James Lock

All Publications

Family therapy for eating disorders in youth: current confusions, advances, and new directions. Current opinion in psychiatry Lock, J. 2018
Abstract

PURPOSE OF REVIEW: Family interventions for eating disorders are often recommended for the treatment of children and adolescents. Treatment studies and a range of treatment guidelines now recommend family-based treatment (FBT) for adolescents with AN and bulimia nervosa. The current report focused on studies that have been conducted over the past 2 years, most of them aimed at augmenting or improving outcomes using a range of new family approaches or adding other forms of therapy to standard FBT.RECENT FINDINGS: There is increasing confusion of what type of family therapy is supported by the evidence, including FBT, FT-AN, MFT-AN, and parent-focused therapy. Seventy-five percentages of the adolescents with anorexia nervosa studies in randomized clinical trials used manualized FBT. None of the other family therapy approaches have more than 16% of the total adolescents with anorexia nervosa studied. Thus, FBT is the only form of family therapy with a substantive evidence base. Augmentation by varying the format of family therapy may be clinically useful, but differences in outcome from standard FBT are minor.SUMMARY: The evidence base supporting the use of family therapy for adolescent anorexia nervosa is for manualized FBT. Augmentations of FBT using different formats (e.g., parents only, family groups, addition of individual therapy) have not demonstrated substantially improved outcomes over standard FBT for anorexia nervosa.

View details for DOI 10.1097/YCO.0000000000000451

View details for PubMedID 30063479
Comorbid depressive symptoms and self-esteem improve after either cognitive-behavioural therapy or family-based treatment for adolescent bulimia nervosa EUROPEAN EATING DISORDERS REVIEW Valenzuela, F., Lock, J., Le Grange, D., Bohon, C. 2018; 26 (3): 253–58
Abstract

This study examined the effect of family-based treatment for bulimia nervosa (FBT-BN) and cognitive behavioral therapy for adolescents (CBT-A) on depressive symptoms and self-esteem in adolescents with BN. Data were collected from 110 adolescents, ages 12-18, who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, text revision criteria for BN or partial BN. Participants were randomly assigned to FBT-BN or CBT-A and completed measures of depressive symptoms and self-esteem before and after treatment and at 6- and 12-month follow-up assessments. Depressive symptoms and self-esteem significantly improved in both treatments, and neither treatment appeared superior on these clinical outcomes. Parents often worry whether FBT-BN addresses comorbid depressive symptoms and low self-esteem. Our findings address this concern, as they demonstrate that FBT-BN does not differ from CBT-A in improving depressive symptoms and self-esteem, and both treatments result in symptom improvement. These findings can help clinicians guide families to choose a treatment that addresses BN and depressive symptoms and low self-esteem.

View details for DOI 10.1002/erv.2582

View details for Web of Science ID 000430661300008

View details for PubMedID 29446174
Attention networks in adolescent anorexia nervosa EUROPEAN CHILD & ADOLESCENT PSYCHIATRY Weinbach, N., Sher, H., Lock, J. D., Henik, A. 2018; 27 (3): 343–51
Abstract

Anorexia nervosa (AN) usually develops during adolescence when considerable structural and functional brain changes are taking place. Neurocognitive inefficiencies have been consistently found in adults with enduring AN and were suggested to play a role in maintaining the disorder. However, such findings are inconsistent in children and adolescents with AN. The current study conducted a comprehensive assessment of attention networks in adolescents with AN who were not severely underweight during the study using an approach that permits disentangling independent components of attention. Twenty partially weight-restored adolescents with AN (AN-WR) and 24 healthy adolescents performed the Attention Network Test which assesses the efficiency of three main attention networks-executive control, orienting, and alerting. The results revealed abnormal function in the executive control network among adolescents with AN-WR. Specifically, adolescents with AN-WR demonstrated superior ability to suppress attention to task-irrelevant information while focusing on a central task. Moreover, the alerting network modulated this ability. No difference was found between the groups in the speed of orienting attention, but reorienting attention to a target resulted in higher error rates in the AN-WR group. The findings suggest that adolescents with AN have attentional abnormalities that cannot be explained by a state of starvation. These attentional dysregulations may underlie clinical phenotypes of the disorder such as increased attention of details.

View details for DOI 10.1007/s00787-017-1057-0

View details for Web of Science ID 000427592600010

View details for PubMedID 28965277
Are parental self-efficacy and family flexibility mediators of treatment for anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Sadeh-Sharvit, S., Arnow, K. D., Osipov, L., Lock, J. D., Jo, B., Pajarito, S., Brandt, H., Dodge, E., Halmi, K. A., Johnson, C., Kaye, W., Wilfley, D., Agras, W. 2018; 51 (3): 275–80
Abstract

Family-based treatment (FBT) for adolescent anorexia nervosa (AN) promotes faster weight restoration when compared to other treatments. However, the mechanisms through which this occurs are not clarified. This study explored the trajectories of parental self-efficacy and perceived family flexibility during FBT and systemic family therapy (SyFT). We also explored whether parental self-efficacy mediates the effects of treatment on weight gain early in treatment.158 adolescents (12-18 years old; 89% girls) and their parents were randomized to FBT or SyFT. Parental self-efficacy as well as adolescents' and parental perceptions of the family's flexibility were collected at baseline and at sessions 2, 4, 6, and 8.Over time, only parents in FBT reported significantly greater self-efficacy. The change in maternal self-efficacy over the first 8 weeks of treatment was a significant mediator of session 10 weight gain. There were no significant group differences in perceived flexibility by session 8.Both parents in FBT and mothers in SyFT understand early the need to change their family's rules and roles. However, the specific strategies of FBT appear to mediate early weight gain in AN.

View details for DOI 10.1002/eat.22826

View details for Web of Science ID 000426857600009

View details for PubMedID 29314160
Subgrouping the users of a specialized app for eating disorders. Eating disorders Sadeh-Sharvit, S., Kim, J. P., Darcy, A. M., Neri, E., Vierhile, M., Robinson, A., Tregarthen, J., Lock, J. D. 2018: 1–12
Abstract

Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.

View details for DOI 10.1080/10640266.2018.1440043

View details for PubMedID 29452025
Feasibility Study Combining Art Therapy or Cognitive Remediation Therapy with Family-based Treatment for Adolescent Anorexia Nervosa EUROPEAN EATING DISORDERS REVIEW Lock, J., Fitzpatrick, K., Agras, W. S., Weinbach, N., Jo, B. 2018; 26 (1): 62–68
Abstract

Adolescents with anorexia nervosa who have obsessive-compulsive (OC) features respond poorly to family-based treatment (FBT). This study evaluated the feasibility of combining FBT with either cognitive remediation therapy (CRT) or art therapy (AT) to improve treatment response in this at-risk group. Thirty adolescents with anorexia nervosa and OC features were randomized to 15 sessions of FBT + CRT or AT. Recruitment rate was 1 per month, and treatment attrition was 16.6% with no differences between groups. Suitability, expectancy and therapeutic relationships were acceptable for both combinations. Correlations between changes in OC traits and changes in cognitive inefficiencies were found for both combinations. Moderate changes in cognitive inefficiencies were found in both groups but were larger in the FBT + AT combination. This study suggests that an RCT for poor responders to FBT because of OC traits combining FBT with either CRT or AT is feasible to conduct. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

View details for DOI 10.1002/erv.2571

View details for Web of Science ID 000418142400008

View details for PubMedID 29152825

View details for PubMedCentralID PMC5732028
Some Questions Pondered on Health and Humanities: Prospects, Opportunities and Challenges ACADEMIC PSYCHIATRY Lock, J. 2017; 41 (6): 707–10
View details for DOI 10.1007/s40596-017-0812-3

View details for Web of Science ID 000417944100002

View details for PubMedID 29168125
Parental guided self-help family based treatment for adolescents with anorexia nervosa: A feasibility study. International journal of eating disorders Lock, J., Darcy, A., Fitzpatrick, K. K., Vierhile, M., Sadeh-Sharvit, S. 2017
Abstract

Family Based Treatment (FBT) is an evidenced based treatment for adolescent Anorexia Nervosa (AN), but many families cannot access it. This study evaluated feasibility, acceptability, and preliminary treatment effects of a parental guided self-help (GSH) version of FBT for adolescent AN.This was a case-series design. Parents of medically stable adolescents (11-18 years) with DSM-5 AN were recruited over 12 months. Parents received online training in parental GSH FBT and 12 20-30 min GSH sessions by phone or online over 6 months. Recruitment, dropout, changes in weight, and eating related psychopathology were assessed. Analyses used mixed modeling that included all data for all participants.Of the 19 families that participated, most were white (94%) and from intact families (88%). Baseline median BMI (mBMI) percent was 85.01% (SD = 4.31). Participants' mBMI percent increased to 97.31% (SD ± 7.48) at the end of treatment (EOT) (ES = 2.06;CI= 0.13-3.99). Eating related psychopathology improved by EOT (ES = 0.58;CI=.04-1.21). Dropout rate was 21% during treatment and 33% during follow-up.Parental GSH-FBT is feasible and acceptable to families willing to undertake online treatment. Follow-up data was only available for 9 families (47%); thus further systematic evaluation is required before reaching conclusions about the efficacy of this approach.

View details for DOI 10.1002/eat.22733

View details for PubMedID 28580715
Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY Rienecke, R. D., Lebow, J., Lock, J., Le Grange, D. 2017; 46 (3): 428-436
View details for DOI 10.1080/15374416.2015.1030755

View details for Web of Science ID 000399741200009
A qualitative analysis of male eating disorder symptoms. Eating disorders Arnow, K. D., Feldman, T., Fichtel, E., Lin, I. H., Egan, A., Lock, J., Westerman, M., Darcy, A. M. 2017: 1-13
Abstract

Insights into how males experience eating disorder symptoms early in the course of illness are important to improve detection efforts and may also provide valuable information for treatment. In this qualitative study, 10 adolescent males and 10 matched female patients completed standardized questionnaires and were interviewed. Results indicated that although there were many similarities between the genders, females were more likely to describe the involvement of family systems and males were more likely to describe involvement in sports as being catalysts for their disorders. Males in this study were more positive about being in treatment.

View details for DOI 10.1080/10640266.2017.1308729

View details for PubMedID 28394743
Weak central coherence in weight-restored adolescent anorexia nervosa: Characteristics and remediation. International journal of eating disorders Weinbach, N., Perry, A., Sher, H., Lock, J. D., Henik, A. 2017
Abstract

Weak central coherence (WCC) refers to a bias towards processing details (local processing) at the expense of paying attention to the bigger picture (global processing). Multiple studies reported WCC in adults with anorexia nervosa (AN). Evidence for WCC in adolescents with AN has been inconsistent. The current study characterizes WCC in weight-restored adolescents with AN (WR-AN) using a direct measure of WCC, and examines whether WCC can be remediated by increasing alertness level-a manipulation that was found useful in enhancing global processing in healthy individuals and clinical populations.40 adolescents (18 WR-AN and 22 healthy adolescents) performed a global/local processing task (Navon task). Auditory alerting cues that elevate alertness level were integrated into the task.Both groups processed global information faster than local information. However, compared with controls, adolescents with WR-AN were better at ignoring an irrelevant bigger picture while attending to details (smaller global interference) and had greater difficulty ignoring irrelevant details while attending to the bigger picture (larger local interference). These differences were attenuated when adolescents with WR-AN were under a state of high alertness. Additionally, the local interference effect was positively correlated with three independent self-report questionnaires assessing eating disorders symptomatology.This study suggests that abnormal interference by irrelevant global and local information is a central characteristic of WCC in adolescents with WR-AN that cannot be accounted for by enduring illness or malnourishment. Additionally, this study demonstrates that WCC can be temporarily remediated by encouraging a state of high alertness.

View details for DOI 10.1002/eat.22711

View details for PubMedID 28370182
Using Technology to Improve Treatment Outcomes for Children and Adolescents with Eating Disorders CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Darcy, A. M., Lock, J. 2017; 26 (1): 33-?
Abstract

Dissemination and implementation of evidence-based treatments are among the biggest challenges facing clinical psychiatry. Developing scalable evidence-based treatments is a major priority and fraught with challenges. This article describes the development of 3 technology-based innovations. It discusses the use of massive open online courses (MOOCs) and mobile applications. Three projects are presented: (1) the modification of a MOOC methodology for psychotherapy training clinicians in manualized family-based therapy (FBT) for adolescents with anorexia nervosa; (2) a modified MOOC platform for the delivery of FBT; and (3) the development of mobile applications for treatment augmentation and delivery.

View details for DOI 10.1016/j.chc.2016.07.010

View details for Web of Science ID 000389788000004

View details for PubMedID 27837940
Where Did He Go? Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Lock, J. D. 2017; 41 (6): 777
View details for DOI 10.1007/s40596-017-0827-9

View details for PubMedID 29019156
Emperor's New. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Lock, J. D. 2017; 41 (6): 761
View details for DOI 10.1007/s40596-017-0826-x

View details for PubMedID 29019153
Patterns of expressed emotion in adolescent eating disorders JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY Rienecke, R. D., Sim, L., Lock, J., Le Grange, D. 2016; 57 (12): 1407-1413
Abstract

This goal of this study was to understand the patterns of expressed emotions (EEs) in adolescent eating disorders. As such, this study compared EE among families of adolescents with anorexia nervosa (AN), bulimia nervosa (BN), and a psychiatric control group, major depressive disorder (MDD). This study also examined the influence of family status (intact vs. nonintact) and the presence of siblings on EE.Two-hundred and fifteen adolescents (ages 12-19) and their families were recruited for this study including 121 adolescents with AN, 54 adolescents with BN, and 40 adolescents with MDD. Adolescents with at least one parent completed the Standardized Clinical Family Interview. Adolescents completed structured diagnostic interviews to assess eligibility for the study, as well as a standardized questionnaire to assess depression.Analyses revealed that fathers showed higher levels of critical comments to adolescents with BN or MDD than those with AN, whereas mothers made more critical comments toward patients with BN. Mothers made the least number of positive remarks toward patients with MDD. In terms of the influence of family status, fathers from intact families showed more expressions of warmth and were less critical than fathers from nonintact families, whereas mothers from intact families were less critical but also made fewer positive remarks than mothers from nonintact families. The presence of siblings appeared to reduce mothers' expression of warmth and emotional overinvolvement.Unique patterns of EE were found to characterize AN, BN, and MDD. Family status and the presence of siblings exert an influence on EE that should be taken into consideration in future research.

View details for DOI 10.1111/jcpp.12594

View details for Web of Science ID 000388500300008

View details for PubMedID 27377705
Does family-based treatment reduce the need for hospitalization in adolescent anorexia nervosa? International journal of eating disorders Lock, J., Agras, W. S., Bryson, S. W., Brandt, H., Halmi, K. A., Kaye, W., Wilfley, D., Woodside, B., Pajarito, S., Jo, B. 2016; 49 (9): 891-894
Abstract

We examined the timing and number of days of hospitalization during the course of treatment, hospitalization effects on outcome, and predictors and moderators of the use of hospitalization in adolescents with anorexia nervosa (AN).Data used in this study were collected from 158 adolescents (ages 12 to 18 years of age) who met DSM-IVTR criteria for AN (exclusive of the amenorrhea criteria) randomized to receive either Family Based Treatment (FBT) or Systemic Family Therapy (SyFT) in a 7 site study.The trajectory of hospital day use is similar in the first 5 weeks irrespective of treatment allocation. However, days of hospitalization continued to increase throughout SyFT but leveled off in FBT after ∼5 weeks of treatment. Early hospitalization was a negative predictor for improvements in percent weight change for both treatment groups (t(1)=2.6, p = 0.011). Co-morbid psychopathology predicted early hospital use in both treatments. Higher levels of eating related obsessions and depression moderated hospitalization rates suggesting that FBT reduces early hospitalization rates compared to SyFT for these subgroups.These data support and extend findings from previous studies by identifying patterns of hospital use, and predictors and moderators of treatment effect for early hospitalization use in adolescent AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:891-894).

View details for DOI 10.1002/eat.22536

View details for PubMedID 27062400
The importance of loss of control while eating in adolescents with purging disorder. International journal of eating disorders Goldschmidt, A. B., Accurso, E. C., O'Brien, S., Kara Fitzpatrick, K., Lock, J. D., Le Grange, D. 2016; 49 (8): 801-804
Abstract

Although many individuals with purging disorder (PD) report loss of control (LOC) eating, it is unclear whether they differ from those who do not, or from other eating disorders involving purging and/or LOC.We compared PD with LOC (PD-LOC), PD without LOC (PD-noLOC), bulimia nervosa (BN), and anorexia nervosa-binge/purge subtype (AN-B/P) on measures of eating-related and general psychopathology in treatment-seeking adolescents.PD-LOC comprised ∼30% of PD diagnoses. PD-LOC and PD-noLOC did not differ from one another, or from BN and AN-B/P, on most measures of psychopathology, with some exceptions. PD-noLOC was similar to AN-B/P (p = 0.99) and significantly different from BN on eating concerns (p < 0.001), while PD-LOC was similar to BN, AN-B/P, and PD-noLOC on this measure (ps ≥ 0.06). PD-LOC reported higher self-esteem than BN, AN-B/P, and PD-noLOC (ps < 0.001).PD was largely similar to other eating disorders characterized by purging, regardless of whether LOC eating was present. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:801-804).

