Onset of bulimia nervosa (BN) typically occurs in adolescence and is frequently accompanied by medical and psychiatric sequelae that may have detrimental effects on adolescent development. Potentially serious medical consequences and high comorbid rates of mood disorders and suicidality underscore the need for early recognition and effective treatments. Research among adolescents with BN has lagged behind that of adults, although evidence is accumulating to support the efficacy of family-based interventions and cognitive behavioral treatments that are adapted for use with adolescent populations. The aim of the current article is to provide an overview of recent research on epidemiology, risk factors, diagnostic issues, and treatment interventions focusing on adolescent BN, and to highlight areas for future research.

Purpose

To examine the prevalence and potential risk factors associated with substance use in adolescents with eating disorders (EDs).

Methods

This cross-sectional study included 290 adolescents, aged 12-18 years, who presented for an initial ED evaluation at The Eating Disorders Program at the University of Chicago Medicine between 2001 and 2012. Several factors including DSM-5 diagnosis, diagnostic scores, and demographic characteristics were examined. Multinomial logistic regression was used to test associations between several factors and patterns of drug use for alcohol, cannabis, tobacco, and any other substance.

Results

Lifetime prevalence of any substance use was found to be 24.6% in those with anorexia nervosa, 48.7% in bulimia nervosa (BN), and 28.6% in ED not otherwise specified. Regular substance use (monthly, daily, and bingeing behaviors) or a substance use disorder was found in 27.9% of all patients. Older age was the only factor associated with regular use of any substance in the final multinomial model. Older age and non-white race was associated with greater alcohol and cannabis use. Although binge-purge frequency and bulimia nervosa diagnosis were associated with regular substance use in bivariate analyses, gender, race, and age were more robustly associated with substance use in the final multinomial models.

Conclusions

Co-morbid substance use in adolescents with EDs is an important issue. Interventions targeting high-risk groups reporting regular substance use or substance use disorders are needed.

Objective

This study aimed to describe and compare the demographic and clinical characteristics of children and adolescents with an eating disorder (ED) and comorbid depression or anxiety.

Method

Data were drawn from intake assessments of children and adolescents at a specialist ED clinic. Demographic characteristics (e.g. age and gender) and clinical characteristics (e.g. body mass, binge eating and purging) were compared between 217 ED participants without comorbidity, 32 with comorbid anxiety, 86 with comorbid depression and 36 with comorbid anxiety and depression.

Results

The groups with comorbid depression had more complex and severe presentations compared with those with an ED and no comorbid disorder and those with comorbid anxiety alone, especially in regard to binge eating, purging, dietary restraint and weight/shape concerns.

Discussion

Depression and anxiety were differentially related to clinical characteristics of EDs. The findings have implications for understanding the relations between these disorders and their potential to impact outcome of ED treatments.

Background

Weak central coherence-a tendency to process details at the expense of the gestalt-has been observed among adults with bulimia nervosa (BN) and is a potential candidate endophenotype for eating disorders (EDs). However, as BN behaviors typically onset during adolescence it is important to assess central coherence in this younger age group to determine whether the findings in adults are likely a result of BN or present earlier in the evolution of the disorder. This study examines whether the detail-oriented and fragmented cognitive inefficiency observed among adults with BN is observable among adolescents with shorter illness duration, relative to healthy controls.

Method

The Rey-Osterrieth Complex Figure Test (RCFT) was administered to a total of 47 adolescents with DSM5 BN, 42 with purging disorder (PD), and 25 healthy controls (HC). Performance on this measure was compared across the three groups.

Results

Those with BN and PD demonstrated significantly worse accuracy scores compared to controls in the copy and delayed recall condition with a moderate effect size. These findings were exacerbated when symptoms of BN increased.

Discussion

Poorer accuracy scores reflect a fragmented and piecemeal strategy that interferes with visual-spatial integration in BN spectrum disorders. This cognitive inefficiency likely contributes to broad difficulties in executive functioning in this population especially in the context of worsening bulimic symptoms. The findings of this study support the hypothesis that poor global integration may constitute a cognitive endophenotype for BN.