Michelle P. Warren

Validity of self-report measures of girls pubertal status.

To understand the meaning of somatic changes to the adolescent and their possible effects on behavior, developmentalists have begun to examine maturational timing and status in detail. Efforts have been hampered by the necessity of obtaining somatic growth data by physician examination. In the present study, 3 self-report methods for rating secondary sexual characteristic growth were compared to physician ratings; the accuracy of self-reported height and weight also was assessed. Specifically, 151 11-, 12-, and 13-year-old girls rated their breast and pubic hair development using schematics of the 5 Tanner stages and filled out the Pubertal Development Scale (PDS); their mothers also rated their daughters development using the Tanner stage schematics. The correlation with physician Tanner ratings was .82 for self-ratings, .85 for ratings by the mother, and between .61 and .67 for self-reports on the PDS. The correlations for self- and actual reports of weight and height were .98 and .75, respectively. The usefulness of the PDS, Tanner ratings, and self-reported height and weight as adequate estimates of pubertal development is discussed.

Co-morbidity of eating disorders and substance abuse review of the literature.

The comorbidity of eating disorders and substance use and abuse has frequently been reported in the past 15 years. To date, however, no synthesis of this literature exists. Here, 51 studies reporting on these associations are reviewed. Studies of substance use and abuse in eating disordered women are considered, as are studies of eating disorders among women classified as substance abusers. The rates of substance abuse among eating disordered women are also examined. This review indicates that associations are stronger with bulimia, and bulimic behaviors, than with anorexia nervosa. Analogously, bulimic anorectics report more substance use and abuse than restricters. The prevalence of drug abuse was not found to differ between the relatives of bulimics and anorectics. Several mechanisms explaining the eating disorder-substance use/abuse link are considered, and suggestions for future research made.

Biological and social contributions to negative affect in young adolescent girls.

This study is a preliminary attempt to investigate whether internal or external pubertal changes and whether social or biological factors are more likely to be associated with negative affect. About 100 white girls aged 10-14 years were given a physical examination, had blood drawn, and filled out the Youth Behavior Profile and a life-events checklist. Negative affect increased during the most rapid rises in hormone levels; however, hormones accounted for only 4% of the variance in negative affect. Pubertal status and timing were not associated with negative affect. In contrast, social factors accounted for more variance than hormonal pubertal factors alone (8%-18%), as did the interaction of negative life events and pubertal factors (9%-15%). Results are discussed in terms of what hormonal activation effects are most likely to be found, the meaning of such effects for subsequent behavior, and the interaction of biological and social events.

Clinical and metabolic features of anorexia nervosa

Abstract A study of 42 patients with anorexia nervosa revealed that a specific symptom complex exists which is characteristic and can easily be differentiated from other causes of cachexia except pure starvation. Most of the patients were white, female, and in early adolescence. The hallmarks of this syndrome include amenorrhea and severe constipation with hypotension, bradycardia, and hypothermia. Leukopenia occurred in 38 per cent and was occasionally accompanied by pancytopenia and hypoplastic bone marrow. Azotemia was present in 40 per cent and hypercarotenemia in 38 per cent. Electrocardiogram changes include low voltage and nonspecific T wave changes. In patients with edema, hypoproteinemia was conspicuously absent. Endocrine findings often include low thyroxine by column, low plasma luteinizing hormone, and occasionally follicle-stimulating hormone but consistently normal to high plasma corticoids with occasional reversal in the circadian rhythm. All signs and symptoms appeared to be reversible with weight gain except the amenorrhea which persists in 46.7 per cent. Three patients died, and attention is drawn to the development of an electrolyte imbalance and sepsis with enterococcus in one. Some of the abnormalities including deranged temperature control, presumed deficient gonadotropin release, and disturbances in the dynamic patterns offecting cyclicity of adrenocorticotropic hormone probably originate in the central nervous system, most likely in the hypothalamus.

Resting metabolic rate and energy balance in amenorrheic and eumenorrheic runners

This study investigated metabolic and nutritional factors in association with athletic menstrual dysfunction (AMD). Three groups of women were studied: amenorrheic runners (amenorrheic), eumenorrheic runners (eumenorrheic), and eumenorrheic sedentary controls (sedentary). Amenorrheic and eumenorrheic were similar in age, weight, percent body fat by hydrodensitometry, training pace and mileage, best 10 km race time, years running, and maximal oxygen consumption. When adjusted for body weight or for fat-free mass by analysis of covariance, RMR was significantly lower in amenorrheic than in eumenorrheic and sedentary. The daily caloric intakes of the groups did not differ significantly, but the amenorrheic scored significantly higher than the eumenorrheic and sedentary on a scale of aberrant eating patterns. Amenorrheic high mileage runners seem to have a less adequate diet than eumenorrheic runners but appear to maintain energy balance and stable weight through a reduction in RMR.