View details for DOI 10.1002/eat.22525

View details for PubMedID 26969189
The Importance of Loss of Control While Eating in Adolescents with Purging Disorder INTERNATIONAL JOURNAL OF EATING DISORDERS Goldschmidt, A. B., Accurso, E. C., O'Brien, S., Fitzpatrick, K. K., Lock, J. D., Le Grange, D. 2016; 49 (8): 801-804
View details for DOI 10.1002/eat.22525

View details for Web of Science ID 000386226800007
Parent-based prevention program for the children of mothers with eating disorders: Feasibility and preliminary outcomes EATING DISORDERS Sadeh-Sharvit, S., Zubery, E., Mankovski, E., Steiner, E., Lock, J. D. 2016; 24 (4): 312-325
Abstract

The children of mothers with eating disorders are at high risk of feeding and eating problems and broader developmental difficulties. The Parent-Based Prevention (PBP) of eating disorders targets risk factors and facilitates behavioral change in parents to mitigate potentially negative outcomes of their children. This pre/post uncontrolled study evaluated the feasibility and preliminary outcomes of PBP. PBP was found to be a feasible intervention for mothers with eating disorders and their spouses, with satisfactory retention rates. A total of 16 intact families were assessed at three measurement points for parents' feeding practices, child outcomes, and maternal functioning. Both parents reported improved feeding practices as well as more positive perceptions of their children in comparison to baseline. These pilot findings suggest that PBP is linked with decreased risk of eating and mental problems among the offspring of mothers with eating disorders.

View details for DOI 10.1080/10640266.2016.1153400

View details for Web of Science ID 000380009900002

View details for PubMedID 26940552
Cognitive Remediation Therapy and Cognitive Behavioral Therapy With an Older Adult With Anorexia Nervosa: A Brief Case Report PSYCHOTHERAPY Darcy, A. M., Fitzpatrick, K. K., Lock, J. 2016; 53 (2): 232-240
Abstract

Cognitive remediation therapy represents a new approach to the treatment of anorexia nervosa (AN) emerging from research, suggesting that adults with chronic AN have specific neurocognitive inefficiencies. Specifically, adults with AN demonstrate an overly detailed cognitive processing bias (Roberts, Tchanturia, & Treasure, 2013) and difficulties shifting set quickly and efficiently (Roberts, Tchanturia, Stahl, Southgate, & Treasure, 2007). These characteristics manifest as rigid, rule-bound, and detail-focused cognitions, beliefs, and behaviors. Versions of these problems appear to persist after weight restoration (Tchanturia et al., 2004) and are observable in patient's healthy sisters (Roberts et al., 2013). Thus, central coherence difficulties and set-shifting problems have been proposed as endophenotypes and maintaining factors of AN (Roberts et al., 2013). (PsycINFO Database Record

View details for DOI 10.1037/pst0000055

View details for Web of Science ID 000378547500012

View details for PubMedID 27267509
Maternal eating disorder history and toddlers' neurodevelopmental outcomes: A brief report. Eating disorders Sadeh-Sharvit, S., Levy-Shiff, R., Lock, J. D. 2016; 24 (2): 198-205
Abstract

This study explored the neurodevelopmental outcomes of toddlers whose mothers have eating disorder histories and the contribution of maternal eating and comorbid psychopathology to the children's cognitive functioning. Twenty-nine mothers with prenatal eating disorders and their toddlers (18-42 months old) were compared to a case-control matched group of mothers with no eating psychopathology and their toddlers. Measures included current maternal eating and co-occurring psychopathology, and a developmental assessment of each child. The children of mothers with eating disorders showed delayed mental and psychomotor development. Severity of maternal eating disorder symptoms emerged as a significant predictor of child development, but other maternal psychopathology did not. Findings suggest that maternal eating disorder history may play a unique role in the development of neurodevelopmental functions in their children.

View details for DOI 10.1080/10640266.2015.1064280

View details for PubMedID 26212212
The interactions of mothers with eating disorders with their toddlers: identifying broader risk factors ATTACHMENT & HUMAN DEVELOPMENT Sadeh-Sharvit, S., Levy-Shiff, R., Arnow, K. D., Lock, J. D. 2016; 18 (4): 418-428
Abstract

The connection between maternal eating disorders and feeding and eating problems among their children has been substantially demonstrated. This pilot study focused on the interactions between mothers with eating disorders and their toddlers in non-feeding situations. Twenty-eight dyads of mothers with prenatal eating disorders and their toddlers were compared to a case-matched control group with no eating disorder. Maternal current eating and co-occurring psychopathology, children's symptoms and mother-child interactions were measured. Mothers with eating disorders were less sensitive to their children, tried to control their children's behaviors more, and were less happy during mother-child interactions. The children in the maternal eating disorder group were rated as less responsive to their mothers and their mothers also reported more behavioral problems than those in the control group. Findings imply that maternal eating disorders may be linked with a wide range of adverse maternal and child behaviors beyond those associated with eating.

View details for DOI 10.1080/14616734.2016.1164201

View details for Web of Science ID 000377804400006

View details for PubMedID 27264338
Expressed Emotion, Family Functioning, and Treatment Outcome for Adolescents with Anorexia Nervosa EUROPEAN EATING DISORDERS REVIEW Rienecke, R. D., Accurso, E. C., Lock, J., Le Grange, D. 2016; 24 (1): 43-51
View details for DOI 10.1002/erv.2389

View details for Web of Science ID 000367064200006

View details for PubMedID 26201083
Child feeding perceptions among mothers with eating disorders. Appetite Sadeh-Sharvit, S., Levy-Shiff, R., Feldman, T., Ram, A., Gur, E., Zubery, E., Steiner, E., Latzer, Y., Lock, J. D. 2015; 95: 67-73
Abstract

Feeding and eating difficulties are documented among the offspring of mothers with eating disorders. Understanding the perspective of mothers with eating disorders is likely essential to develop parent-based early prevention programs for children of these mothers. In the present study, twenty-nine mothers who were diagnosed with an eating disorder prior to becoming mothers and who currently had toddler age children participated in a semi-structured interview examining maternal functioning and child feeding. The maternal perceptions that emerged from the interviews were sorted into central themes and subcategories using interpretive phenomenological analysis. Data indicate that mothers with eating disorders express preoccupation with their child's eating, shape and weight, and many dilemmas about child feeding. They also reported rarity of family meals and their toddlers' preliminary awareness of maternal symptoms. Maternal concerns regarding child nutrition, feeding and weight were reported as more intense in regards to daughters. These maternal perceptions illuminate the maternal psychological processes that underlie the feeding and eating problems of the children of mothers with lifetime eating disorders. Findings should be addressed in the evaluation, treatment, and research of adult and childhood eating disorders.

View details for DOI 10.1016/j.appet.2015.06.017

View details for PubMedID 26145278
Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa. Journal of the American Academy of Child and Adolescent Psychiatry Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., Jo, B. 2015; 54 (11): 886-94 e2
Abstract

There is a paucity of randomized clinical trials (RCTs) for adolescents with bulimia nervosa (BN). Prior studies suggest cognitive-behavioral therapy adapted for adolescents (CBT-A) and family-based treatment for adolescent bulimia nervosa (FBT-BN) could be effective for this patient population. The objective of this study was to compare the relative efficacy of these 2 specific therapies, FBT-BN and CBT-A. In addition, a smaller participant group was randomized to a nonspecific treatment (supportive psychotherapy [SPT]), whose data were to be used if there were no differences between FBT-BN and CBT-A at end of treatment.This 2-site (Chicago and Stanford) randomized controlled trial included 130 participants (aged 12-18 years) meeting DSM-IV criteria for BN or partial BN (binge eating and purging once or more per week for 6 months). Outcomes were assessed at baseline, end of treatment, and 6 and 12 months posttreatment. Treatments involved 18 outpatient sessions over 6 months. The primary outcome was defined as abstinence from binge eating and purging for 4 weeks before assessment, using the Eating Disorder Examination.Participants in FBT-BN achieved higher abstinence rates than in CBT-A at end of treatment (39% versus 20%; p = .040, number needed to treat [NNT] = 5) and at 6-month follow-up (44% versus 25%; p = .030, NNT = 5). Abstinence rates between these 2 groups did not differ statistically at 12-month follow-up (49% versus 32%; p = .130, NNT = 6).In this study, FBT-BN was more effective in promoting abstinence from binge eating and purging than CBT-A in adolescent BN at end of treatment and 6-month follow-up. By 12-month follow-up, there were no statistically significant differences between the 2 treatments.Study of Treatment for Adolescents With Bulimia Nervosa; http://clinicaltrials.gov/; NCT00879151.

View details for DOI 10.1016/j.jaac.2015.08.008

View details for PubMedID 26506579

View details for PubMedCentralID PMC4624104
An exploratory examination of patient and parental self-efficacy as predictors of weight gain in adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Byrne, C. E., Accurso, E. C., Arnow, K. D., Lock, J., Le Grange, D. 2015; 48 (7): 883-888
View details for DOI 10.1002/eat.22376

View details for Web of Science ID 000363460300010

View details for PubMedID 25808269
Development of a smartphone application for eating disorder self-monitoring INTERNATIONAL JOURNAL OF EATING DISORDERS Tregarthen, J. P., Lock, J., Darcy, A. M. 2015; 48 (7): 972-982
View details for DOI 10.1002/eat.22386

View details for Web of Science ID 000363460300021

View details for PubMedID 26213130
Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa. Journal of the American Academy of Child and Adolescent Psychiatry Le Grange, D., Lock, J., Agras, W. S., Bryson, S. W., Jo, B. 2015; 54 (11): 886-894 e2
View details for DOI 10.1016/j.jaac.2015.08.008

View details for PubMedID 26506579
Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study. Behaviour research and therapy Lock, J., Le Grange, D., Agras, W. S., Fitzpatrick, K. K., Jo, B., Accurso, E., Forsberg, S., Anderson, K., Arnow, K., Stainer, M. 2015; 73: 90-95
Abstract

Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT.45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups.There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early.The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.

View details for DOI 10.1016/j.brat.2015.07.015

View details for PubMedID 26276704
An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY Lock, J. 2015; 44 (5): 707-721
Abstract

Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.

View details for DOI 10.1080/15374416.2014.971458

View details for Web of Science ID 000359534900001

View details for PubMedID 25580937
Family-based Treatment of Child and Adolescent Eating Disorders CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Forsberg, S., Lock, J. 2015; 24 (3): 617-?
View details for DOI 10.1016/j.chc.2015.02.012

View details for Web of Science ID 000358187300013
Family-based Treatment of Child and Adolescent Eating Disorders. Child and adolescent psychiatric clinics of North America Forsberg, S., Lock, J. 2015; 24 (3): 617-629
Abstract

Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT.

View details for DOI 10.1016/j.chc.2015.02.012

View details for PubMedID 26092743
Central coherence in adolescents with bulimia nervosa spectrum eating disorders INTERNATIONAL JOURNAL OF EATING DISORDERS Darcy, A. M., Fitzpatrick, K. K., Manasse, S. M., Datta, N., Klabunde, M., Colborn, D., Aspen, V., Stiles-Shields, C., Labuschagne, Z., Le Grange, D., Lock, J. 2015; 48 (5): 487-493
Abstract

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.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.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.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.

View details for DOI 10.1002/eat.22340

View details for Web of Science ID 000356684500006

View details for PubMedID 25146149
Decreasing body dissatisfaction using a brief conditioning intervention BEHAVIOUR RESEARCH AND THERAPY Aspen, V., Martijn, C., Alleva, J. M., Nagel, J., Perret, C., Purvis, C., Saekow, J., Lock, J., Taylor, C. B. 2015; 69: 93-99
Abstract

Body dissatisfaction in females is common and a risk factor for the development of an eating disorder. This study tested whether body dissatisfaction could be improved using a brief conditioning intervention in which photographs of participants' bodies were selectively paired with positive social stimuli (smiling faces) and photographs of other bodies were paired with neutral or negative social stimuli (neutral and frowning faces).39 women (mean age = 22.46; 64.1% Caucasian) with high body dissatisfaction were randomized to either the evaluative conditioning intervention (n = 22) or to a delayed waitlist control condition (n = 17). Body dissatisfaction (specifically, shape and weight concern), restraint, eating concern, and self-esteem were assessed at baseline, post treatment and again after four and 12 weeks.Compared to women in the delayed waitlist control condition, women in the treatment condition demonstrated a significant decrease in shape and weight concern, and a significant increase in self-esteem. Similar trends were found for the control condition after they completed the intervention. Changes at post treatment related to body dissatisfaction were maintained at 12-week follow-up.Repeatedly pairing photographs of an individual's body with positive social feedback may lead to improved body image and self-esteem.

View details for DOI 10.1016/j.brat.2015.04.003

View details for Web of Science ID 000355054500011

View details for PubMedID 25912670
Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. Journal of clinical child and adolescent psychology Rienecke, R. D., Lebow, J., Lock, J., Le Grange, D. 2015: 1-9
Abstract

The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.

View details for PubMedID 25945418
The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa. International journal of eating disorders Stiles-Shields, C., DclinPsy, B. B., Lock, J., Le Grange, D. 2015; 48 (4): 392-396
Abstract

This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN).Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes.About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05).The results of this secondary exploratory data suggest that DE is prevalent for adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:392-396).

View details for DOI 10.1002/eat.22281

View details for PubMedID 24729068
The Effect of Driven Exercise on Treatment Outcomes for Adolescents with Anorexia and Bulimia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Stiles-Shields, C., Bamford, B., Lock, J., Le Grange, D. 2015; 48 (4): 392-396
View details for DOI 10.1002/eat.22281

View details for Web of Science ID 000352862900006
Implementing highly specialized and evidence-based pediatric eating disorder treatment: protocol for a mixed methods evaluation IMPLEMENTATION SCIENCE Couturier, J., Kimber, M., Lock, J., Barwick, M., McVey, G., Findlay, S., Webb, C., Boettcher, M., Niccols, A., Woodford, T. 2015; 10
View details for DOI 10.1186/s13012-015-0231-3

View details for Web of Science ID 000352054400001
Family Functioning in Two Treatments for Adolescent Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Ciao, A. C., Accurso, E. C., Fitzsimmons-Craft, E. E., Lock, J., Le Grange, D. 2015; 48 (1): 81-90
Abstract

Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives.Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology.In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT.Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:81-90).

View details for DOI 10.1002/eat.22314

View details for Web of Science ID 000346768200012

View details for PubMedID 24902822
A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological medicine Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., le Grange, D., Jo, B., Clarke, S., Rhodes, P., Hay, P., Touyz, S. 2015; 45 (2): 415-427
Abstract

Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12-18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.

View details for DOI 10.1017/S0033291714001573

View details for PubMedID 25017941
Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome? Journal of eating disorders Byrne, C. E., Kass, A. E., Accurso, E. C., Fischer, S., O'Brien, S., Goodyear, A., Lock, J., Le Grange, D. 2015; 3: 49-?
Abstract

Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN.Data were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted.Thirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission.Results suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns.

View details for DOI 10.1186/s40337-015-0086-7

View details for PubMedID 26677412
Implementing highly specialized and evidence-based pediatric eating disorder treatment: protocol for a mixed methods evaluation. Implementation science Couturier, J., Kimber, M., Lock, J., Barwick, M., McVey, G., Findlay, S., Webb, C., Boettcher, M., Niccols, A., Woodford, T. 2015; 10: 40-?
Abstract

Eating disorders, which include anorexia nervosa and bulimia nervosa, are common in adolescent females and can have serious emotional and physical consequences, including death. Despite our knowledge about the severity of these illnesses, previous research indicates that adolescent patients are not receiving the best available treatment with fidelity. The main goal of this project is to reduce the knowledge gap between what research indicates is the best known treatment and what is actually delivered in clinical practice. Informed by the National Implementation Research Network model and the Consolidated Framework for Implementation Research meta-theory, our primary study aim is to increase the capacity of Ontario-based therapists to provide family-based treatment, by providing training and ongoing supervision.We will use a multi-site case study with a mixed method pre/post design to examine several implementation outcomes across four eating disorder treatment programs. We will provide a training workshop on family-based treatment as well as ongoing monthly supervision. In addition, we will assemble implementation teams at each site and coach them by phone on a monthly basis regarding any process issues. Our main outcomes include fidelity to the treatment model using quantitative evaluation of audio-recorded therapy sessions, as well as qualitative analysis of the perceptions of the implementation process using audio-recorded focus groups with all clinicians and administrators involved in the study.To our knowledge, this is the first study to evaluate an implementation strategy for an evidence-based treatment for eating disorders. Challenges to date include obtaining ethics approval at all sites, and recruitment. This research will help to inform future studies on how to best implement evidence-based treatments in this field.

