 to 21years. Latent growth modeling was used. PA decreased over time whereas ST and symptoms of depression and anxiety increased over time. Controlling for sex, ethnicity, school location, zBMI, birth year, and parents' education, initially higher anxiety was associated with initially higher ST (covariance=.88, p

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.

Background. Failure to resist chronic obsessive-compulsive symptoms may denote an altered state of cognitive control. We searched for the cerebral regions engaged in this dysfunction. Method. Differences in brain regional activity were examined by event-related functional magnetic regional imaging (fMRI) in a group of adolescents or young adults (n=12) with childhood-onset obsessive-compulsive disorder (OCD), relative to healthy subjects. Subjects performed a conflict task involving the presentation of two consecutive and possibly conflicting prime and target numbers. Patients' image dataset was further analysed according to resistance or non-resistance to symptoms during the scans. Results. Using volume correction based on a priori hypotheses, an exploratory analysis revealed that, within the prime-target repetition condition, the OCD subjects activated more than healthy subjects a subregion of the anterior cingulate gyrus and the left parietal lobe. Furthermore, com- pared with ' resistant ' patients, the 'non-resistant ' OCD subjects activated a bilateral network including the precuneus, pulvinar and paracentral lobules. Conclusions. Higher regional activations suggest an abnormal amplification process in OCD sub- jects during the discrimination of repetitive visual stimuli. The regional distribution of functional changes may vary with the patients' ability to resist obsessions.

Resume L’hypothese principale de cette etude est de confirmer la prevalence elevee de l’alexithymie chez les toxicomanes en verifiant son independance par rapport aux variables sociodemographiques (sexe, âge, categorie socioprofessionnelle). Dans un deuxieme temps, le lien entre alexithymie et etat depressif chez les toxicomanes est etudie. Pour ce faire, un echantillon de 128 toxicomanes repondant aux criteres DSM IV de dependance aux substances psychoactives (alcool exclu) a ete apparie selon les variables sociodemographiques a un echantillon temoin de 128 sujets. Differents instruments d’hetero et d’auto-evaluation ont ete utilises : TAS-20 pour l’alexithymie, BDI a 13 items pour l’evaluation de la symptomatologie depressive, et MINI. Les resultats, aussi bien en analyse dimensionnelle que categorielle, confirment la prevalence elevee de l’alexithymie chez les toxicomanes (43,5 %) par rapport a celle des temoins (24,6 %). Cette difference est obtenue grâce a la composante emotionnelle, la composante cognitive ne differenciant pas les deux echantillons. L’alexithymie, dans la population des toxicomanes, est independante des variables sociodemographiques. Au BDI, 66,4 % des toxicomanes presentent une symptomatologie depressive (significativement plus frequente pour le sexe feminin), contre seulement 26 % des temoins. La complexite des rapports entre alexithymie et depression est discutee, la TAS et le BDI correlant significativement, surtout pour le facteur « difficulte a identifier ses emotions ». Dans notre etude, l’alexithymie apparait comme thymo-dependante.

ObjectiveClinical observations and a review of the literature led us to hypothesize that certain personality and character traits could provide improved understanding, and thus improved prevention, of suicidal behaviour among young women with eating disorders.MethodThe clinical group consisted of 152 women aged between 18 and 24 years, with DSM-IV anorexia nervosa/restrictive type (AN-R = 66), anorexia nervosa/purging type (AN-P = 37), bulimia nervosa/non-purging type (BN-NP = 9), or bulimia nervosa/purging type (BN-P = 40). The control group consisted of 140 subjects. The assessment measures were the Minnesota Multiphasic Personality Inventory—second version (MMPI-2) scales and subscales, the Beck Depression Inventory (BDI) used to control for current depressive symptoms, plus a specific questionnaire concerning suicide attempts.ResultsSuicide attempts were most frequent in subjects with purging behaviour (30.0% for BN-P and 29.7% for AN-P). Those attempting suicide among subjects with eating disorders were mostly students (67.8%). For women with AN-R the scales for ‘Depression’ and ‘Antisocial practices’ represented significant suicidal risk, for women with AN-P the scales for ‘Hysteria’, ‘Psychopathic deviate’, ‘Shyness/Self-consciousness’, ‘Antisocial Practices’, ‘Obsessiveness’ and ‘Low self-esteem’ were risk indicators and for women with BN-P the ‘Psychasthenia’, ‘Anger’ and ‘Fears’ scales were risk indicators.ConclusionThis study provides interesting results concerning the personality traits of young women with both eating disorders and suicidal behaviour. Students and those with purging behaviour are most at risk. Young women should be given more attention with regard to the risk of suicide attempts if they: (a) have AN-R with a tendency to self-punishment and antisocial conduct, (b) have AN-P with multiple physical complaints, are not at ease in social situations and have antisocial behaviour, or (c) if they have BN-P and tend to be easily angered with obsessive behaviour and phobic worries. The MMPI-2 is an interesting assessment method for the study of traits indicating a risk of suicidal behaviour in young subjects, after controlling for current depressive pathology.

