Influence of peer pressure on bulimia rates in college females http://www.sciencedirect.com.ezlibproxy.unisa.edu.au/science/article/pii/S0022249603000695 Consequences of teenage anorexia and predisposing factors? http://search.proquest.com.ezlibproxy.unisa.edu.au/docview/204519171?

accountid=14649
OCD/anxiety: Sixteen individuals in the AN group (31%) compared with 4 in the COMP group (8%) had met criteria for obsessive compulsive disorder (OCD) at some time in their lives (p <.01). Most of these had met such criteria ever since their early school years and continued to do so during the course of the eating disorder. Ten individuals in the AN group (20%) compared with three (6%) in the COMP group continued to meet criteria for OCD at the time of the follow-up study (p <.05). The finding of a high rate of obsessive compulsive symptomatology in AN is in accord with several earlier studies (Steinhausen and Glanville, 1983; Halmi et al., 1991). Almost 30% of all AN cases in our study were diagnosed as having an empathy disorder. In the AN group, results in this respect tended to be consistent over time. This subgroup of AN patients had a premorbid history and outcome status suggesting impairment in the ability to conceive of mental states and rigidity and restraint in emotional expression and initiative, something that has recently been demonstrated in another follow-up study (Casper, 1990) of long-term recovered AN patients. Alexithymia (impairment in the ability to describe and identify feelings; which could be said to constitute one aspect of empathy disorder) has long been reported in AN, and has recently been confirmed to be present in controlled studies (Bourke et al., 1992; Schmidt et al., 1993). Psychotic disorders: In the AN group, 1 female met criteria for schizoaffective disorder and 2 other
females met criteria for psychosis NOS in between the two studies. One female with AN may have met criteria for schizophrenia (even at the time of the follow-up study). However, she had been diagnosed as suffering from an autisticlike condition from early childhood, and the history she provided at interview was so vague as to preclude the confirmation of a schizophrenia diagnosis with confidence, even after we had scrutinized her psychiatric/medical records. If bipolar disorder is accepted as a psychotic disorder, altogether 6 individuals in the AN group had had a psychotic episode before age 21 years. This did not apply in any of the COMP group cases (p <.05). Axis I/II: All the AN cases had met criteria for at least one Axis I diagnosis other than AN at least once in their lifetime, compared with 39% in the COMP group (p <.001). At follow-up those free of eating disorder were more often free from other Axis I diagnoses. Personality Disorders (SCID Axis II) At follow-up, 41% of the individuals with AN met the criteria for at least one axis II (personality disorder) diagnosis compared with 18% in the COMP group (p <.02; Table V). Cluster C personality disorders were by far the most common. Nineteen individuals (37%) in the AN group had at least one cluster C diagnosis compared to 10% in the COMP group (p <.001). At age 16 years, 35% of the AN cases had been assigned a premorbid diagnosis of obsessive compulsive personality disorder (OCPD). At follow-up, OCPD, rated by a clinical researcher blind to the original diagnosis of AN, was still significantly more prevalent in the AN group. The diagnoses of OCPD were very consistent over time (see I. C. Gillberg et al., 1995, for details). Empathy Disorder Fifteen subjects (29%) in the AN group had an empathy disorder compared to 2 (4%) in the COMP group (p < .01). Of the 15 individuals in the AN group with an empathy disorder, 5 females and 1 male met criteria for Asperger syndrome. In addition, 4 female subjects had an autistic-like condition. The male subject with Asperger syndrome had already been diagnosed with this condition at age 16 years. The 9 females who were diagnosed with Asperger syndrome or autistic-like condition at follow-up had all been diagnosed with autistic-like condition, OCPD, Tourette syndrome or "identity disorder" in the original study (Tables VI and VII).

Of the 17 cases with empathy disorder (15 subjects in the AN and 2 in the COMP group), 10 were in the "top 20" of poor outcomes according to the averaged Morgan-Russell scales scores. In this group of poor outcome cases, 4 reported that they were recovered (in spite of their very obvious poor functioning according to more objective measures, such as very low weight, menstrual abnormalities, and poor social relationships). All these four had empathy disorder.

In summary, most adolescent-onset AN cases recover from AN within 6-7 years. A majority develop bulimic symptomatology. Almost all AN cases are seriously depressed at some time during the course of the eating disorder, but it is unusual for depression to precede AN or to persist after the eating disorder. Obsessive compulsive disorder/obsessive compulsive personality disorders were very common and consistent over time, and they seemed to be quite often associated with empathy problems. The presence of empathy disorder predicted poor outcome better than the eating disorder or any other comorbid Axis I diagnosis. The results of the study suggests that, at least in a subgroup, AN should be viewed rather as a marker for an underlying longer term psychiatric disorder than a discrete disease entity. This has implications for treatment and rehabilitation. One cannot expect recovery from eating disorder symptoms to be accompanied by acceptable psychosocial adjustment in all cases.