View details for DOI 10.1186/s13012-015-0231-3

View details for PubMedID 25888744
Family-based treatment with transition age youth with anorexia nervosa: a qualitative summary of application in clinical practice. Journal of eating disorders Dimitropoulos, G., Freeman, V. E., Allemang, B., Couturier, J., McVey, G., Lock, J., Le Grange, D. 2015; 3 (1): 1-?
Abstract

Family based treatment (FBT) has been empirically investigated in adolescents between the ages of 12 and 19 years of age. Although parental control over eating symptoms and the weight gain process are temporary and necessary due to serious medical complications, FBT may be developmentally inappropriate when working with older adolescents. To date, there are no studies identifying how the principles of this model are used differentially across different stages of adolescence. This study aimed to identify how clinicians informed by FBT employ this model with transition age youth (TAY) (16-21) with an eating disorder.Using content analysis, seven individual interviews and six focus groups were conducted with 34 clinicians from specialized Eating Disorder Treatment programs across Ontario, Canada.Participants consistently reported modifying FBT to increase its developmental appropriateness with TAY in the following ways: working more collaboratively with the patient, increasing individual time spent with the patient prior to the family meeting, providing greater opportunities for the individual to practice eating without parental support and introducing relapse prevention in the latter phase of the treatment.In all adaptations of the model, participants in focus groups and individual interviews cited the age of the individual with the eating disorder, their level of autonomy and independence in all areas of their lives, and their pending transfer of care from paediatric to adult eating disorder programs as main factors that influenced the modification of FBT with TAY. While adaptations were made across all three phases of FBT, adherence to the model progressively declined over the course of treatment with adaptations increasing significantly in the later phases. Future research is needed to evaluate the effectiveness of an adapted version of FBT with TAY.

View details for DOI 10.1186/s40337-015-0037-3

View details for PubMedID 25685349
A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents PSYCHOLOGICAL MEDICINE Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., le Grange, D., Jo, B., Clarke, S., Rhodes, P., Hay, P., Touyz, S. 2015; 45 (2): 415-427
View details for DOI 10.1017/S0033291714001573

View details for Web of Science ID 000349617100016
Development and Evaluation of a Treatment Fidelity Instrument for Family-Based Treatment of Adolescent Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Forsberg, S., Fitzpatrick, K. K., Darcy, A., Aspen, V., Accurso, E. C., Bryson, S. W., Agras, S., Arnow, K. D., Le Grange, D., Lock, J. 2015; 48 (1): 91-99
Abstract

This study provides data on the psychometric properties of a newly developed measure of treatment fidelity in Family-Based Treatment (FBT) for adolescent anorexia nervosa (AN). The Family Therapy Fidelity and Adherence Check (FBT-FACT) was created to evaluate therapist adherence and competency on the core interventions in FBT.Participants were 45 adolescents and their families sampled from three randomized clinical trials evaluating treatment for AN. Trained fidelity raters evaluated 19 therapists across 90 early session recordings using the FBT-FACT. They also rated an additional 15 session 1 recordings of an alternate form of family therapy-Systemic Family Therapy for the purpose of evaluating discriminant validity of the FBT-FACT. The process of development and the psychometric properties of the FBT-FACT are presented.Overall fidelity ratings for each session demonstrated moderate to strong inter-rater agreement. Internal consistency of the measure was strong for sessions 1 and 2 and poor for session 3. Principal components analysis suggests sessions 1 and 2 are distinct interventions.The FBT-FACT demonstrates good reliability and validity as a measure of treatment fidelity in the early phase of FBT. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:91-99).

View details for DOI 10.1002/eat.22337

View details for Web of Science ID 000346768200013

View details for PubMedID 25142619
Relapse From Remission at Two- to Four-Year Follow-Up in Two Treatments for Adolescent Anorexia Nervosa JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY le Grange, D., Lock, J., Accurso, E. C., Agras, W. S., Darcy, A., Forsberg, S., Bryson, S. W. 2014; 53 (11): 1162-1167
View details for DOI 10.1016/j.jaac.2014.07.014

View details for Web of Science ID 000343620600005
Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa A Randomized Parallel Trial JAMA PSYCHIATRY Agras, W. S., Lock, J., Brandt, H., Bryson, S. W., Dodge, E., Halmi, K. A., Jo, B., Johnson, C., Kaye, W., Wilfley, D., Woodside, B. 2014; 71 (11): 1279-1286
View details for DOI 10.1001/jamapsychiatry.2014.1025

View details for Web of Science ID 000344989100010
Predicting clinical outcome using brain activation associated with set-shifting and central coherence skills in Anorexia Nervosa. Journal of psychiatric research Garrett, A. S., Lock, J., Datta, N., Beenhaker, J., Kesler, S. R., Reiss, A. L. 2014; 57: 26-33
Abstract

Patients with Anorexia Nervosa (AN) have neuropsychological deficits in Set-Shifting (SS) and central coherence (CC) consistent with an inflexible thinking style and overly detailed processing style, respectively. This study investigates brain activation during SS and CC tasks in patients with AN and tests whether this activation is a biomarker that predicts response to treatment.FMRI data were collected from 21 females with AN while performing an SS task (the Wisconsin Card Sort) and a CC task (embedded figures), and used to predict outcome following 16 weeks of treatment (either 16 weeks of cognitive behavioral therapy or 8 weeks cognitive remediation therapy followed by 8 weeks of cognitive behavioral therapy).Significant activation during the SS task included bilateral dorsolateral and ventrolateral prefrontal cortex and left anterior middle frontal gyrus. Higher scores on the neuropsychological test of SS (measured outside the scanner at baseline) were correlated with greater DLPFC and VLPFC/insula activation. Improvements in SS following treatment were significantly predicted by a combination of low VLPFC/insula and high anterior middle frontal activation (R squared = .68, p = .001). For the CC task, visual and parietal cortical areas were activated, but were not significantly correlated with neuropsychological measures of CC and did not predict outcome.Cognitive flexibility requires the support of several prefrontal cortex resources. As previous studies suggest that the VLPFC is important for selecting context-appropriate responses, patients who have difficulties with this skill may benefit the most from cognitive therapy with or without cognitive remediation therapy. The ability to sustain inhibition of an unwanted response, subserved by the anterior middle frontal gyrus, is a cognitive feature that predicts favorable outcome to cognitive treatment. CC deficits may not be an effective predictor of clinical outcome.

View details for DOI 10.1016/j.jpsychires.2014.06.013

View details for PubMedID 25027478
Prevalence and Clinical Significance of Night Eating Syndrome in University Students JOURNAL OF ADOLESCENT HEALTH Runfola, C. D., Allison, K. C., Hardy, K. K., Lock, J., Peebles, R. 2014; 55 (1): 41-48
Abstract

Most studies of night eating syndrome (NES) fail to control for binge eating, despite moderate overlap between the two conditions. Establishing the independent clinical significance of NES is imperative for it to be considered worthy of clinical attention. We compared students with and without NES on eating disorder symptomatology, quality of life, and mental health, while exploring the role of binge eating in associations.Students (N = 1,636) ages 18-26 years (M = 20.9) recruited from 10 U.S. universities completed an online survey including the Night Eating Questionnaire (NEQ), Eating Disorder Examination-Questionnaire (EDE-Q), Project Eating Among Teens, and the Health-Related Quality of Life-4. NES was diagnosed according to endorsement of proposed diagnostic criteria on the NEQ. Groups (NES vs. non-NES) were compared on all dependent variables and stratified by binge eating status in secondary analyses.The prevalence of NES in our sample was 4.2%; it decreased to 2.9% after excluding those with binge eating. Body mass index did not differ between groups, but students with NES were significantly more likely to have histories of underweight and anorexia nervosa. In students with NES, EDE-Q scores were significantly higher; purging, laxative use, and compulsive exercise were more frequent; quality of life was reduced; and histories of depression, attention-deficit/hyperactivity disorder, and self-injury were more common. Binge eating did not account for all of these differences; the presence of it and NES was associated with additive risk for psychopathology on some items.NES may be a distinct clinical entity from other DSM-5 eating disorders.

View details for DOI 10.1016/j.jadohealth.2013.11.012

View details for Web of Science ID 000338266700006

View details for PubMedID 24485551

View details for PubMedCentralID PMC4065810
Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behaviour research and therapy Accurso, E. C., Ciao, A. C., Fitzsimmons-Craft, E. E., Lock, J. D., Le Grange, D. 2014; 56: 1-6
Abstract

The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment.

View details for DOI 10.1016/j.brat.2014.02.006

View details for PubMedID 24632109
Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa. International journal of eating disorders Le Grange, D., Accurso, E. C., Lock, J., Agras, S., Bryson, S. W. 2014; 47 (2): 124-129
Abstract

Determine whether early weight gain predicts full remission at end-of-treatment (EOT) and follow-up in two different treatments for adolescent anorexia nervosa (AN), and to track the rate of weight gain throughout treatment and follow-up.Participants were 121 adolescents with AN (mean age = 14.4 years, SD = 1.6), from a two-site (Chicago and Stanford) randomized controlled trial. Adolescents were randomly assigned to family-based treatment (FBT) (n = 61) or individual adolescent focused therapy (AFT) (n = 60). Treatment response was assessed using percent of expected body weight (EBW) and the global score on the Eating Disorder Examination (EDE). Full remission was defined as having achieved ≥95% EBW and within one standard deviation of the community norms of the EDE. Full remission was assessed at EOT as well as 12-month follow-up.Receiver operating characteristic analyses showed that the earliest predictor of remission at EOT was a gain of 5.8 pounds (2.65 kg) by session 3 in FBT (area under the curve (AUC) = 0.670; p = .043), and a gain of 7.1 pounds (3.20 kg) by session 4 in AFT (AUC = 0.754, p = .014). Early weight gain did not predict remission at follow-up for either treatment. A survival analysis showed that weight was marginally superior in FBT as opposed to AFT (Wald chi-square = 3.692, df = 1, p = .055).Adolescents with AN who receive either FBT or AFT, and show early weight gain, are likely to remit at EOT. However, FBT is superior to AFT in terms of weight gain throughout treatment and follow-up. (Int J Eat Disord 2014; 47:124-129).

View details for DOI 10.1002/eat.22221

View details for PubMedID 24190844
Parent-Therapist Alliance in Family-Based Treatment for Adolescents with Anorexia Nervosa EUROPEAN EATING DISORDERS REVIEW Forsberg, S., Lotempio, E., Bryson, S., Fitzpatrick, K. K., Le Grange, D., Lock, J. 2014; 22 (1): 53-58
Abstract

This study aimed to describe the role of parent alliance in Family-Based Treatment (FBT) for adolescents with anorexia nervosa (AN). Differences between parent and child alliance with the therapist, mothers' and fathers' alliance, and their relationship to outcome were examined.Independent observers rated audiotapes of early therapy sessions to assess the therapeutic alliance of parents and adolescents with AN in FBT. Outcome was defined using a previously established cut-point for recovery from AN.Mothers' and fathers' alliance scores with the therapist were similar and significantly higher than adolescent alliance scores early in treatment. Combined parent alliance did not predict recovery at the end of treatment. Difference in alliance scores between mothers and fathers, and parents and their child also did not predict recovery at the end of treatment.In FBT, parents developed a strong alliance with the therapist early in treatment. These scores were consistent with the focus in FBT on parental management of eating disorder symptoms, as was the fact that alliance between adolescents and therapists was lower. Although parental therapeutic alliance was likely important in FBT, its role in treatment response remains uncertain. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

View details for DOI 10.1002/erv.2242

View details for Web of Science ID 000328554600008

View details for PubMedID 23861093
Do end of treatment assessments predict outcome at follow-up in eating disorders? International journal of eating disorders Lock, J., Agras, W. S., Le Grange, D., Couturier, J., Safer, D., Bryson, S. W. 2013; 46 (8): 771-778
Abstract

To examine the predictive value of end of treatment (EOT) outcomes for longer term recovery status.We used signal detection analysis to identify the best predictors of recovery based on outcome at EOT using five different eating disorder samples from randomized clinical treatment trials. We utilized a transdiagnostic definition of recovery that included normalization of weight and eating related psychopathology.Achieving a body weight of 95.2% of expected body weight by EOT is the best predictor of recovery for adolescents with anorexia nervosa (AN). For adults with AN, the most efficient predictor of weight recovery (BMI > 19) was weight gain to greater than 85.8% of ideal body weight. In addition, for adults with AN, the most efficient predictor of psychological recovery was achievement of an eating disorder examination (EDE) weight concerns score below 1.8. The best predictor of recovery for adults with Bulimia Nervosa (BN) was a frequency of compensatory behaviors less than two times a month. For adolescents with BN, abstinence from purging and reduction in the EDE restraint score of more than 3.4 from baseline to EOT were good predictors of recovery. For adults with binge eating disorder, reduction of the Global EDE score to within the normal range (<1.58) was the best predictor of recovery.The relationship between EOT response and recovery remains understudied. Utilizing a transdiagnostic definition of recovery, no uniform predictors were identified across all eating disorder diagnostic groups. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:771-778).

View details for DOI 10.1002/eat.22175

View details for PubMedID 23946139
Do in-vivo behaviors predict early response in family-based treatment for anorexia nervosa? Behaviour research and therapy Darcy, A. M., Bryson, S. W., Agras, W. S., Fitzpatrick, K. K., Le Grange, D., Lock, J. 2013; 51 (11): 762-766
Abstract

The aim of the study is to explore whether identified parental and patient behaviors observed in the first few sessions of family-based treatment (FBT) predict early response (weight gain of 1.8 kg by session four) to treatment. Therapy film recordings from 21 adolescent participants recruited into the FBT arm of a multi-site randomized clinical trial were coded for the presence of behaviors (length of observed behavior divided by length of session recording) in the first, second and fourth sessions. Behaviors that differed between early responders and non-early responders on univariate analysis were entered into discriminant class analyses. Participants with fewer negative verbal behaviors in the first session and were away from table during the meal session less had the greatest rates of early response. Parents who made fewer critical statements and who did not repeatedly present food during the meal session had children who had the greatest rates of early response. In-vivo behaviors in early sessions of FBT may predict early response to FBT. Adaptations to address participant resistance and to decrease the numbers of critical comments made by parents while encouraging their children to eat might improve early response to FBT.

View details for DOI 10.1016/j.brat.2013.09.003

View details for PubMedID 24091274
The role of the pediatrician in family-based treatment for adolescent eating disorders: opportunities and challenges. journal of adolescent health Katzman, D. K., Peebles, R., Sawyer, S. M., Lock, J., Le Grange, D. 2013; 53 (4): 433-440
Abstract

Empiric research supports that family-based treatment (FBT) is an effective treatment for adolescents with eating disorders. This review outlines the role of the pediatrician in FBT for adolescent eating disorders, specifically focusing on how pediatric care changes during treatment, and discusses current challenges and misconceptions regarding FBT. Although FBT introduces unique challenges to pediatricians trained in earlier eating disorder treatment approaches, effective support of the approach by pediatricians is critical to its success.

View details for DOI 10.1016/j.jadohealth.2013.07.011

View details for PubMedID 24054079
Are Adolescent Treatment Studies of Eating Disorders Utilizing Clinically Relevant Samples? A Comparison of RCT and Clinic Treatment-Seeking Youth with Eating Disorders EUROPEAN EATING DISORDERS REVIEW Stiles-Shields, C., Goldschmidt, A. B., Lock, J., Le Grange, D. 2013; 21 (5): 420-424
Abstract

To assess potential selection bias in participant recruitment for randomized controlled trials (RCTs) of adolescent eating disorders (EDs), we compared participants recruited for RCTs evaluating psychosocial treatments with individuals seeking fee-for-service outpatient ED treatment [clinic treatment-seeking (CTS)].Participants were 214 adolescents presenting to an outpatient ED research-clinical program (92.1% female; M age = 15.4 ± 1.8 years). ANOVA and chi-square tests assessed differences between CTS participants and those presenting for no-cost treatment through RCTs. A secondary analysis compared RCT participants to participants eligible for the RCTs that opted for fee-for-service treatment.RCT participants had greater baseline ED and general psychopathology (p < .001); however, CTS participants were more likely to present with a comorbid psychiatric disorder (p < .05) and higher family income (p < .05).Results suggest that RCT participants did not have less pathology than CTS participants. While preliminary, results do not indicate a systematic population bias in selecting healthier patients for RCTs involving adolescent ED. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

View details for DOI 10.1002/erv.2228

View details for Web of Science ID 000322922700011

View details for PubMedID 23483619
Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J., Agras, W. S., Fitzpatrick, K. K., Bryson, S. W., Jo, B., Tchanturia, K. 2013; 46 (6): 567-575
View details for DOI 10.1002/eat.22134

View details for Web of Science ID 000323436800005
Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? International journal of eating disorders Lock, J., Agras, W. S., Fitzpatrick, K. K., Bryson, S. W., Jo, B., Tchanturia, K. 2013; 46 (6): 567-575
Abstract

OBJECTIVE: There are limited data supporting specific treatments for adults with anorexia nervosa (AN). Randomized clinical trials (RCTs) for adults with AN are characterized by high attrition limiting the feasibility of conducting and interpreting existing studies. High dropout rates may be related to the inflexible and obsessional cognitive style of patients with AN. This study evaluated the feasibility of using cognitive remediation therapy (CRT) to reduce attrition in RCTs for AN. METHOD: Forty-six participants (mean age of 22.7 years and mean duration of AN of 6.4 years) were randomized to receive eight sessions of either CRT or cognitive behavioral therapy (CBT) over 2 months followed by 16 sessions of CBT for 4 months. RESULTS: During the 2-month CRT vs. CBT treatment, rates of attrition were lower in CRT (13%) compared with that of CBT (33%). There were greater improvements in cognitive inefficiencies in the CRT compared with that of the CBT group at the end of 2 months. There were no differences in other outcomes. DISCUSSION: These results suggest that CRT is acceptable and feasible for use in RCTs for outpatient treatment of AN. CRT may reduce attrition in the short term. Adequately powered future studies are needed to examine CRT as an outpatient treatment for AN.