The aim of this study was to examine response and remission rates in outpatients treated with sertraline or fluoxetine who were suffering from two depression subtypes: anxious-depression and severe depression. Data were pooled from five double-blind studies comparing fluoxetine versus sertraline for the treatment of DSM-III-R or IV major depression. Clinical outcome was assessed using the Hamilton Depression Rating Scale (HAM-D) and the Clinical Global Impression-Improvement scale (CGI-I). One thousand and eighty-eight patients were randomized, with 654 (60%) meeting criteria for anxious depression and 212 (19%) meeting criteria for high severity depression. For the total sample, treatment response was similar for both sertraline and fluoxetine. In the high severity subgroup, the mean (+/-SD) HAM-D score at week 12 was 8.9+/-5.7 for sertraline and 10.8+/-6.9 for fluoxetine (P=0.07), and the mean (+/-SD) CGI-I score was 1.5+/-0.7 for sertraline and 2.0+/-1.1 for fluoxetine (P=0.005). CGI-I responder rates were 88% versus 71% (P=0.03) in the high severity subgroup, and 84% versus 79% (P=0.16) in the anxious-depression subgroup. Overall, sertraline and fluoxetine showed comparable antidepressant efficacy, although sertraline may offer an advantage in those patients with severe depression.

Nous proposons dans cette article de faire une revue des traitements psychotropes du trouble obsessionnel compulsif chez l’enfant et l’adolescent et de discuter leur place, leur indication a cote des autres abords therapeutiques. On dispose de donnees solides aujourd’hui pour affirmer que les inhibiteurs de la recapture de la serotonine reduisent au plan clinique la severite des symptomes obsessionnels compulsifs chez la plupart des enfants ou adolescents atteints du trouble. Neanmoins, l’amelioration n’est souvent que partielle, peu de sujets deviennent asymptomatiques, et un traitement prolonge est souvent necessaire. Les psychotherapies cognitivo-comportementales, basees sur une exposition graduee aux stimuli anxiogenes (obsessions) et une prevention de la reponse comportementale (compulsions), semblent avoir des effets plus durables, et sont de ce fait le traitement de premiere intention dans les formes moderees sans comorbidite du trouble. Comme le TOC survient dans un contexte de difficultes adaptatives et psychopathologiques diverses, un abord psychotherapique individuel ou familial, une association de psychotropes ou un abord educatif pourront aussi etre proposes.

Resume L’alexithymie est un terme invente par Sifneos qui se caracterise par l’absence de mots pour exprimer ses emotions (a : privatif ; lexi : mots ; thymie : emotions, humeur). Apres avoir passe en revue les differents modeles etiopathogeniques de l’alexithymie et les instruments psychometriques permettant de quantifier cette dimension, nous donnons les premiers resultats du reseau dependance concernant la prevalence de l’alexithymie chez des patients souffrant de conduites d’addictions (alcoolisme, toxicomanie, anorexie, boulimie) comparativement a une population temoin. Dans le cadre de cette etude multicentrique, 654 patients presentant des conduites de dependance selon le DSM-IV ont ete compares a 767 temoins apparies sur l’âge, le sexe et le niveau socioprofessionnel ; ces sujets avaient entre 15 et 50 ans. L’alexithymie fut evaluee par la Toronto Alexithymia Scale dans sa version a 20 items. La prevalence de l’alexithymie en population generale etait de 20,7 %. Ses relations avec les donnees sociodemographiques montrent que l’alexithymie dans notre population temoin n’etait pas correlee a l’âge, ni avec le sexe, ni avec le niveau socio-educatif. En revanche, les sujets appartenant aux couches sociales defavorisees s’averaient plus alexithymiques que les autres. A l’instar des donnees de la litterature, la prevalence de l’alexithymie etait significativement plus elevee dans le cadre des conduites de dependance (variant de 63 % chez les patients alcooliques a 41 % chez les patients toxicomanes) comparativement aux sujets temoins. Cette difference etait en grande partie liee a la composante emotionnelle de l’alexithymie et non a sa composante cognitive.

