Josep Toro

Assessment of sociocultural influences on the aesthetic body shape model in anorexia nervosa

The prevailing aesthetic body shape model in our culture – that of slenderness – plays a leading role in eating disorders. A questionnaire (CIMEC) was prepared in an attempt to measure the influence of the agents and situations that transmit this model. The CIMEC questionnaire was applied to 59 anorectics and 59 normal girls matched by age and social class. Highly significant differences were found between the scores obtained from both groups, showing the patients to have a much greater involvement with the sociocultural agents encouraging weight loss. Factorial analysis of the discriminating items gave rise to 5 factors, each of which also significantly differentiated between anorectics and the normal group. The questionnaire, in two versions, showed satisfactory internal consistency and appropriate sensitivity and specificity and would serve as a sound instrument for screening. It calls into question the causal relationship between anorexia nervosa and sociocultural influences.

Predictors of bone mineral density reduction in adolescents with anorexia nervosa.

OBJECTIVES To determine which variables are associated with a significant reduction in bone mineral density (BMD) in adolescent anorexia nervosa and to establish guidelines for indication of bone densitometry. METHOD One hundred seventy patients (treated from 1997 until 1999), aged 10 to 17 years, with a DSM-IV diagnosis of anorexia nervosa were evaluated by dual-energy-x-ray absorptiometry in the lumbar spine (L2-L4) and the femoral neck. The results were compared with the normative data for BMD values by age and sex in Spanish adolescents. RESULTS 44.1% of patients had osteopenia at the lumbar spine and 24.7% at the femoral neck. The following variables were related to osteopenia: more than 12 months since onset of the disorder (p < .001), more than 6 months of amenorrhea (p < .001), body mass index <15 (p < .001), calcium intake <600 mg/day (p < .01), and <3 hours/week of physical activity (p < .001). In a stepwise logistic regression analysis to predict reduced spinal BMD, 3 variables-months elapsed since the onset of weight loss, calcium intake, and body mass index--correctly classified 78.8% of patients. CONCLUSIONS Adolescent anorexia nervosa patients with the characteristics outlined above are at high risk of reduced BMD, and densitometry is recommended to determine the degree of osteopenia.

Body shape, publicity and anorexia nervosa

SummaryAdvertisements in Spanish womens magazines have been analysed in order to verify the impact of commercial advertising encouraging slimming. Directly or indirectly, 22.5% of advertisements encourage weight loss. Aesthetic rather than health motivations predominate. Advertising impact is mainly targeted at a female population in the 14 to 18 age group from upper and middle social class backgrounds living in towns over 50.000 inhabitants. This demographic coincidence with anorexia nervosa suggests that advertising may be thought of as a cultural environmental risk factor for this disorder.

Adolescent Anorexia Nervosa: The Catch-up Effect in Bone Mineral Density After Recovery

OBJECTIVE To determine whether bone mineral density (BMD) loss can be reversed in adolescent anorexic patients. METHOD A prospective study with 108 anorexia nervosa patients (DSM-IV) from 12 to 17 years of age at the Eating Disorders Unit in the Hospital Clinic of Barcelona (Spain). They were first evaluated by dual-energy x-ray absorptiometry in lumbar spine and femoral neck consecutively from 1997 until 1999 and reexamined after 6 to 30 months. Results were compared with normative values of bone mass. RESULTS Patients with poor outcome (n = 44) had a bone mass loss. Patients with good short-term outcome were divided in two groups. The group with normal BMD at first evaluation (n = 41) had a bone mass gain per year of 3.0% at lumbar spine and 0.5% at femoral neck. The group with low BMD at first evaluation (n = 23) had an increase per year of 9.1% at lumbar spine and 4.5% at femoral neck. In a multiple linear regression analysis with the variables body mass index, age, months with menstruation, and BMD zscore at first evaluation, the only predictor of BMD increase was the first z score both at the lumbar spine (coefficient R = 0.64; p < .001) and at the femoral neck (coefficient R = 0.5; p < .001). CONCLUSIONS There is a catch-up effect in adolescent patients with low BMD but good short-term outcome.

Anorexia nervosa in a Spanish adolescent sample: an 8-year longitudinal study.

Objective

Eating disorders in ballet dancing students: Problems and risk factors

OBJECTIVE To study the prevalence of symptoms of eating disorders and risk eating behaviours and the relationship between life at a dance school and the risk of developing an eating disorder (ED) in an adolescent population of Spanish dance students. METHODS Questionnaires were used to assess attitudes to eating, cultural influences on the body shape model, eating disorders (DSM-IV) and risk factors for eating disorders in 76 adolescent dance students (age 12-17 years) at the Barcelona Theatre Institute. Subjects were compared with a community sample of 453 female adolescents. To study the relationship between ED and characteristics of this particular school, an original questionnaire was administered to 105 students at the school aged from 12 to 21 years. RESULTS The prevalence of eating disorders and several risk attitudes and behaviours were similar in the dance students and the female adolescents from the general population. Students at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies. In contrast, Body Mass Index (BMI) had hardly any influence on these experiences. Depressive symptoms were associated almost exclusively with experience of stressors and aversive situations. CONCLUSIONS Dance school students do not necessarily present a greater risk of ED than other girls of the same age. The risk of ED may be associated with greater pressure from coaches, with attitudes related to the ED itself, or with depressive symptoms, rather than with the BMI.