View details for DOI 10.1002/eat.22134

View details for PubMedID 23625628
A review of attention biases in women with eating disorders. Cognition & emotion Aspen, V., Darcy, A. M., Lock, J. 2013; 27 (5): 820-838
Abstract

There is robust evidence that women with eating disorders (EDs) display an attention bias (AB) for disorder-salient stimuli. Emerging data suggest that the presence of these biases may be due, in part, to neurological deficits, such as poor set shifting and weak central coherence. While some have argued that these biases function to predispose and/or act to maintain disordered eating behaviours, evidence supporting this view has rarely been examined. This report summarises and integrates the existing literature on AB in EDs and other related psychiatric disorders to better understand its potential role in the development and maintenance of an ED. The domains reviewed include experimental data using the dot-probe and modified Stroop task and neurobiological findings on AB in women with EDs as well as the role of AB in current theoretical models. We conclude by proposing an integrated model on the role of AB in EDs and discuss treatment approaches aimed at modifying these biases.

View details for DOI 10.1080/02699931.2012.749777

View details for PubMedID 23228135
The Eating Disorder Examination Questionnaire (EDE-Q) among university men and women at different levels of athleticism. Eating behaviors Darcy, A. M., Hardy, K. K., Lock, J., Hill, K. B., Peebles, R. 2013; 14 (3): 378-381
Abstract

The aim of the current study was to establish norms for the Eating Disorder (ED) Examination Questionnaire (EDE-Q) among competitive athletes and to explore the contribution of level of athletic involvement and gender to ED psychopathology, as measured by the EDE-Q. University students (n=1637) from ten United States universities were recruited online via a social networking website and asked to complete an anonymous survey. The sample was then divided according to gender and level of sports participation. Females scored higher than males regardless of level of athleticism. Lower mean scores were frequently observed among those involved in competitive sports exclusively and highest scores among those involved in recreational sports (alone or in addition to competitive athletics). Recreational activity seems to be important in stratifying risk among competitive athletes; gender is an important interaction term in athletic populations.

View details for DOI 10.1016/j.eatbeh.2013.04.002

View details for PubMedID 23910784
Factor structure of the Eating Disorder Examination Questionnaire (EDE-Q) in male and female college athletes. Body image Darcy, A. M., Hardy, K. K., Crosby, R. D., Lock, J., Peebles, R. 2013; 10 (3): 399-405
Abstract

The study explored the psychometric properties of the Eating Disorder Examination Questionnaire (EDE-Q) among 1637 university students. Participants were divided into male (n=432) and female (n=544) competitive athletes, and male (n=229) and female (n=429) comparison groups comprised of individuals who had not engaged in competitive sports for at least one year. All groups were subjected to confirmatory factor analysis (CFA) to test the fit of the published factor structure in this population, and then exploratory FA (EFA). A three-factor solution was the best fit for three out of four groups, with a two-factor solution providing best fit for the male comparison group. The first factor for all groups resembled a combined Shape and Weight Concern subscale. The factor structure among male and female competitive athletes was remarkably similar; however, non-competitive athletic/low activity males appear qualitatively different from other groups.

View details for DOI 10.1016/j.bodyim.2013.01.008

View details for PubMedID 23453695
Patients' characteristics and the quality of the therapeutic alliance in family-based treatment and individual therapy for adolescents with anorexia nervosa JOURNAL OF FAMILY THERAPY LoTempio, E., Forsberg, S., Bryson, S. W., Fitzpatrick, K. K., Le Grange, D., Lock, J. 2013; 35: 29-52
View details for DOI 10.1111/1467-6427.12011

View details for Web of Science ID 000315971000003
Therapeutic alliance in two treatments for adolescent anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Forsberg, S., Lotempio, E., Bryson, S., Fitzpatrick, K. K., Le Grange, D., Lock, J. 2013; 46 (1): 34-38
Abstract

The aim of this study was to examine the relationship between therapeutic alliance and treatment outcome (remission status) in family-based treatment (FBT) and adolescent-focused therapy (AFT) for adolescents with anorexia nervosa (AN).Independent observers rated audiotapes of early therapy sessions using the Working Alliance Inventory-Observer Version (WAI-o). Outcome was defined using established cut-points for full and partial remission. To control for effects of early symptom improvement, changes in weight- and eating-related psychopathology prior to the alliance session were calculated and entered as a covariate in each analysis.Participants in AFT had significantly higher alliance scores; however, overall scores were high in both therapies. The alliance was not a predictor of full remission for either treatment, though it was a non-specific predictor for partial remission.Therapeutic alliance is achievable in adolescents with AN in both AFT and FBT, but demonstrated no relationship to full remission of the disorder.

View details for DOI 10.1002/eat.22047

View details for Web of Science ID 000312300000005

View details for PubMedID 22836506
Set-shifting among adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Fitzpatrick, K. K., Darcy, A., Colborn, D., Gudorf, C., Lock, J. 2012; 45 (7): 909-912
Abstract

Set-shifting difficulties are documented for adults with anorexia nervosa (AN). However, AN typically onsets in adolescents and it is unclear if set-shifting difficulties are a result of chronic AN or present earlier in its course. This study examined whether adolescents with short duration AN demonstrated set-shifting difficulties compared to healthy controls (HC).Data on set-shifting collected from the Delis-Kaplan executive functioning system and Wisconsin card sort task (WCST) as well as eating psychopathology were collected from 32 adolescent inpatients with AN and compared with those from 22 HCs.There were no differences in set-shifting in adolescents with AN compared to HCs on most measures.The findings suggest that set-shifting difficulties in AN may be a consequence of AN. Future studies should explore set-shifting difficulties in a larger sample of adolescents with the AN to determine if there is sub-set of adolescents with these difficulties and determine any relationship of set-shifting to the development of a chronic from of AN.

View details for DOI 10.1002/eat.22027

View details for Web of Science ID 000310271600014

View details for PubMedID 22692985
Set-Shifting Among Adolescents With Bulimic Spectrum Eating Disorders PSYCHOSOMATIC MEDICINE Darcy, A. M., Fitzpatrick, K. K., Colborn, D., Manasse, S., Datta, N., Aspen, V., Shields, C. S., Le Grange, D., Lock, J. 2012; 74 (8): 869-872
Abstract

Set-shifting difficulties are observed among adults with bulimia nervosa (BN). This study aimed to assess whether adolescents with BN and BN spectrum eating disorders exhibit set-shifting problems relative to healthy controls.Neurocognitive data from 23 adolescents with BN were compared with those from 31 adolescents with BN-type eating disorder not otherwise specified and 22 healthy controls on various measures of set-shifting (Trail Making Task [shift task], Color-Word Interference, Wisconsin Card Sorting Test, and Brixton Spatial Anticipation Task).No significant differences in set-shifting tasks were found among groups (p >.35), and effect sizes were small (Cohen f < 0.17).Cognitive inflexibility may develop over time because of the eating disorder, although it is possible that there is a subset of individuals in whom early neurocognitive difficulty may result in a longer illness trajectory. Future research should investigate the existence of neurocognitive taxons in larger samples and use longitudinal designs to fully explore biomarkers and illness effects.clinicaltrials.gov NCT00879151.

View details for DOI 10.1097/PSY.0b013e31826af636

View details for Web of Science ID 000310047800011

View details for PubMedID 23001391
Disordered Eating in a Digital Age: Eating Behaviors, Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content JOURNAL OF MEDICAL INTERNET RESEARCH Peebles, R., Wilson, J. L., Litt, I. F., Hardy, K. K., Lock, J. D., Mann, J. R., Borzekowski, D. L. 2012; 14 (5)
Abstract

Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users.To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life.We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores.We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m(2); 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores.Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.

View details for DOI 10.2196/jmir.2023

View details for Web of Science ID 000315108100030

View details for PubMedID 23099628
Recruitment and retention in an adolescent anorexia nervosa treatment trial INTERNATIONAL JOURNAL OF EATING DISORDERS Brownstone, L., Anderson, K., Beenhakker, J., Lock, J., le Grange, D. 2012; 45 (6): 812-815
Abstract

To investigate recruitment and retention for a randomized controlled trial (RCT) of adolescent anorexia nervosa (AN), as prior studies suggest that these are significant hurdles to completing meaningful RCTs in this population.Retrospective analyses of recruitment and retention rates were conducted for a multisite RCT of family-based treatment (FBT) versus adolescent-focused therapy (AFT) recruiting adolescents between 12 and 18 years of age with AN.Adolescent participants were recruited from a variety of both medical and nonmedical sources. Recruitment goals were met in time (October 2004-March 2007). Percent retention rates were high across both treatment types (84% for FBT and 92% for AFT), and these rates did not differ significantly.These results reveal that recruitment and retention of adolescent patients with AN to RCTs are feasible in contrast to the experience in adult studies. It is likely that characteristics of our clinical programs make recruitment easier than in other settings, e.g., child and adolescent focused, specialized eating disorders program with an emphasis on outpatient treatment, recognized leaders in the field, and a history of clinical excellence with this population.

View details for DOI 10.1002/eat.22010

View details for Web of Science ID 000307342100012

View details for PubMedID 22407438
Family-based Early Intervention for Anorexia Nervosa EUROPEAN EATING DISORDERS REVIEW Jones, M., Voelker, U., Lock, J., Taylor, C. B., Jacobi, C. 2012; 20 (3): e137-e143
Abstract

This study explores whether potential risk factors for anorexia nervosa (AN) can be modified by a family-based Internet-facilitated intervention and examines the feasibility, acceptability, and short-term efficacy of the Parents Act Now programme in the USA and Germany.Forty-six girls aged 11-17 were studied during a 12-month period and evaluated at screening, baseline, and post-intervention. Parents participated in the six-week intervention.Twenty-four per cent of girls (n = 791) screened met the risk criteria for AN. Parents accessed the majority of the online sessions and rated the programme favourably. At post-assessment, 16 of 19 participants evidenced reduced risk status. Participants remained stable or increased in ideal body weight and reported decreased eating disorder attitudes and behaviours.Results suggest that an easily disseminated, brief, online programme with minimal therapist support is feasible, accepted favourably by parents, and may be beneficial for prevention of exacerbation of AN pathology.

View details for DOI 10.1002/erv.2167

View details for Web of Science ID 000302947500004

View details for PubMedID 22438094
Challenges in Conducting a Multi-Site Randomized Clinical Trial Comparing Treatments for Adolescent Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J., Brandt, H., Woodside, B., Agras, S., Halmi, W. K., Johnson, C., Kaye, W., Wilfley, D. 2012; 45 (2): 202-213
Abstract

To describe obstacles in the implementation of a controlled treatment trial of adolescent anorexia nervosa (AN).The original aim was to enter 240 participants with AN to one of four cells: Behavioral family therapy (BFT) plus fluoxetine; BFT plus placebo; systems family therapy (SFT) plus fluoxetine; SFT plus placebo.Recruitment was delayed pending a satisfactory resolution concerning participant safety. After 6 months of recruitment it became clear that the medication was associated with poor recruitment leading to a study redesign resulting in a comparison of two types of family therapy with a projected sample size of 160. One site was unable to recruit and was replaced.Problems with the delineation of safety procedures, recruitment, re-design of the study, and replacement of a site, were the main elements resulting in a 1-year delay. Suggestions are made for overcoming such problems in future AN trials.

View details for DOI 10.1002/eat.20923

View details for Web of Science ID 000301228500005

View details for PubMedID 21495052
Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa BEHAVIOUR RESEARCH AND THERAPY le Grange, D., Lock, J., Agras, W. S., Moye, A., Bryson, S. W., Jo, B., Kraemer, H. C. 2012; 50 (2): 85-92
Abstract

Few of the limited randomized controlled trails (RCTs) for adolescent anorexia nervosa (AN) have explored the effects of moderators and mediators on outcome. This study aimed to identify treatment moderators and mediators of remission at end of treatment (EOT) and 6- and 12-month follow-up (FU) for adolescents with AN (N = 121) who participated in a multi-center RCT of family-based treatment (FBT) and individual adolescent focused therapy (AFT). Mixed effects modeling were utilized and included all available outcome data at all time points. Remission was defined as ≥ 95% IBW plus within 1 SD of the Eating Disorder Examination (EDE) norms. Eating related obsessionality (Yale-Brown-Cornell Eating Disorder Total Scale) and eating disorder specific psychopathology (EDE-Global) emerged as moderators at EOT. Subjects with higher baseline scores on these measures benefited more from FBT than AFT. AN type emerged as a moderator at FU with binge-eating/purging type responding less well than restricting type. No mediators of treatment outcome were identified. Prior hospitalization, older age and duration of illness were identified as non-specific predictors of outcome. Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT).

View details for DOI 10.1016/j.brat.2011.11.003

View details for Web of Science ID 000301019200001

View details for PubMedID 22172564
CLINICAL SEVERITY OF NIGHT EATING SYNDROME IN EATING DISORDERED ADOLESCENTS: A CASE SERIES Runfola, C., Payne, A., Allison, K., Lock, J., Peebles, R. ELSEVIER SCIENCE INC. 2012: S62–S63
View details for Web of Science ID 000300243000132
Transdiagnostic Theory and Application of Family-Based Treatment for Youth With Eating Disorders COGNITIVE AND BEHAVIORAL PRACTICE Loeb, K. L., Lock, J., Greif, R., Le Grange, D. 2012; 19 (1): 17-30
View details for Web of Science ID 000299800600003
Cultural variability in expressed emotion among families of adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Hoste, R. R., Labuschagne, Z., Lock, J., Le Grange, D. 2012; 45 (1): 142-145
Abstract

To examine the cultural variability in Expressed Emotion (EE) among families of white and ethnic minority adolescents with anorexia nervosa (AN).One-hundred and eighty-nine AN patients and their parents completed the Eating Disorder Examination and the Structured Clinical Family Interview, from which EE ratings were made.No differences were found in the number of white and minority families classified as high EE. White families were higher on warmth (W) and tended to be higher on positive remarks (PR) than minority families. High EE was associated with a longer duration of illness, but was not related to eating disorder pathology.Few differences were found between white and ethnic minority families on the EE dimensions of CC, hostility (H), or EOI. Differences between families on W and PR, however, may have important treatment implications.

View details for DOI 10.1002/eat.20888

View details for Web of Science ID 000298063600021

View details for PubMedID 22170027
The eating disorders examination in adolescent males with anorexia nervosa: How does it compare to adolescent females? INTERNATIONAL JOURNAL OF EATING DISORDERS Darcy, A. M., Doyle, A. C., Lock, J., Peebles, R., Doyle, P., Le Grange, D. 2012; 45 (1): 110-114
Abstract

The study aimed to explore the Eating Disorder Examination (EDE) for adolescent males with eating disorders (EDs) compared with adolescent females with EDs.Data were collected from 48 males and matched on percent median body weight (MBW) and age to 48 females at two sites.Adolescent males with anorexia nervosa-type presentation scored significantly lower than matched females on Shape Concern, Weight Concern, and Global score. They also scored lower on a number of individual items.The EDE has clinical utility with adolescent males with anorexic-type presentation although males' scoring ranges are consistently lower than those from adolescent females with similar clinical presentations. Males scored significantly lower on a number of items representing core symptoms such as desire to lose weight. More research is needed to gain a better understanding of the experience of adolescent males with EDs, particularly in relation to the nature of shape concern.