Objective: The study was designed to assess whether social avoidance symptoms and/or comorbid anxiety disorders were predictive factors of social disability in subjects with eating disorders. Method: Sixty-three subjects with anorexia nervosa or bulimia nervosa were assessed for lifetime diagnoses of anxiety disorders, childhood history of separation anxiety disorder, social avoidance symptoms and social disability. Results: On the Groningen Social Disabilities Schedule, 86% of the anorexics and 65% of the bulimics had disability regarding the ‘social role’, and 86% and 61% disability regarding the ‘occupational role’. Using all subsets logistic regression analyses, predictive factors of disability were: (1) for the social role, social avoidance symptom score (p

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Ipser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD005170. DOI: 10.1002/14651858.CD005170.pub2. Further information for this Cochrane review is available in this issue of EBCH in the accompanying Summary article. Copyright © 2010 John Wiley & Sons, Ltd.

A rejecting and overprotective parenting style is considered to be an important risk factor for the development of anxiety disorders. This study examined the role of perceived parental bonding as a potential environmental risk factor for panic disorder (PD) in unaffected offspring with parental PD. Children with a biological parent with PD (n = 71) and children of parents with no psychiatric history (n = 80) participated in the study. Results indicate that high risk children do not perceive their parents as being more protective and less caring than low risk controls. The optimal bonding type (high care, low protection) was the most frequently reported parenting style across groups. The constraining type of maternal bonding (high care, high protection) was less frequently reported by high risk children (p < 0.05). Overall, these data suggest that parental PD does not compromise the parent–child bonds in never-ill offspring.

Objective To estimate the prevalence of current psychiatric disorders among children and adolescents (collectively called children) of mothers entering treatment for depression; to examine maternal predictors of child psychopathology among children of depressed mothers; and to determine consistency of findings with a similar child study ancillary to Sequenced Treatment Alternatives to Reduce Depression (STAR⁎D) from seven United States sites (STAR⁎D-Child). Method Mothers (N = 82) with major depressive disorder (MDD) enrolled in a treatment study in Ottawa (Ontario, Canada) or New York City, and their eligible children (N = 145) (aged 7 through 17 years) were assessed independently when the mother enrolled. Results Among the children of depressed mothers, 42% had at least one current psychiatric diagnosis, including affective (15%), anxiety (19%), behavioral (23%), and/or substance use (2%) disorders. In all, 40% of the children were rated as impaired by clinical assessors. Mothers' comorbid anxiety disorders predicted the highest rates of current disorders in the child in both studies. The severity of the mother's depression predicted behavioral problems in the child. The current and lifetime rates of psychiatric disorders in the children of depressed mothers were compared to rates found in STAR⁎D Child and findings were consistent. Both studies used similar diagnostic assessments. Conclusion Given the high prevalence of offspring psychiatric disorders, inquiring about the mental health of the children when a depressed mother comes for treatment, and referring children for treatment when appropriate, are important.

Paediatric OCD is the disorder, in child psychiatry, whose clinical picture most closely resembles its adult counterpart. Despite a relative diversity, the symptom pool is remarkably finite, and very similar to that seen in older individuals. Prevalence, comorbidity, and response to behavioural and drug treatment also appear similar across the lifespan. For tic disorders, there is continuity between child and adult presentations, but the disease is much more prone to resolve spontaneously, or to be less disruptive in adulthood. Both OCD and tics occur more often in males than in females, and are likely to be linked to an array of neurobiological abnormalities, many of which remain to be understood. Invaluable benefits can now be obtained from available behavioural and pharmacological treatments, but complete remission remains uncertain and long-term management may be required. Thus, the treatment of OCD and tics in children and adolescents remains a clinical challenge. It requires careful assessment of the targeted symptoms and, in many cases, comorbidity; attention to the quality of the child's functioning at home and with peers; use of specific CBT interventions, which are not readily available (or accessible) in all communities; patience and caution in the choice and adjustment of medication; and vigilance in watching potential side effects. Given the possible chronicity of OCD and/or tic disorders, and their changing patterns in severity and impact over the childhood and adolescent years, optimal treatment generally requires a long-term ongoing relationship with the child and family. Current conceptualizations of OCD and tic disorders have been shaped by advances in systems neuroscience and functional in vivo neuroimaging. Continued success in these areas should lead to the targetting of specific brain circuits for more intensive research. This should include testing novel pharmacological agents, tracking treatment response using neuroimaging techniques, and possibly investigating circuit-based therapies using deep-brain stimulation for refractory cases. The identification of the PANDAS subgroup of patients, with an abrupt onset and dramatic exacerbations, certainly brings new insights into the pathophysiology of OCD and tic disorders, and may lead to new assessment and treatment strategies. The increasing evidence for susceptibility genes in OCD and tic disorders will also doubtless point to new therapeutic directions. Furthermore, it is likely that many of the empirical findings used in research on paediatric OCD and tic disorders will be relevant to a better understanding of both normal development, and other disorders of childhood onset.

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.