Behavioral treatment of a case of psychogenic urinary retention

The case involved a thirteen-year-old girl with a history of different urological disorders who since the age of four showed several rituals associated with micturition as well as progressively intense urinary retention. Micturition occupied 2 to 12 hours a day. Treatment consists of systematic desensitization through imagery and in vivo together with progressive response prevention of ritualized behaviours. Cognitive therapy and parent counselling is also used. Normality is attained after 7 weeks treatment and maintained at 18 months follow-up. Psychiatric diagnosis is simple phobia to micturition.

Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment

Several studies have related motivation to change and treatment response in adult patients with bulimia nervosa but there are no longitudinal studies analysing this relationship in adolescents. The objective was to determine whether motivation to change is related to clinical improvement after treatment in adolescent patients with bulimia nervosa. The Bulimia Nervosa Stages of Change Questionnaire, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI) were administered at the beginning of treatment to 40 adolescent patients with bulimia nervosa (DSM-IV) (mean age = 16.2 years). Thirty-one patients were re-assessed after 6 months of treatment. The majority of clinical and psychological variables improved significantly at the second evaluation. There were significant correlations between initial motivation to change and improvement in number of binges and the EDI-2 scales of Bulimia and Interoceptive Awareness. In the stepwise multiple linear regression analysis, which included initial motivation to change and other potential confounding variables such as age, BDI, duration of disorder and body mass index, only motivation to change was selected as a predictor of improvement in number of binges (standardized β coefficient = 0.45; p = 0.012) and of decrease on the Bulimia scale (standardized β coefficient = 0.43; p = 0.029). Regarding improvement in Interoceptive Awareness, only the BDI score was selected as an independent predictor (β coefficient = 0.58; p = 0.002). In conclusion, in adolescent patients receiving treatment for bulimia nervosa, improvement in bulimic symptomatology seems to be especially related to initial motivation to change.

Body image, risk factors for eating disorders and sociocultural influences in Spanish adolescents

The aim was to study differences between male and female adolescents as regards body dissatisfaction, some risk factors for eating disorders, and exposure to social influences that create ideal body figures among these populations. A questionnaire comprising 40 items was administered to 240 male adolescents at 12 public and private schools in Barcelona. Twenty-nine of the questions were the same as those in another study administered to a sample of 675 female adolescents attending similar schools in the same geographical area. The other 11 questions were specifically for males. The differences between boys and girls were highly significant on almost all the items. Girls’ scores were significantly higher (p=0.000) in the following areas: dieting and exercising in order to be thin; feelings of anxiety on seeing or showing the body in public; tendency to focus on the bodies of others and on the amount of food they eat; the belief that thin people are more popular. In addition, the girls were significantly more vulnerable to potentially dangerous social influences. For the most part, males sought a heavier, more muscular body. Though a minority of males also feared being overweight, one out of four ate more than normal to gain weight and two out of three exercised to develop their muscles. The same proportion reported envying the build of certain actors. In adolescence, the ideal body figures of the sexes vary widely. This divergence reflects a greater risk of eating disorders in girls, who are also far more exposed to social situations that cause body dissatisfaction and shape risk attitudes and behaviors.

D8/17 monoclonal antibody: an unclear neuropsychiatric marker.

Objective: It has been hypothesized that monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in patients with rheumatic fever, childhood onset obsessive-compulsive disorder (OCD), Tourette syndrome (TS) or prepubertal anorexia nervosa (AN). Our purpose was to replicate these studies in a Spanish population and to determine whether D8/17 identifies a subgroup of these patients, focusing especially on OCD subjects. Method: D8/17 expression was assessed with double immunofluorescence and flow cytometry using monoclonal immunoglobulin M (IgM) in three groups of patients with diagnoses of OCD (n = 17), TS (n = 5) and prepubertal AN (n = 5), recruited during 2001. Results: In the sample studied the average percentage of B cells expressing D8/17 was 4.8%. The D8/17 positive proportion of B lymphocytes was above 11% in only two out of 17 OCD patients (7.4% of total sample) and in none of the TS or prepubertal AN patients. No statistically significant differences were found in mean percentages of D8/17 between the three groups. Conclusions: In the sample studied the expression of D8/17 in B cells was very low and the great majority of patients were negative for the D8/17 marker. The molecular characterization of D8/17 would be a major step forward in clarifying its implication for these diseases.