View details for DOI 10.1002/eat.20896

View details for Web of Science ID 000298063600014

View details for PubMedID 22170022
Eating Disorders in Youth: Diagnostic Variability and Predictive Validity INTERNATIONAL JOURNAL OF EATING DISORDERS Loeb, K. L., Le Grange, D., Hildebrandt, T., Greif, R., Lock, J., Alfano, L. 2011; 44 (8): 692-702
Abstract

The primary aim was to examine the utility of DSM-IV criteria in predicting treatment outcome in a sample of adolescents with eating disorders.We (a) descriptively compared the baseline rates of anorexia nervosa (AN) and bulimia nervosa (BN) across multiple reference points for diagnostic criteria, (b) using ROC curve analyses, assessed the sensitivity and specificity of each diagnostic criterion in predicting clinical outcome, and (c) with logistic regression analyses, examined the incremental predictive value of each criterion.Results show a high degree of variability in the baseline diagnostic profiles as a function of the information used to inform each DSM-IV criterion. For AN, Criterion A yielded the best predictive validity, with Criteria B-D providing no significant incremental value. For BN, none of the measures had a significant AUC, and results from logistic regression analyses showed that none of the indicators were robust in predicting outcome.For AN, the existing Criterion A is appropriate for children and adolescents, and is sufficient to predict outcome in the context of active refusal to maintain a normal weight as well as multiple informants and behavioral indicators of the psychological aspects of AN. For BN, predictive validity could not be established.

View details for DOI 10.1002/eat.20872

View details for Web of Science ID 000297309300004

View details for PubMedID 22072406
Parental Expressed Emotion of Adolescents with Anorexia Nervosa: Outcome in Family-Based Treatment INTERNATIONAL JOURNAL OF EATING DISORDERS le Grange, D., Hoste, R. R., Lock, J., Bryson, S. W. 2011; 44 (8): 731-734
Abstract

The purpose of this study was to determine the relationship between expressed emotion (EE) and outcome in family-based treatment (FBT) for anorexia nervosa (AN).Eighty-six adolescents with AN participated in an RCT comparing two doses of FBT. Seventy-nine of these patients and their parents participated in a structured interview, from which EE ratings were made at baseline. Parents were compared on five subscales of EE as well as overall level of EE (high vs. low).Overall EE levels were low with 32.9% of families presenting as High EE at baseline. Ratings of baseline warmth for both mothers (p = .014) and fathers (p = .037) were related to good outcome at end-of-treatment.EE in parents of adolescents with AN is remarkably low. Notwithstanding, parental warmth may be a predictor of good outcome.

View details for DOI 10.1002/eat.20877

View details for Web of Science ID 000297309300010

View details for PubMedID 22072411
Family Treatment for Eating Disorders in Youth and Adolescents PSYCHIATRIC ANNALS Lock, J. 2011; 41 (11): 547-551
View details for DOI 10.3928/00485713-20111017-08

View details for Web of Science ID 000299818200008
Evaluation of family treatment models for eating disorders CURRENT OPINION IN PSYCHIATRY Lock, J. 2011; 24 (4): 274-279
Abstract

Interest in the effectiveness of family interventions for eating disorders has increased over the past 5 years. This review considers the theoretical justification and current evidence base for the use of family treatments for eating disorders in children and adolescents.Family-based treatment is the best studied treatment. It has the strongest evidence base for effectiveness for anorexia nervosa in adolescents. Family-based treatment can be delivered in several formats and doses, and preliminary data suggest it can be disseminated by training and manuals. There is a more limited evidence base demonstrating the usefulness of family interventions for bulimia nervosa in adolescents.The implications of the findings of this review are that family interventions are the current first-line treatment for adolescent anorexia nervosa and promising for adolescent bulimia nervosa. Pilot studies suggest that family interventions can be disseminated in diverse clinical settings.

View details for DOI 10.1097/YCO.0b013e328346f71e

View details for Web of Science ID 000291030800003

View details for PubMedID 21519263
Self-Injury in Adolescents With Eating Disorders: Correlates and Provider Bias JOURNAL OF ADOLESCENT HEALTH Peebles, R., Wilson, J. L., Lock, J. D. 2011; 48 (3): 310-313
Abstract

Self-injurious behavior (SIB) is common among adolescents, and has been shown to be associated with eating disorders (ED). This study examines the prevalence of SIB and SIB screening in adolescents with ED, and associations with binge eating, purging, and diagnosis.Charts of 1,432 adolescents diagnosed with ED, aged 10-21 years, at an academic center between January 1997 and April 2008, were reviewed.Of patients screened, 40.8% were reported to be engaging in SIB. Patients with a record of SIB were more likely to be female, have bulimia nervosa, or have a history of binge eating, purging, co-morbid mood disorder, substance use, or abuse. Patients who engaged in both binge eating and purging were more likely to report SIB than those engaged in restrictive behavior or either behavior alone. Providers documented screening for SIB in fewer than half of the patients. They were more likely to screen patients who fit a profile of a self-injurer: older patients who binge, purge, or had a history of substance use.SIB was common in this population, and supports extant literature on associations with bulimia nervosa, mood disorders, binge eating, purging, abuse, and substance use. Providers may selectively screen patients.

View details for DOI 10.1016/j.jadohealth.2010.06.017

View details for Web of Science ID 000287478300016

View details for PubMedID 21338905
Use of Mirtazapine in an Adult with Refractory Anorexia Nervosa and Comorbid Depression: A Case Report INTERNATIONAL JOURNAL OF EATING DISORDERS Safer, D. L., Darcy, A. M., Lock, J. 2011; 44 (2): 178-181
Abstract

The objective of this report was to describe an efficacious treatment of an adult with long-standing anorexia nervosa (AN). A 50-year-old woman with an over 7-year history of AN and comorbid major depression had been treated unsuccessfully with numerous psychotropic medications, manualized cognitive behavior therapy, and an intensive outpatient treatment program before referral. After treatment with mirtazapine, she gained weight and her depression improved. A 9-month follow-up revealed a maintenance of these benefits. Mirtazapine may be useful for older, chronically ill patients presenting with AN and comorbid depression.

View details for DOI 10.1002/eat.20793

View details for Web of Science ID 000287551500011

View details for PubMedID 20127940
Anorexia nervosa. Clinical evidence Fitzpatrick, K. K., Lock, J. 2011; 2011
Abstract

Anorexia nervosa is characterised by a low body mass index (BMI), fear of gaining weight, denial of current low weight and its impact on health, and amenorrhoea. Estimated prevalence is highest in teenage girls, and up to 0.7% of this age group may be affected. While most people with anorexia nervosa recover completely or partially, about 5% die of the condition, and 20% develop a chronic eating disorder. Young women with anorexia nervosa are at increased risk of bone fractures later in life. METHODS AND OUTCOMES: We conducted a systematic review, and aimed to answer the following clinical questions: What are the effects of treatments in anorexia nervosa? What are the effects of interventions to prevent or treat complications of anorexia nervosa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review we present information relating to the effectiveness and safety of the following interventions: atypical antipsychotic drugs, benzodiazepines, cyproheptadine, inpatient/outpatient treatment setting, oestrogen treatment (HRT or oral contraceptives), older-generation antipsychotic drugs, psychotherapy, refeeding, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants.

View details for PubMedID 21481284
Cognitive remediation therapy for eating disorders: development, refinement and future directions. Current topics in behavioral neurosciences Tchanturia, K., Lock, J. 2011; 6: 269-287
Abstract

In this chapter, we aim to address some basic conceptual and practical questions about cognitive remediation therapy (CRT) for eating disorders. We begin by providing an overall historical, conceptual, and theoretical framework for CRT. Next, we discuss the specific indications for how and why CRT might be useful for eating disorders based on existing neuropsychological research evidence. We also provide an overview of the types of tasks and stimuli used in CRT and a general protocol for a manualized version of CRT. In addition, modifications of the adult CRT manual for use with adolescents as well as preliminary acceptability of the approach with this younger age group are described. We also propose various ways to integrate CRT in a variety of inpatient and outpatient programmes. Finally, a discussion of potential future directions in research using the tools of neurocognitive assessment, imaging and treatment research is provided.

View details for DOI 10.1007/7854_2010_90

View details for PubMedID 21243481
Aberrant Brain Activation During a Response Inhibition Task in Adolescent Eating Disorder Subtypes AMERICAN JOURNAL OF PSYCHIATRY Lock, J., Garrett, A., Beenhakker, J., Reiss, A. L. 2011; 168 (1): 55-64
Abstract

Behavioral and personality characteristics associated with excessive inhibition and disinhibition are observed in patients with eating disorders, but neural correlates of inhibitory control have not been examined in adolescents with these disorders.Thirteen female adolescents with binge eating and purging behaviors (i.e., bulimia nervosa or anorexia nervosa, binge eating/purging type);14 with anorexia nervosa, restricting type; and 13 healthy comparison subjects performed a rapid, jittered event-related go/no-go task. Functional magnetic resonance images were collected using a 3 Tesla GE scanner and a spiral pulse sequence. A whole-brain three-group analysis of variance in SPM5 was used to identify significant activation associated with the main effect of group for the comparison of correct no-go versus go trials. The mean activation in these clusters was extracted for further comparisons in SPSS.The binge eating/purging group showed significantly greater activation than the healthy comparison group in the bilateral precentral gyri, anterior cingulate cortex, and middle and superior temporal gyri as well as greater activation relative to both comparison and restricting type anorexia subjects in the hypothalamus and right dorsolateral prefrontal cortex. Within-group analysis found that only the restricting type anorexia group showed a positive correlation between the percent correct on no-go trials and activation in posterior visual and inferior parietal cortex regions.The present study provides preliminary evidence that during adolescence, eating disorder subtypes may be distinguishable in terms of neural correlates of inhibitory control. This distinction is consistent with differences in behavioral impulsivity in these patient groups.

View details for DOI 10.1176/appi.ajp.2010.10010056

View details for Web of Science ID 000285868100010

View details for PubMedID 21123315
Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa ARCHIVES OF GENERAL PSYCHIATRY Lock, J., Le Grange, D., Agras, S., Moye, A., Bryson, S. W., Jo, B. 2010; 67 (10): 1025-1032
Abstract

Evidence-based treatment trials for adolescents with anorexia nervosa are few.To evaluate the relative efficacy of family-based treatment (FBT) and adolescent-focused individual therapy (AFT) for adolescents with anorexia nervosa in full remission.Randomized controlled trial.Stanford University and The University of Chicago (April 2005 until March 2009).One hundred twenty-one participants, aged 12 through 18 years, with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement. Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT. Participants were assessed at baseline, end of treatment (EOT), and 6 months' and 12 months' follow-up posttreatment.Full remission from anorexia nervosa defined as normal weight (≥95% of expected for sex, age, and height) and mean global Eating Disorder Examination score within 1 SD of published means. Secondary outcome measures included partial remission rates (>85% of expected weight for height plus those who were in full remission) and changes in body mass index percentile and eating-related psychopathology.There were no differences in full remission between treatments at EOT. However, at both the 6- and 12-month follow-up, FBT was significantly superior to AFT on this measure. Family-based treatment was significantly superior for partial remission at EOT but not at follow-up. In addition, body mass index percentile at EOT was significantly superior for FBT, but this effect was not found at follow-up. Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT, but there were no differences at follow-up.Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT, FBT was more effective in facilitating full remission at both follow-up points.clinicaltrials.gov Identifier: NCT00149786.

View details for Web of Science ID 000282917400005

View details for PubMedID 20921118
All Better? How Former Anorexia Nervosa Patients Define Recovery and Engaged in Treatment EUROPEAN EATING DISORDERS REVIEW Darcy, A. M., Katz, S., Fitzpatrick, K. K., Forsberg, S., Utzinger, L., Lock, J. 2010; 18 (4): 260-270
Abstract

The purpose of this study was to explore how individuals with anorexia nervosa (AN) engage in treatment and define recovery. A mixed methods design was used to triangulate the experience of 20 women with a history of AN. Interview data were analysed thematically to explore frequency of emergent themes and current eating disorder psychopathology was assessed using standardized self-report measures. Participants' mean age was 29.35 (SD = 12.11). Participants' scores were indicative of persistent psychopathology. Those with more involvement in treatment choice had better motivation to change and normalized eating. Participants' definition of recovery mapped on well to current research conceptualizations, though a substantial proportion of the group expressed some ambivalence around the concept. Results are interpreted in the context of self-determination theory of motivation and suggest that patients should be involved collaboratively in the formulation of shared goals and concepts of recovery in treatment settings.

View details for DOI 10.1002/erv.1020

View details for Web of Science ID 000280080100003

View details for PubMedID 20589765
Family-based treatment for adolescents with anorexia nervosa: a dissemination study. Eating disorders Couturier, J., Isserlin, L., Lock, J. 2010; 18 (3): 199-209
Abstract

This open trial of Family-Based Treatment for Anorexia Nervosa was completed in order to assess the dissemination of this treatment, including effectiveness, fidelity, and acceptability. Fourteen adolescents with Anorexia Nervosa were recruited with mean age 14.0+1.5 years (range 12-17 years). Therapists were trained using a workshop, manual and weekly supervision. Sessions were videotaped and rated for treatment fidelity. Pre- and post- treatment assessments were compared. Weight was significantly increased by an average of 7.8 kg. Dietary restraint showed significant improvement, as did interoceptive deficits and maturity fears. Of the 9 participants who had secondary amenorrhea at baseline, 8 had regained menstrual function. Treatment fidelity was rated as at least considerable 72% of the time in phase I of the treatment. Adolescents and parents found the treatment to be acceptable. This preliminary investigation of the dissemination of Family-Based Treatment for adolescents with Anorexia Nervosa indicates that this treatment is effective not only for weight restoration, but also in improving some psychological symptoms including dietary restraint, interoceptive deficits, and maturity fears. In addition, this treatment was adopted with considerable fidelity and was acceptable to adolescents and parents.

View details for DOI 10.1080/10640261003719443

View details for PubMedID 20419524
Are Diagnostic Criteria for Eating Disorders Markers of Medical Severity? PEDIATRICS Peebles, R., Hardy, K. K., Wilson, J. L., Lock, J. D. 2010; 125 (5): E1193-E1201
Abstract

The objective of this study was to compare the medical severity of adolescents who had eating disorders not otherwise specified (EDNOS) with those who had anorexia nervosa (AN) and bulimia nervosa (BN).Medical records of 1310 females aged 8 through 19 years and treated for AN, BN, or EDNOS were retrospectively reviewed. Patients with EDNOS were subcategorized into partial AN (pAN) and partial BN (pBN) when they met all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria but 1 for AN or BN, respectively. Primary outcome variables were heart rate, systolic blood pressure, temperature, and QTc interval on electrocardiogram. Additional physiologically significant medical complications were also reviewed.A total of 25.2% of females had AN, 12.4% had BN, and 62.4% had EDNOS. The medical severity of patients with EDNOS was intermediate to that of patients with AN and BN in all primary outcomes. Patients with pAN had significantly higher heart rates, systolic blood pressures, and temperatures than those with AN; patients with pBN did not differ significantly from those with BN in any primary outcome variable; however, patients with pAN and pBN differed significantly from each other in all outcome variables. Patients with pBN and BN had longer QTc intervals and higher rates of additional medical complications reported at presentation than other groups.EDNOS is a medically heterogeneous category with serious physiologic sequelae in children and adolescents. Broadening AN and BN criteria in pediatric patients to include pAN and pBN may prove to be clinically useful.

View details for DOI 10.1542/peds.2008-1777

View details for Web of Science ID 000277232800055

View details for PubMedID 20385643

View details for PubMedCentralID PMC3078569
Classification of Eating Disturbance in Children and Adolescents: Proposed Changes for the DSM-V EUROPEAN EATING DISORDERS REVIEW Bravender, T., Bryant-Waugh, R., Herzog, D., Katzman, D., Kriepe, R. D., Lask, B., le Grange, D., Lock, J., Loeb, K. L., Marcus, M. D., Madden, S., Nicholls, D., O'Toole, J., Pinhas, L., Rome, E., Sokol-Burger, M., Wallin, U., Zucker, N. 2010; 18 (2): 79-89
Abstract

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

View details for DOI 10.1002/erv.994

View details for Web of Science ID 000275096000004

View details for PubMedID 20151366
Treatment of Adolescent Eating Disorders: Progress and Challenges. Minerva psichiatrica Lock, J. 2010; 51 (3): 207–16
Abstract

OBJECTIVE: Although eating disorders are common psychiatric disorders that usually onset during adolescence, few evidence-based treatments for this age group have been identified. A critical review of treatments used for Anorexia Nervosa (AN) and Bulimia Nervosa (BN) and related conditions (EDNOS) is provided that summarizes the rationale for the treatments, evidence of effectiveness available, and outcomes. METHOD: Critical review of published randomized clinical trials (RCTs). RESULTS: There are only seven published RCTs of psychotherapy for AN in adolescents with a total of 480 subjects. There are only two published RCTs for outpatient psychotherapy for adolescent BN with a total of 165 subjects. There are no published RCTs examining medications for adolescent AN or BN. For adolescent AN, Family-Based Treatment (FBT) is the treatment with the most evidence supporting its use. Three RCTs suggest that FBT is superior to individual therapy at the end of treatment; however, at follow-up differences between individual and family approaches are generally reduced. For adolescent BN, one study found no differences between Cognitive Behavioral Therapy and FBT at the end of treatment or follow-up, while the other found FBT superior to individual therapy. CONCLUSIONS: Although the evidence remains limited, FBT appears to be the first line treatment for adolescent AN. There is little evidence to support a specific treatment for adolescent BN. There is a need for additional studies of treatment of child and adolescent eating disorders. New treatments studies may build on current evidence as well as examine new approaches based on novel findings in the neurosciences about cognitive and emotional processes in eating disorders.