The prevalence of personality disorders (PDs) in individuals with AN is high, with variations between studies ranging from 22% to 87% (mean 50%). 12 Also, studies of patients with childhood and adolescent-onset AN compared with controls have found an increased prevalence of PDs in young adulthood. 13,14 The Cluster C disorders, avoidant, dependent. and obsessive-compulsive PDs, are by far the most frequent in individuals with AN, with an average prevalence of 45%. Low self-esteem is found in many psychiatric disorders and is particularly common in depression. 23,29 There is divergent evidence as to whether low self-esteem in patients with AN is dependent on comorbid depression or independently associated with the ED.

http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/pdfviewer/pdfviewer?sid=278d6de157df-4aca-8e29-7f2e3410be1e%40sessionmgr10&vid=18&hid=16

http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/detail?sid=f6146b30-cf12-40eb-b012a57a0c1736d6%40sessionmgr12&vid=1&hid=16&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=p syh&AN=1991-07733-001Argues that anorexia nervosa and many forms of bulimia are a prominent form of obsessivecompulsive (OC) illness in Western culture. The centrality of obsessive rumination on food and dietary matters and of compulsive elimination and self-starvation rituals has not been fully considered. These conditions are manifestations of a modern OC disorder reflecting the impact of social influences on developmental difficulties and symptomatology during adolescence.

http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/detail?sid=1ff7afa4-c4d7-43b5-b1bfc4b15182bf43%40sessionmgr14&vid=1&hid=16&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=p zh&AN=2009-19610-000 http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/detail?sid=979810c5-eabb-442d-8137c1c2fe5938ed%40sessionmgr10&vid=1&hid=16&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=p bh&AN=18898989

Self persperctive: http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/detail?vid=4&hid=16&sid=a93d67bfb910-4908-b82498cf95e169a1%40sessionmgr13&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=pbh&AN=218070 30 http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/pdfviewer/pdfviewer?sid=278d6de157df-4aca-8e29-7f2e3410be1e%40sessionmgr10&vid=13&hid=16 Anxiety and peer groups

Being a member of a crowd in itself did not predict socialization of social anxiety, but adolescents in the Radical crowd were more influenced by their peers social anxiety than adolescents who did not affiliate with the Radical crowd group. The results suggest that through a bidirectional process, adolescents affiliating with Radical crowds may narrow their peer relationship ties in time, and in turn socialize each others social anxiety.

http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/detail?sid=8ceb981a-1e15-4e3e-82abf88211caa2bd%40sessionmgr4&vid=1&hid=16&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=psy h&AN=2011-24561-013 Self esteem Second, after the group therapy, perception of physical appearance, self-concept related to weight and shape, self-concept related to others and perception of happiness and satisfaction (all

within self-esteem) and social withdrawal (within social skills) improved signicantly in both groups. Third, in self-esteem variables (perception of intellectual and school status, physical appearance and freedom from anxiety) and social skills variables (consideration forothers and social withdrawal), the improvement was signicantly higher in BN-rd than in AN-rd. We found higher levels of selfcontempt related to weight and shape and a poorer perception of intellectual and school status and behaviour adjustment in our BN-rd sample. In general, lower self-esteem is related to the endorsement of stereotyped beliefs about thinness and dissatisfaction with appearance and weight (Cooper & Fairburn, 1992), and is a risk factor for dietary restraint and disordered eating; what is more, higher levels of body dissatisfaction and body image concerns among young people are also associated with lower global self-worth and greater dissatisfaction with other aspects of life (Strauss & Pollack, 2003). So, selfesteem is also related to the perception of academic achievement: adolescents reported that, apart from their relationships, their performance at school was the most central feature in their feelings of self-worth (Geller, Zaitsoff, & Srikameswaran, 2002). Eating disturbances also have detrimental effects on performance on a range of cognitive tasks including problemsolving ability. http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/pdfviewer/pdfviewer?sid=6968e8d09d42-453d-af06-31aaa4e165fe%40sessionmgr11&vid=2&hid=16 http://www.sciencedirect.com.ezlibproxy.unisa.edu.au/science/article/pii/S1057740810000239 An association between low self-esteem and AN is well documented. 4,6,22,23 In a retrospective study of risk factors for AN, Fairburn et al. 3 found that negative self-evaluation and perfectionism in childhood were particularly typical antecedents of both AN and bulimia nervosa (BN). Low self-esteem has been associated with the development of eating problems in several longitudinal studies. 4,2426 However, two longitudinal studies that controlled for baseline pathology found no signicant impact of selfesteem on the risk for ED 27 or the outcome of ED.28 http://web.ebscohost.com.ezlibproxy.unisa.edu.au/ehost/pdfviewer/pdfviewer?sid=278d6de157df-4aca-8e29-7f2e3410be1e%40sessionmgr10&vid=18&hid=16