The relation of eating problems and amenorrhea in ballet dancers.

Exercise-induced amenorrhea has received considerable attention in the medical literature. The combination of exercise and low body weight is thought to exert synergistic effects in the pathogenesis of amenorrhea, while the role of dieting and eating problems, another possible causative mechanism, has not been examined. A sample of 55 adult dancers in national and regional classical ballet companies was studied; their mean age was 24.7 yr. Fifty-six percent of the dancers had delayed menarche (age 14 or later) and 19% of the sample were currently amenorrheic (5 months or longer). One-third of the dancers reported having had an eating problem (self-reported anorexia nervosa or bulimia). Amenorrhea and reported eating problems were significantly related: 50% of amenorrheics reported anorexia nervosa while 13% of the normals did. In addition, prolonged amenorrhea was significantly related to dieting (as measured by EAT-26 scales, a measure of dieting behavior). As expected, leanness and absolute weight also were related to prolonged amenorrhea. Amenorrhea in this sample of adult dancers was not related to current activity level or age at which training began. Thus, eating problems may be one factor in the pathogenesis of prolonged amenorrhea in certain athletic groups.

The female athlete and menstrual function.

Purpose of review In the past year, there have been remarkable advancements in the understanding of the female athletes pathology and in recognizing the specific needs of women participating in both recreational and competitive sports. The purpose of this review is to highlight the recent developments in the field of female athletes and menstrual function. Recent findings Although the female athletic triad, consisting of disordered eating, amenorrhea and osteoporosis, has been clinically recognized, there have been few studies quantifying the long-term effects. This review summarizes recently explored topics, including: disordered eating as a main culprit of menstrual irregularities, long-term longitudinal studies following female athletes through to retirement, and current treatment options. Summary Understanding the causes, profiles and the prevention of menstrual irregularities in the female athlete should help decrease its prevalence among women involved in athletics. The literature reviewed in this article stresses the importance of early detection, as well as the consequences of eating disorders, menstrual disturbances and bone loss left untreated.

The role of selectivity in the pathogenesis of eating problems in ballet dancers

Forty-nine dancers from four national ballet companies in America (N = 32) and the Peoples Republic of China (N = 17) were surveyed (mean age, 24.6 +/- 4.18) from highly and moderately selective dance companies. The less selected American dancers reported significantly more eating problems (46% vs 11%; P less than 0.05), anorectic behaviors (2.77 vs 1.11; P less than 0.05), and familial obesity (42% vs 5%; P less than 0.05) than the Americans chosen from a company school. Differences were not found on these variables between the highly selected American and Chinese dancers. All of the groups reported a delay in menarche and weighed approximately 14% below their ideal weight for height. These data suggest that dancers who have survived a stringent process of early selection may be more naturally suited to the thin body image demanded by ballet and so less at risk for the development of eating problems. In addition, delayed menarche is typical of the majority of national dancers and probably is reflective of genetic and environmental factors.

The Psychological Significance of Secondary Sexual Characteristics in Nine- to Eleven-Year-Old Girls.

82 9-11-year-old girls were seen in order to study the onset of puberty as represented by breast and pubic hair growth. Girls filled out self-report scales, mothers rated their daughters breast and pubic hair development using schematic representations of the Tanner stages, and height was measured by a nurse practitioner. Breast growth, but not pubic hair growth, was expected to be associated with a positive body image, positive peer relationships, superior adjustment, and the rating of adult roles as important (marriage, children, and careers). These expectations were confirmed for all but the adult role measures. Controlling for pubic hair growth did not alter the findings for breast development. Associations with height also were examined. Height was linked to superior adjustment and career importance. These findings are discussed in terms of possible roles that different pubertal events may play in the self-definitions of young adolescents as well as the meaning of various physical changes to the girl and to others.

Eating disorders and substance use : a dancing vs a nondancing population

The association between eating disorders, substance use, and emotional distress is well recognized in the literature. To determine whether dancers who are known to be at risk for eating disorders were also at risk for other emotional disorders, the co-occurrence of eating disorders, substance use, and emotional distress among dancers (N = 50) and nondancers (N = 56) was examined. These young adult women were part of a longitudinal study of the complications of decreased bone density. Participants filled out questionnaires about eating behavior, substance use, and emotional functioning. A clinical interview determined the existence of eating disorders (DSM-III-R). Physiological data, including an assessment of current health, also were collected. There were no differences in disordered eating between the two subject groups. Associations existed within each group, however. Many associations including substance use and emotional distress were found among the nondancers, while no associations were found among the dancers. Thus, eating disorders in a group of subjects at risk because of professional pressures to remain thin revealed a profile which differed significantly from that of women developing eating disorders in the general population.