View details for PubMedID 21532979

View details for PubMedCentralID PMC3083856
Academy for Eating Disorders Position Paper: The Role of the Family in Eating Disorders INTERNATIONAL JOURNAL OF EATING DISORDERS le Grange, D., Lock, J., Loeb, K., Nicholls, D. 2010; 43 (1): 1-5
View details for DOI 10.1002/eat.20751

View details for Web of Science ID 000273106100001

View details for PubMedID 19728372
Trying to Fit Square Pegs in Round Holes: Eating Disorders in Males JOURNAL OF ADOLESCENT HEALTH Lock, J. D. 2009; 44 (2): 99-100
View details for DOI 10.1016/j.jadohealth.2008.11.001

View details for Web of Science ID 000262966400002

View details for PubMedID 19167655
COMPETITIVE SPORTS, EATING BEHAVIORS, AND MENSTRUAL HEALTH IN FEMALE COLLEGE ATHLETES Peebles, R., Bell, K., Carlson, J., Wilson, J., Allison, K., Lock, J., Jacobson, M., Hardy, K., Bachrach, L. ELSEVIER SCIENCE INC. 2009: S16–S16
View details for Web of Science ID 000263270100036
Advances in psychotherapy for children and adolescents with eating disorders. American journal of psychotherapy Lock, J., Fitzpatrick, K. K. 2009; 63 (4): 287-303
Abstract

There is a significant lag in the development of evidence based approaches for eating disorders in children and adolescents despite the fact that these disorders typically onset during these developmental periods. Available studies suggest that psychotherapy is the best available approach to these disorders. Specific studies support the use of family based interventions, adolescent focused individual therapy, and developmentally adapted cognitive behavioral therapy in this age group. The current report summarizes the available evidence supportive of each of these treatment modalities, as well as, provides a description of the rationale and principle therapeutic targets and intervention types. Future directions in psychotherapy research in child and adolescent eating disorders are discussed.

View details for PubMedID 20131739
Is there a relationship between parental self-reported psychopathology and symptom severity in adolescents with anorexia nervosa? Eating disorders Ravi, S., Forsberg, S., Fitzpatrick, K., Lock, J. 2009; 17 (1): 63-71
Abstract

The current study aimed to screen for indications of psychopathology displayed by the parents of adolescents diagnosed with Anorexia Nervosa (AN), and examine the relationship between severity of adolescent eating disorder symptoms and parental psychopathology. Sixty female adolescents diagnosed with DSM-IV-TR AN (restricting-type and binge-purge-type) were administered the Eating Disorder Examination (EDE) and parents completed the Symptom Checklist 90-Revised (SCL-90-R). As compared to established non-patient norms, both fathers and mothers of adolescents with AN reported greater levels of obsessive compulsive behaviors, hostility, depression, and anxiety as measured by the SCL-90-R. In addition, duration of AN was positively associated with hostility scores in fathers, and global EDE scores were associated with hostility in mothers. While parental scores on the SCL-90 were elevated as compared to community samples, results of this study do not support a direct influence of parental psychopathology on symptom severity of adolescent AN. Increasing rates of hostility scores in parents with increased duration of AN may represent either a response to the presence of the disorder or be a maintaining factor for AN.

View details for DOI 10.1080/10640260802570122

View details for PubMedID 19105061
Anorexia nervosa. Clinical evidence Lock, J. D., Fitzpatrick, K. K. 2009; 2009
Abstract

Anorexia nervosa is characterised by a low body mass index (BMI), fear of gaining weight, denial of current low weight and its impact on health, and amenorrhoea. Estimated prevalence is highest in teenage girls, and up to 0.7% of this age group may be affected. While most people with anorexia nervosa recover completely or partially, about 5% die of the condition, and 20% develop a chronic eating disorder. Young women with anorexia nervosa are at increased risk of bone fractures later in life. METHODS AND OUTCOMES: We conducted a systematic review which aimed to answer the following clinical questions: What are the effects of treatments for anorexia nervosa? What are the effects of interventions to prevent or treat complications of anorexia nervosa? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.In this systematic review we present information relating to the effectiveness and safety of the following interventions: anxiolytic drugs, cyproheptadine, inpatient/outpatient treatment setting, oestrogen treatment, psychotherapy, refeeding, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants.

View details for PubMedID 19445758
Exploring possible mechanisms of change in family-based treatment for adolescent bulimia nervosa JOURNAL OF FAMILY THERAPY Lock, J., Le Grange, D., Crosby, R. 2008; 30 (3): 260-271
View details for Web of Science ID 000257565500004
Costs of remission and recovery using family therapy for adolescent anorexia nervosa: a descriptive report. Eating disorders Lock, J., Couturier, J., Agras, W. S. 2008; 16 (4): 322-330
Abstract

This paper reports on the costs of overall treatment for a cohort of adolescent patients with AN treated with a similar regimen consisting of inpatient medical stabilization, outpatient family therapy, and psychiatric medications for co-morbid psychiatric conditions. Most of the costs associated with outcome were secondary to medical hospitalization. However, the overall costs per remission varied widely depending on the threshold used. However, compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment.

View details for DOI 10.1080/10640260802115969

View details for PubMedID 18568922
Predictors and moderators of outcome in family-based treatment for adolescent bulimia nervosa JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY le Grange, D., Crosby, R. D., Lock, J. 2008; 47 (4): 464-470
Abstract

To explore the predictors and moderators of treatment outcome for adolescents with bulimia nervosa (BN) who participated in family-based treatment or individual supportive psychotherapy.Data derived from a randomized controlled trial (n = 80) of family-based treatment of BN and supportive psychotherapy were used to explore possible predictors and moderators of treatment outcome.Participants with less severe Eating Disorder Examination eating concerns at baseline were more likely to have remitted (abstained from binge eating and purging) after treatment (odds ratio [OR] 0.47; p <.01) and follow-up (OR 0.53; p <.01), regardless of the treatment that they received. Participants with lower baseline depression scores were more likely to have partial remission (no longer meeting study entry criteria) after treatment (OR 0.93; p <.01), whereas those with fewer binge-eating/purging episodes at baseline were more likely to have partial remission at follow-up (OR 0.98; p <.05). In terms of moderators, participants with less severe eating disorder psychopathology (Eating Disorder Examination global score), receiving FBT-BN, were more likely to meet criteria for partial remission at follow-up (OR 0.44; p <.05).Lower eating concerns are the best predictor of remission for adolescents with BN, and family-based treatment of BN may be most effective in those cases with low levels of eating disorder psychopathology.

View details for DOI 10.1097/CHI.0b013e3181640816

View details for Web of Science ID 000254266100015

View details for PubMedID 18388765
A review of medication use for children and adolescents with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent Couturier, J., Lock, J. 2007; 16 (4): 173-176
Abstract

This paper aims to review the research literature on the use of medication for eating disorders in children and adolescents.The literature was reviewed on the pharmacotherapy of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). The PubMed database was searched for all articles on medication use in the child and adolescent population using the terms medication, antipsychotic, antidepressant, child, adolescent, eating disorders, anorexia nervosa and bulimia nervosa.Very little literature exists on the use of medication for the treatment of eating disorders in children and adolescents. There is one retrospective study on the use of SSRIs and some case reports on atypical antipsychotics for children and adolescents with AN, and one small open trial on SSRIs for adolescent BN.Evidence-based pharmacological treatment for children and adolescents with eating disorders is not yet possible due to the limited number of studies available. It appears that olanzapine and other atypical antipsychotics may prove to be promising for AN at low body weights. It remains uncertain whether SSRIs are helpful in preventing relapse in AN. For children and adolescents with BN, the first line pharmacological option is fluoxetine given the large evidence base of this drug with the adult population and a small open trial of adolescents with BN.

View details for PubMedID 18392170
Classification of child and adolescent eating disturbances - Workgroup for classification of eating disorders in children and adolescents (WCEDCA) INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J. 2007; 40: S117-S122
Abstract

: The purpose of this article is to summarize major conceptual and clinical variables related to age-appropriate and developmentally appropriate classification of eating problems and disorders in children and adolescents.A review of current classifications and related literature in child development is provided. Problems with current classification schemes are identified and discussed.Current classifications are inadequate to address the clinical and research needs of children and adolescents with eating disturbances and disorders.A range of possible changes in classification strategies for eating disorders in children and adolescents are described.

View details for Web of Science ID 000250229900026

View details for PubMedID 17868122
The addition of a parent and clinician component to the eating disorder examination for children and adolescents INTERNATIONAL JOURNAL OF EATING DISORDERS Couturier, J., Lock, J., Forsberg, S., Vanderheyden, D., Lee, H. Y. 2007; 40 (5): 472-475
Abstract

Our goal was to evaluate the addition of parent and clinician reports to the eating disorder examination (EDE) when used with children and adolescents.The EDE was completed with 117 children and adolescents with eating disorders (mean age 14.95 +/- 1.91 years). A slightly modified version of the EDE was completed with parents, and clinician summary scores were assigned. Repeated measures analysis was used to compare child, parent, and clinician scores.In those 70 participants with anorexia nervosa (AN) or eating disorder not otherwise specified with a restrictive pattern (EDNOS-R), child scores were significantly lower than parent scores and clinician scores on restraint and weight concerns. On eating concerns and shape concerns, child scores were lower than clinician scores. Participants with bulimia nervosa (BN) or eating disorder not otherwise specified with binge eating or purging (EDNOS-BP), reported more restraint and shape concerns than parents (n = 47), but their scores did not differ from clinician ratings. No differences were seen in this group on weight concerns or eating concerns.Parent and clinician reports are particularly important when assessing children and adolescents with AN or EDNOS-R, but may be less critical for those with BN or EDNOS-BP.

View details for DOI 10.1002/eat.20379

View details for Web of Science ID 000247356400012

View details for PubMedID 17726771
Open trial of family-based treatment for full and partial anorexia nervosa in adolescence: Evidence of successful dissemination JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Loeb, K. L., Walsh, B. T., Lock, J., Le Grange, D., Jones, J., Marcus, S., Weaver, J., Dobrow, I. 2007; 46 (7): 792-800
Abstract

There is a paucity of evidence-based interventions for anorexia nervosa (AN). An innovative family-based treatment (FBT), developed at the Maudsley Hospital and recently put in manual form, has shown great promise for adolescents with AN. Unlike traditional treatment approaches, which promote sustained autonomy around food, FBT temporarily places the parents in charge of weight restoration. This aim of this open trial was to investigate the feasibility and effectiveness of delivering FBT at a site beyond the treatment's origin and manualization.Twenty adolescents (ages 12-17) with AN or subthreshold AN were treated with up to 1 year of FBT using the published treatment manual. Outcome indices included the percentage of ideal body weight, menstrual status, the Eating Disorder Examination (EDE) subscales scores, and the Children's Depression Rating Scale-Revised score.Of the 20 patients recruited, 15 (75%) completed a full course of treatment. Intent-to-treat analyses showed significant improvement over time in the percentage of ideal body weight (t = -4.46, p =.000), menstrual status (p =.002), EDE Restraint (z = -3.02, p =.003), EDE Eating Concern (z = -2.10, p =.04), but not in EDE Shape Concern or Weight Concern subscales or Children's Depression Rating Scale-Revised score.This open trial provides evidence that FBT can be successfully disseminated, replicating the high retention rates and significant improvement in the psychopathology of adolescent AN seen at the original sites.

View details for DOI 10.1097/chi.0b013e318058a98e

View details for Web of Science ID 000247442600003

View details for PubMedID 17581443
Dialectical behavior therapy modified for adolescent binge eating disorder: A case report COGNITIVE AND BEHAVIORAL PRACTICE Safer, D. L., Lock, J., Couturier, J. L. 2007; 14 (2): 157-167
View details for Web of Science ID 000246548800007
Anorexia nervosa in Asian-American adolescents: Do they differ from their non-Asian peers INTERNATIONAL JOURNAL OF EATING DISORDERS Lee, H., Lock, J. 2007; 40 (3): 227-231
Abstract

This study reports on the clinical characteristics and phenomenology of anorexia nervosa (AN) in Asian-American adolescents, and compares them with a non-Asian sample.Data were obtained from a family therapy trial for adolescents with AN. Demographic details were collected and participants assessed on a series of structured interviews. Data from Asian participants were compared with that from non-Asians.Asians scored lower on all the Eating Disorder Examination (EDE) subscales, significantly on the restraint subscale (1.48 vs. 2.80, p = 0.016) and weight concerns subscale (1.35 vs. 2.30, p = 0.026). They also scored higher on the Family Environment Scale achievement orientation subscale (6.50 vs. 4.81, p = 0.011).Asians are demographically similar to their non-Asian peers but tend to come from higher-income families who were more achievement oriented. EDE scores suggest Asians tend to report fewer symptoms. The apparent lack of fat-phobia among Asians could be related to this overall under-reporting of symptoms.

View details for DOI 10.1002/eat.20364

View details for Web of Science ID 000245089100005

View details for PubMedID 17262816
Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J., Couturier, J., Bryson, S., Agras, S. 2006; 39 (8): 639-647
Abstract

The purpose of this study is to explore the predictors of dropout and remission in the treatment of adolescent anorexia nervosa (AN) using family therapy.Data derived from a randomized clinical trial comparing short and long term family therapy for adolescents with AN were used. A rotated component analysis was employed to reduce the number of variables and to address problems of collinearity and multiple testing. Dropout was defined as participating in less than 80% of the assigned therapy. Participants were classified as remitted if they obtained an ideal body weight greater than 95% and a global eating disorder Examination score within two standard deviations of community norms at the end of 12 months.Co-morbid psychiatric disorder and being randomized to longer treatment predicted greater dropout. The presence of co-morbid psychiatric disorder, being older, and problematic family behaviors led to lower rates of remission. A reduction of child behavioral symptoms, a decline in problematic family behaviors, and early weight gain were all within treatment changes that increased the chance of remission.Co-morbid psychiatric disorder, family behaviors, and early response to treatment are important factors when predicting dropout and remission in family therapy for adolescent AN.

View details for DOI 10.1002/eat.20328

View details for Web of Science ID 000242196400003

View details for PubMedID 16927385
The relationship between perfectionism, eating disorders and athletes: a review. Minerva pediatrica Forsberg, S., Lock, J. 2006; 58 (6): 525-536
Abstract

Perfectionism is a potentially maladaptive personality trait implicated in a number of psychopathologies. As our understanding of the construct perfectionism has shifted from more unidimensionally focused conceptualizations to multidimensional ones, our ability to assess its bearing on various disorders has grown. One particular area in which perfectionism appears to play an important role is among eating disorder patients. The personalities of both those with anorexia nervosa (AN) and bulimia nervosa (BN) are thought to be intrinsically perfectionistic, which suggests a need to understand the role perfectionism plays in the development, course and outcome of these disorders. There is also an increased focus on perfectionism among athletes and its relationship to the higher prevalence of eating disorders in this group. With the institution of Title IX in the United States (which prohibited sex discrimination in higher educational settings) the participation of women in various sports has increased exponentially and with it concerns about their well-being in a milieu where a risk for menstrual irregularities, osteoporosis and eating disorders (the female athlete triad) are common. However, conflicting data suggests that athletics may be a protective factor in the development of eating disorders on the one hand, or it may be a risk factor on the other. Thus, it has become important to examine other variables, such as perfectionism, that may influence the outcome, one way or another. This review examines the current evidence about the relations between perfectionism, athletics and eating disorders.

View details for PubMedID 17093375
Role of therapeutic alliance in family therapy for adolescent anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Pereira, T., Lock, J., Oggins, J. 2006; 39 (8): 677-684
Abstract

The purpose of this study is to examine the role of therapeutic alliance in predicting treatment dropout, response and outcome in a cohort of adolescents with anorexia nervosa (AN) and their families who were treated using a manualized form of family-based therapy (FBT).Independent assessors scored early and late therapeutic alliances for patients and parents using the Working Alliance Inventory-Observer (WAIo). Outcomes were weights and scores on the subscales of the Eating Disorder Examination at the end of 12 months of FBT.Therapeutic alliance throughout treatment was strong both for adolescents and for their parents. A strong early alliance with adolescents was associated with early treatment response in terms of weight gain. A strong early alliance with parents prevented dropout, whereas a strong late parental alliance predicted their child's total weight gain at the end of treatment.Therapeutic alliance in both patients and parents treated with FBT is generally strong and likely contributes to treatment retention and treatment outcome.

View details for DOI 10.1002/eat.20303

View details for Web of Science ID 000242196400008

View details for PubMedID 16937386
How do children with eating disorders differ from adolescents with eating disorders at initial evaluation? JOURNAL OF ADOLESCENT HEALTH Peebles, R., Wilson, J. L., Lock, J. D. 2006; 39 (6): 800-805
Abstract

To compare the clinical presentation of children with eating disorders (ED) to that of adolescents with ED.Demographic, medical, and psychiatric data of all 959 in- and outpatients (85 males, 874 females) 8-19 years of age diagnosed with ED that presented to an academic center between 1997 and 2005 were examined via retrospective record review. Young patients (n = 109) were defined as aged < 13 years at presentation, and older patients (n = 850) > or = 13 years and < 20 years.Compared with older adolescents (mean 15.6 years, SD 1.4), younger patients (mean 11.6 years, SD 1.2) were more likely to be male (chi2 = 9.25, p < .005) or diagnosed with eating disorder not otherwise specified (EDNOS) (chi2 = 5.09, p < or = .05), and less likely to be diagnosed with bulimia nervosa (BN) (chi2 = 13.45, p < or = .001). There were no significant differences in anorexia nervosa (AN) diagnoses between groups. Young patients were less likely to report purging (chi2 = 26.21, p < .001), binge eating (chi2 = 26.53, p < .001), diet pill (chi2 = 13.31, p < .001) or laxative use (chi2 = 6.82, p < .001) when compared with older teens. Young patients weighed less in percentage ideal body weight (p < .05), had a shorter duration of disease (p < .001), and had lost weight more rapidly than older adolescent patients (p < or = .001).There are important diagnostic and gender differences in younger patients. Young ED patients presented at a lower percentage of ideal body weight and had lost weight more rapidly, which may put them at higher risk for future growth sequelae than their older counterparts.

View details for DOI 10.1016/j.jadohealth.2006.05.013

View details for Web of Science ID 000242360100003

View details for PubMedID 17116508
Is family therapy useful for treating children with anorexia nervosa? Results of a case series JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Le Grange, D., Forsberg, S., Hewell, K. 2006; 45 (11): 1323-1328
Abstract

Research suggests that family-based treatment (FBT) is an effective treatment for adolescents with anorexia nervosa (AN). This retrospective case series was designed to examine its usefulness with younger children.Data were abstracted from medical records of 32 children with a mean age of 11.9 years (range 9.0-12.9) meeting diagnostic criteria for AN (n=29) and eating disorder not otherwise specified-restricting type (n=3) who were treated at two sites with FBT. Baseline characteristics, before and after weights, and Eating Disorder Examination (EDE) scores were compared with an adolescent cohort (N=78) with a mean age of 15.5 years (range 13.1-18.4) who were treated with FBT.Children with AN share most disordered eating behaviors with their adolescent counterparts; however, their EDE scores are significantly lower than adolescents at both pre- and posttreatment assessments. Over the course of treatment with FBT, children showed statistically and clinically significant weight gain and improvements in eating disordered thinking as measured by the EDE.FBT appears to be an acceptable and effective treatment for AN in children.

View details for DOI 10.1097/01.chi.0000233208.43427.4c

View details for Web of Science ID 000241415600006

View details for PubMedID 17075354
What is recovery in adolescent anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Couturier, J., Lock, J. 2006; 39 (7): 550-555
Abstract

The principal aim of this study is to describe the types of problems faced in defining recovery from anorexia nervosa (AN) as well as to illustrate the magnitude that various definitions have on recovery rates for AN.Comparative rates of recovery from AN using a range of definitions (percent ideal body weight, psychological recovery, and combinations of these variables) were calculated using long-term outcome data from a study of adolescents treated for AN. In addition, a Kaplan-Meier survival analysis was used to model recovery over the long-term follow-up period.Recovery rates varied highly, depending on the definition used, from 57.1% to 94.4%. Using survival analysis, the mean time to remission for weight (>85% ideal body weight) was 11.3 months, significantly shorter than for Eating Disorder Examination score recovery at 22.6 months (log rank = 16.1, p = 0.0001).Agreement of definitions of recovery may be dependent on specific goals of a particular study or treatment; however, in order to compare and contrast categorical outcomes, a consistent definition of recovery is needed in the literature. Both weight and psychological symptoms appear to be important in a definition of recovery.

View details for DOI 10.1002/eat.20309

View details for Web of Science ID 000241445400003

View details for PubMedID 16791851
Do supplementary items on the eating disorder examination improve the assessment of adolescents with anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Couturier, J. L., Lock, J. 2006; 39 (5): 426-433
Abstract

Given that adolescents with anorexia nervosa (AN) typically have lower scores on the Eating Disorder Examination (EDE) than expected, the current study examined whether the inclusion of eight supplementary items developed by the authors of the EDE better captured the symptoms of adolescents with AN.A dataset consisting of EDEs from 86 adolescents was examined by 3 primary methods: (1) baseline subscale scores were compared before and after the addition of the supplementary items, (2) the internal consistency of the EDE with the addition of these items was examined, and (3) each of these items was compared before and after treatment.After the addition of the supplementary items, the Eating Concern and Weight Concern subscales were significantly increased, whereas the Restraint subscale was significantly decreased, and the Shape Concern subscale was unchanged. Internal consistency was improved on the Eating Concern, Weight Concern, and Shape Concern subscales, and was decreased on the Restraint subscale. Three of eight items showed a significant decrease with treatment.Although the addition of some of these eight supplementary items better captured the psychopathology of adolescents with AN, scores were still substantially below expected, indicating that the exploration of other methods of assessment is needed.

View details for DOI 10.1002/eat.20258

View details for Web of Science ID 000238343800010

View details for PubMedID 16565999
Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Couturier, J., Agras, W. S. 2006; 45 (6): 666-672
Abstract

To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up.This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated in a randomized clinical trial using family therapy between 1999 and 2002.Eighty-three percent (71/86) of subjects participated in follow-up assessments of current psychological and psychosocial functioning. In addition, 49% (35) were interviewed using the Eating Disorder Examination. Mean length of follow-up was 3.96 years (range 2.3-6.0 years). There were no statistically significant differences between the two groups on any measure at long-term follow-up. As a whole, the group was doing well with 89% above 90% ideal body weight, 74% with Eating Disorder Examination scores within the normal range, and 91% of postmenarcheal females not on birth control had menstrual return.A short course of family therapy is as effective as a longer course at follow-up.

View details for DOI 10.1097/01.chi.0000215152.61400.ca

View details for Web of Science ID 000237788200007

View details for PubMedID 16721316
Cognitive-behavioral therapy for adolescents with binge eating syndromes: A case series INTERNATIONAL JOURNAL OF EATING DISORDERS Schapman-Williams, A. M., Lock, J., Couturier, J. 2006; 39 (3): 252-255
Abstract

Published empirically based studies of psychotherapies for bulimia nervosa (BN) have been conducted solely with adult populations. The current study extends the extant literature by piloting a version of cognitive-behavioral therapy (CBT) for BN adapted for an adolescent population.The participants were referred for treatment for binge eating and purging behaviors at a university clinic. Patients received pretreatment and posttreatment interviews assessing the frequency of their binge eating and purge behaviors, and they also completed pretreatment and posttreatment assessments with the Eating Disorders Examination (EDE).Results indicated significant reductions in the frequency of binge eating from pretreatment to posttreatment. Furthermore, all subscale scores of the EDE showed significant declines from pretreatment to posttreatment.The authors concluded that CBT adapted for adolescents with bulimic symptoms appears to be a promising intervention worthy of further study in adolescents.

View details for DOI 10.1002/eat.20253

View details for Web of Science ID 000236437500011

View details for PubMedID 16511836
Denial and minimization in adolescents with anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Couturier, J. L., Lock, J. 2006; 39 (3): 212-216
Abstract

This study examines symptoms of denial in 86 adolescents with anorexia nervosa (AN) using a dataset from a family therapy trial.Using the Restraint subscale of the Eating Disorders Examination (EDE) at baseline, participants were divided into deniers (n = 15), minimizers (n = 21), and admitters (n = 50). These subgroups were compared with analysis of variance (ANOVA; Tukey post-hoc analysis) on a variety of assessment and treatment variables at baseline and at 12 months.Although body mass index (BMI) was not significantly different, all subscale scores of the EDE were lower in the deniers compared with the admitters (p = .0001 for all subscales) at baseline. Minimizers also scored lower than admitters on 3 of 4 subscales (p = .0001 for the Restraint, Weight Concern, and Shape Concern subscales of the EDE). At baseline and at 12 months, there were no significant differences on the Youth Self-Report or the Child Behavior Checklist. At 12 months, the only significant difference was in the Restraint subscale, with deniers still scoring lower than admitters (p = .015).Denial and minimization appear to be common processes occurring in adolescents with AN and present difficulties in assessment.

View details for DOI 10.1002/eat.20241

View details for Web of Science ID 000236437500005

View details for PubMedID 16485271
What is remission in adolescent anorexia nervosa? A review of various conceptualizations and quantitative analysis INTERNATIONAL JOURNAL OF EATING DISORDERS Couturier, J., Lock, J. 2006; 39 (3): 175-183
Abstract

The current article evaluated models of remission in anorexia nervosa (AN).A dataset from 86 adolescents with AN was used to model definitions of remission by using (a) Morgan-Russell categories, (b) criteria proposed by Pike, (c) criteria proposed by Kordy, et al. (d) DSM-IV-text revision criteria, (e) other weight thresholds, (f) psychological symptoms (Eating Disorder Examination [EDE] scores), and (g) combinations of these.The mean age was 15.2 +/- 1.6 years. Remission rates varied from 3% to 96% depending on the method used. Combining percent ideal body weight and EDE scores appeared to reduce the variability in rates, capture the most meaningful aspects of remission, and avoid the pitfalls of other methods.These methods of defining remission produce a wide range of outcomes, demonstrating the importance of defining remission consistently. Weight and psychological variables combined appear most important in defining remission.

View details for DOI 10.1002/eat.20224

View details for Web of Science ID 000236437500001

View details for PubMedID 16485268
A comparison of short- and long-term family therapy for adolescent anorexia nervosa JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Agras, W. S., Bryson, S., Kraemer, H. C. 2005; 44 (7): 632-639
Abstract

Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy.Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or long-term treatment (20 sessions over 12 months) and evaluated at the end of 1 year using the Eating Disorder Examination (EDE) between 1999 and 2002.Although adequately powered to detect differences between treatment groups, an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups. Although a nonsignificant finding does not prove the null hypothesis, in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level. However, post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment.A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short-duration anorexia nervosa. However, there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment.

View details for DOI 10.1097/01.chi.0000161647.82775.0a

View details for Web of Science ID 000230035300010

View details for PubMedID 15968231
The dearth of psychological treatment studies for anorexia nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS le Grange, D., Lock, J. 2005; 37 (2): 79-91
Abstract

Anorexia nervosa (AN) was first described more than 130 years ago, yet few psychological treatments have been formally studied. Our objective was to review the available studies to understand whether these may highlight directions for future investigation.Medline and PsycINFO were consulted to identify relevant treatment studies. Twenty psychotherapy treatment studies were identified for review. These were divided in terms of patient age (adolescent vs. adult) and type of study (uncontrolled vs. controlled).Without exception, adolescent studies (uncontrolled or controlled) involved the parents or family in the treatment. The adult studies were much more varied in terms of treatments that were compared. Most studies were statistically underpowered and only one utilized manualized treatments. More recent investigations have attempted to remedy these methodologic shortcomings.The review highlights the effectiveness of one particular treatment modality for adolescents, but emphasizes the compelling need for further and larger systematic investigation into treatments for both adolescent and adult AN.

View details for DOI 10.1002/eat.20085

View details for Web of Science ID 000227487100001

View details for PubMedID 15732072
Suicidality in adolescents being treated with antidepressant medications and the black box label: Position paper of the Society for Adolescent Medicine JOURNAL OF ADOLESCENT HEALTH Lock, J., Walker, L. R., Rickert, V. I., Katzman, D. K. 2005; 36 (1): 92-93
View details for DOI 10.1016/j.jadohealth.2004.11.125

View details for Web of Science ID 000226494200016

View details for PubMedID 15702497
Adjusting cognitive behavior therapy for adolescents with bulimia nervosa: results of case series. American journal of psychotherapy Lock, J. 2005; 59 (3): 267-281
Abstract

This article reviews the types of adjustments needed to an adult protocol of cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) to make it more acceptable to an adolescent population. Employing developmental principles as well as clinical experience as guidelines, these modifications include the involvement of parents, recognition of the interaction of treatment with normal adolescent developmental tasks, and allowances for typical cognitive and emotional immaturity on treatment procedures. Outcomes from a series of adolescents with BN who were treated with this modified-CBT approach show results similar to those expected in adult populations treated using CBT.

View details for PubMedID 16370133
Family-based treatment of eating disorders INTERNATIONAL JOURNAL OF EATING DISORDERS Lock, J., le Grange, D. 2005; 37: S64-S67
Abstract

The current article provides a brief description of the theory and empirical support for family treatment of eating disorders. The main literature related to family treatment for anorexia nervosa (AN) and bulimia nervosa (BN) is reviewed and the findings highlighted. Family treatment, particularly as devised by researchers at the Maudsley Hospital, appears to be an effective treatment for adolescents with short-term AN. It also may be an appropriate treatment for BN in the same age group, although evidence for this is in much shorter supply. Data support the use of family treatments for adolescents with eating disorders. Controlled trials and other systematic research are needed to determine whether family treatment is the best approach.

View details for DOI 10.1002/eat.20122

View details for Web of Science ID 000228980900015

View details for PubMedID 15852323
Effective treatments for adolescent eating disorders Journal of Mental Health Lock, J., Gowers, S 2005; 14: 599-610
Athletics, perfectionism, and disordered eating. Eating and weight disorders : EWD Hopkinson, R. A., Lock, J. 2004; 9 (2): 99-106
Abstract

To determine the effects of sex, perfectionism, level of athletic participation (varsity vs. recreational), and type of sport (swimming, running, or soccer) on disordered eating.Male and female swimmers, runners, and soccer players at Stanford University were recruited at both the recreational and varsity level. Athletes were given the Multidimensional Perfectionism Scale (MPS), the Eating Attitudes Test-26 (EAT-26), the Eating Disorders Examination Questionnaire (EDE-Q), and a survey on demographics and level of athletic competition. Of 257 athletes identified, 250 (97.3%) returned the questionnaires.A Multivariate Analysis of Variance (MANOVA) was used to assess the variables' effects on disordered eating attitudes. Significant main effects were found for Sex (F5,199=25.7, p<0.001), Level (F5,199=2.5, p<0.05), and Perfectionism (F10,400=3.0, p<0.001). Only two of the ten interaction terms were significant: Sex by Level of athletic participation (F5,199=3.2, p<0.01) and Sex by Perfectionism (F10,400=2.1, p<0.05). Females displayed higher disordered eating than males. Disordered eating attitudes increased with perfectionism and were greater for recreational athletes than varsity, but this trend was significant for females only. Type of sport showed no significant effects. When examining physiological data a higher percentage of varsity females had irregular periods (42.9%) or amenorrhea (14.3%) than recreational females (13.4% and 2.9%, respectively).Males showed little variability in their data due to low disordered eating scores overall, thus demonstrated few significant results. The greatest risk factor for disordered eating attitudes for females was perfectionism, which crossed all athletic divisions. Although recreational athletes seemed more at risk psychologically, the varsity athletes had more physiological risk.

View details for PubMedID 15330076
Report of the National Institutes of Health Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa INTERNATIONAL JOURNAL OF EATING DISORDERS Agras, W. S., Brandt, H. A., Bulik, C. M., Dolan-Sewell, R., Fairburn, C. G., HALMI, K. A., Herzog, D. B., Jimerson, D. C., Kaplan, A. S., Kaye, W. H., le Grange, D., Lock, J., Mitchell, J. E., Rudorfer, M. V., Street, L. L., Striegel-Moore, R., Vitousek, K. M., Walsh, B. T., Wilfley, D. E. 2004; 35 (4): 509-521
Abstract

Anorexia nervosa (AN) is associated with serious medical morbidity and has the highest mortality rate of all psychiatric disorders. The National Institutes of Health (NIH) Workshop on Overcoming Barriers to Treatment Research in Anorexia Nervosa convened on September 26-27, 2002 to address the dearth of treatment research in this area. The goals of this workshop were to discuss the stages of illness and illness severity, pharmacologic interventions, psychological interventions, and methodologic considerations.The program consisted of a series of brief presentations by moderators, each followed by a discussion of the topic by workshop participants, facilitated by the session chair.This report summarizes the major discussions of these sessions and concludes with a set of recommendations related to the development of treatment research in AN based on these findings.It is crucial that treatment research in this area be prioritized.

View details for DOI 10.1002/eat.10261

View details for Web of Science ID 000221120900237

View details for PubMedID 15101067
Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment JOURNAL OF FAMILY THERAPY Krautter, T., Lock, J. 2004; 26 (1): 66-82
View details for Web of Science ID 000188354600004
Is manualized family-based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment Journal of Family Therapy Krautter, T., Lock, J 2004; 26: 66-82
Treatment of adolescent anorexia nervosa using family-based treatment Clinical Case Series Krautter, T., Lock, J 2004; 3: 107-123
What predicts maintenance of weight for adolescents medically hospitalized for anorexia nervosa? Eating disorders Lock, J., Litt, I. 2003; 11 (1): 1-7
Abstract

We assessed the relationship between outcomes at one year and a variety of possible predictors among a group of adolescents who were hospitalized for medical complications associated with adolescent onset AN. We reviewed the 12 month outcomes of 41 adolescent patients admitted for medical complications associated with AN to our center. Data on initial percent ideal body weight, length of initial hospitalization, and percent ideal body weight at discharge from first admission were collected. Our primary outcome measure was percent ideal body weight obtained 12 months after initial discharge. Using multiple linear regression to predict percent ideal body weight achieved at 12 months postdischarge, we found that only percent of ideal body weight at discharge predicted better outcomes. Response to initial hospitalization in terms of weight gain, rather than admission weight or length of initial hospital stay, predict better outcomes at 12 months. These results suggest the need for further study of predictors of response to intensive hospital treatment in order to improve initial response rates and ultimately to better outcomes postdischarge.

View details for PubMedID 16864282
Assessment of eating disorders in adolescents with anorexia nervosa: Self-report questionnaire versus interview INTERNATIONAL JOURNAL OF EATING DISORDERS Passi, V. A., Bryson, S. W., Lock, J. 2003; 33 (1): 45-54
Abstract

To compare the Eating Disorder Examination (EDE) with the self-report version (EDE-Q) in a population of adolescents with anorexia nervosa.Twenty-eight adolescent women meeting criteria for anorexia nervosa were assessed using both measures. The self-report version (EDE-Q) was given both before and (Time 1) after (Time 2) administration of the interview-based version (EDE).The results comparing the EDE with the EDE-Q at Time 1 were consistent with previous studies. Specifically, high correlations were generated on each of the four subscales (Dietary Restraint, Eating Concern, Shape Concern, Weight Concern) where the EDE-Q consistently overestimated the EDE. However, significant differences between the two measures were found on all subscales except Dietary Restraint. Agreement was best for the Weight Concern subscale and worst for the Eating Concern subscales. Comparing the EDE with the EDE-Q at Time 2, agreement improved for all subscales whereas significant differences were found on only two of the four subscales (Eating Concern and Shape Concern).Adolescents with anorexia nervosa report information on the EDE-Q as well as any of the other populations that have been studied. The results suggest that providing information to participants before they complete the self-report measure could improve scores on the EDE-Q.

View details for DOI 10.1002/eat.10113

View details for Web of Science ID 000180055100005

View details for PubMedID 12474198
Children and adolescents with eating disorders: The state of the art PEDIATRICS Rome, E. S., Ammerman, S., Rosen, D. S., Keller, R. J., Lock, J., Mammel, K. A., O'Toole, J., Rees, J. M., Sanders, M. J., Sawyer, S. M., Schneider, M., Sigel, E., SILBER, T. J. 2003; 111 (1)
Abstract

Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues.This article builds on previous background and position papers outlining issues relevant to the care of the adolescent patient with an eating disorder.The eating disorder special interest group from the Society for Adolescent Medicine recognized the need to update the state of the art published guidelines for the care of the adolescent patient with an eating disorder. This article was a multidisciplinary, group effort to summarize the current knowledge of best practice in the field.This article summarizes newer findings on pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, care from the primary care clinician's perspective, appropriate use of a multidisciplinary team, and issues of managed care and reimbursement.Primary prevention combined with early recognition and treatment helps decrease morbidity and mortality in adolescents with eating disorders.

View details for Web of Science ID 000180135200016

View details for PubMedID 12509603
Risk and protective factors for juvenile eating disorders. European child & adolescent psychiatry Steiner, H., Kwan, W., Shaffer, T. G., Walker, S., Miller, S., Sagar, A., Lock, J. 2003; 12: I38-6
Abstract

Eating disorders are prevalent and complicated disorders which are difficult to treat. Unicausal and main effects models are not likely to do justice to the complexity of psychopathology encountered, as one considers etiology and pathogenesis. Risk and protection can arise out of several domains: biological, psychological and social. Risk and protective factors aggregate in specific developmental phases and interact to produce adverse outcomes. Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis. Applying the insights of developmental psychopathology to these disorders has considerable potential to lead to early and preventive interventions. Reviewing the current literature from this perspective and updating a similar discussion from 8 years ago, we witness a continued accumulation of quality empirical data. Compared to previous reviews, the field's attention has shifted to psychosocial/cultural domains relevant to eating, away from biological risk. In the aggregate, these data make possible the increasing differentiation of eating disorders from other psychopathology, and the specific pathways in which anorexia and bulimia may develop. Understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. While an ideal study would be longitudinal, such studies are still extremely difficult to conduct and costly, thus, forcing us to further our understanding from lagged designs, cross-sectional data and case control studies. While these have many limitations, they do seem to produce an increasingly coherent account of the development of these disorders and prepare us for more targeted and longitudinal study of high risk populations.

View details for PubMedID 12567214
Family-based therapy for adolescents with bulimia nervosa. American journal of psychotherapy Le Grange, D., Lock, J., Dymek, M. 2003; 57 (2): 237-251
Abstract

Bulimia nervosa is occurring with increasing frequency among adolescents. Yet, no studies have examined effective treatments for this patient population. Involving the family in the treatment of adolescents with anorexia nervosa has proven to be helpful. A small series of cases has demonstrated that family-based treatment might also be beneficial for adolescents with bulimia nervosa. Moreover, treatment studies for adolescents with anorexia nervosa have demonstrated that family-based treatment does benefit binge eating/purging anorexics. Therefore, preliminary evidence seems to support the use of family-based treatment for adolescent bulimia nervosa. In this article, we review our current knowledge of family-based treatment for adolescents with an eating disorder, and present a case that has completed treatment in order to demonstrate the outline and main interventions of this manualized treatment. While this case demonstrates the successful resolution of bulimia in an adolescent female, at least in the short term, the efficacy of family-based treatment for this patient population is yet to be determined, and is currently being examined in a randomized controlled study at The University of Chicago.

View details for PubMedID 12817553
Children and adolescents with eating disorders: The state of the art Pediatrics Rome, E., Ammerman, S, Rosen, D, Keller, R, Lock, J, Mammal, K, O'Toole, J, Rees, J, Sanders, M, Schneider, M, Sigel, E, Silber, T 2003; 111: e98-e108
What predicts weight maintenance for adoelscents medicaly hospitalized for anorexia nervosa Eating Disorders Lock, J., Litt, I 2003; 33: 1-7
Family-based treatment for adolescents with bulimia nervosa American Journal of Psychotherapy Le Grange, D., Lock, J, Dymek, M 2003; 57: 237-250
Eating attitudes in high school students in the Philippines: a preliminary study. Eating and weight disorders : EWD Lorenzo, C. R., Lavori, P. W., LOCK, J. D. 2002; 7 (3): 202-209
Abstract

The purpose of this study was to examine the prevalence of abnormal eating attitudes among high school students from Pasig Catholic College in the Philippines.Two survey questionnaires, the Eating Attitudes Test (EAT) and Beck's Depression Inventory (BDI), were administered to 932 high school students. The height and weight of the subjects were measured, and their body mass indices (BMI) calculated.The prevalence of abnormal eating attitudes according to the EAT scores was 14.5 +/- 3.2% among males and 15.0 +/- 3.5% among females, comparable to the 7-22% found in Western countries. There was a weak correlation between the EAT scores and BMI (r=0.180, p=0.01), and between the EAT scores and Beck's Depression Inventory (r=0.187, p=0.01).The results indicate the presence of abnormal eating attitudes among Filipino high school students from Pasig Catholic College, which suggests that further study of eating disorders and their associated risks is warranted.

View details for PubMedID 12452252
Treating adolescents with eating disorders in the family context - Empirical and theoretical considerations CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA Lock, J. 2002; 11 (2): 331-?
Abstract

The author described the Maudsley approach for family treatment of adolescent AN and the empirical evidence supporting its use in this population. This treatment focuses on the family as a resource for recovery and puts the patients in charge of re-feeding their affected child. Its success seems to depend on the successful motivation of parents to take on this task and see it through while simultaneously supporting the processes of adolescent development as they reemerge. Although this treatment is promising, substantial data to support its being the best approach for adolescents with AN are lacking. The author also described a theoretical model for involving parents in CBT for adolescents with BN. Although CBT is accepted as the most efficacious treatment for adults with BN, it has not been tested systematically in adolescents. At the same time, it is clear that the adult models of CBT for BN are unlikely to be successful without modifications that take into account the realities of adolescence. Although CBT as a model is likely to be acceptable to adolescents, parents are needed to promote motivation, provide a supportive milieu for behavioral change, and provide guidance and support in stressful periods that lead to relapse. It is important that CBT that is appropriately modified to include parents be tested for its efficacy in adolescents with BN. Preliminary, uncontrolled results are promising.

View details for Web of Science ID 000176490000011

View details for PubMedID 12109324
Bulimia Nervosa in adolescents: Treatment, eating pathology, and comorbidity South African Psychiatry Review Le Grange, D., Lock, J 2002; August: 19-23
Assessing guilt in adolescents with anorexia nervosa American Journal of Psychotherapy Bergholdt, K., Lock, J 2002; 56: 378-390
Viiolence and sexual minority youth Journal of School Violence Lock, J. 2002; 1: 77-89
The Child Abuse Potential inventory and pregnancy outcome in expectant adolescent mothers CHILD ABUSE & NEGLECT Zelenko, M. A., Huffman, L. C., Brown, B. W., Daniels, K., Lock, J., Kennedy, Q., Steiner, H. 2001; 25 (11): 1481-1495
Abstract

The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity.The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed.In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors.The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.

View details for Web of Science ID 000172247300006

View details for PubMedID 11766012
Can family-based treatment of anorexia nervosa be manualized? The Journal of psychotherapy practice and research Lock, J., le Grange, D. 2001; 10 (4): 253-261
Abstract

The authors report on the development of a manual for treating adolescents with anorexia nervosa modeled on a family-based intervention originating at the Maudsley Hospital in London. The manual provides the first detailed account of a clinical approach shown to be consistently efficacious in randomized clinical trials for this disorder. Manualized family therapy appears to be acceptable to therapists, patients, and families. Preliminary outcomes are comparable to what would be expected in clinically supervised sessions. These results suggest that through the use of this manual a valuable treatment approach can now be tested more broadly in controlled and uncontrolled settings.

View details for PubMedID 11696652

View details for PubMedCentralID PMC3330678
Poor adolescent expectant mothers: Can we assess their potential for child abuse? JOURNAL OF ADOLESCENT HEALTH Zelenko, M. A., Huffman, L., Lock, J., Kennedy, Q., Steiner, H. 2001; 29 (4): 271-278
Abstract

To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers.Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies.Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him.Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers' role.

View details for Web of Science ID 000171209100006

View details for PubMedID 11587911
Associated health risks of adolescents with disordered eating: How different are they from their peers? Results from a high school survey CHILD PSYCHIATRY & HUMAN DEVELOPMENT Lock, J., Reisel, B., Steiner, H. 2001; 31 (3): 249-265
Abstract

In this study, we compare health risks of adolescents with disordered eating to those of their peers without disordered eating. A self-report health survey from a community sample of 1769 high school students was used to compare emotional, medical, and social behaviors of these two groups. Risk data for disordered eating students was compared within and across genders. Adolescents with disordered eating are at increased risk for emotional and physical health problems compared to their peers. Overall health risks for boys and girls with disordered eating are quite similar. However, boys with disordered eating develop associated health risk profiles that differentiate them from male peers by having increased mental health, sexual and physical abuse, and general health problems. Girls with disordered eating have associated health risks for substance use and sexual risk-taking that distinguished them from their female peers.

View details for Web of Science ID 000166288700006

View details for PubMedID 11196014
What is the best way to treat adolescents with anorexia nervosa? Eating Disorders Lock, J. 2001; 9: 275-278
Perinatal complications and child abuse in a poverty sample CHILD ABUSE & NEGLECT Zelenko, M., Lock, J., Kraemer, H. C., Steiner, H. 2000; 24 (7): 939-950
Abstract

Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment.Medical charts of 206 children ages 0-3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose medical record indicated a report to CPS based on prenatal findings (Early Maternal Inadequacy group [EMI]), children whose medical record indicated a report to CPS based only on postnatal findings (Child Maltreatment group [CM]), and a control group without CPS report (NM).Compared to the CM and the NM groups, children in the EMI group showed significantly lower birth weight and higher neonatal morbidity as measured by Apgar scores, frequency of oxygen requirement and intubation at birth, frequency of admission to Neonatal Intensive Care unit, and frequency of neonatal medical problems. There was no significant difference between the CM and the NM groups in birth weight, gestational age, and other measures of morbidity.The results of the study suggest that perinatal complications are associated with prenatal maltreatment. Previously reported strong associations between neonatal morbidity and child abuse are more likely a result of antecedent prenatal maternal behaviors (early maternal inadequacy). Early maternal inadequacy, a clinically and demographically distinct phenomenon, is important due to serious health, development and financial implications and deserves further exploration.

View details for Web of Science ID 000087428700006

View details for PubMedID 10905418
Gay, lesbian, and bisexual youth risks for emotional, physical, and social problems: Results from a community-based survey JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J., Steiner, H. 1999; 38 (3): 297-304
Abstract

Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.

View details for Web of Science ID 000078832100018

View details for PubMedID 10087691
How clinical pathways can be useful: An example of a clinical pathway for the treatment of anorexia nervosa in adolescents Clinical Child Psychology and Psychiatry Lock, J. 1999; 4: 331-340
Relationships between sexual orientation and coping styles in gay, lesbian, and bisexual youth from a community high school Jounal of the Gay and Lesbian Medical Association Lock, J., Steiner, H 1999; 3: 77-82
Multi-center open label sertraline study in adolescent outpatients with major depression Journal of the American Academy of Child and Adolescent Psychiatry Ambrosini, P., Wagner, K, Biederman, J, Glick, I, Tan, C, Elia, J, Hebeler, J, Rabinovich, H, Lock, J 1999; 38: 566-572
Severe somatoform disorders in adolescence: A case series using a rehabilitation model for intervention Clinical Child Psychology and Psychiatry Lock, J., Giamona, A 1999; 4: 341-351
Origins of homophobia in males - Psychosexual vulnerabilities and defense development Annual Meeting of the Academy-of-Child-and-Adolescent-Psychiatry Lock, J., Kleis, B. ASSN ADVAN PSYCHOTHERAPY. 1998: 425–36
Abstract

To better understand the origins of homophobia among males.Literature review and clinical illustration.Data suggest that there is a range of homophobic attitudes.We illustrate how homophobic attitudes can be associated with a hierarchy of defensive styles. We propose that these defensive styles are used to manage a range of psychosexual developmental anxieties in boys and men.

View details for Web of Science ID 000081787400003

View details for PubMedID 9861423
Pregnancy and early parenthood: Factors in the development of anorexia nervosa? INTERNATIONAL JOURNAL OF EATING DISORDERS Benton-Hardy, L. R., Lock, J. 1998; 24 (2): 223-226
Abstract

Most psychologic and social theories of anorexia focus on the developmental pressures that challenge adolescent girls. Pregnancy, which causes profound physical, emotional, and cognitive changes, could represent an amplification of these developmental pressures. In this case study, pregnancy is suggested as a possible contributor to the development of anorexia in a 17-year-old female. Although she has other factors associated with the development of anorexia, the psychological and physical changes of pregnancy appear to be the crucial changes which precipitated anorexia nervosa.

View details for Web of Science ID 000075022100012

View details for PubMedID 9697021
Psychosexual development in adolescents with chronic medical illnesses 150th Annual Meeting of the American-Psychiatric-Association Lock, J. AMER PSYCHIATRIC PUBLISHING, INC. 1998: 340–49
Abstract

The author provides a literature review and developmental formulation, with the goal to assist clinicians working with medically ill adolescents with psychosexual issues. MEDLINE and PsychINFO database searches of English-language medical journal articles published between 1986 and 1997 for articles related to medical illness and psychosexual development in adolescence were done. The author found that little systematic research on the psychosexual implications of medical illnesses for adolescents has been undertaken, but existing studies suggest that psychosexual development is negatively affected by medical illness. A three-phase model of adolescent psychosexual development is presented, with specific psychosexual tasks associated with each phase. Impediments to progressing through adolescent psychosexual phases due to medical conditions are identified, and case examples are provided. The author concludes that clinicians working with adolescents with medical conditions should attend to the possibility of psychosexual impediments in these adolescents and use developmentally appropriate methods for assessing and treating these difficulties when they arise.

View details for Web of Science ID 000075014800005

View details for PubMedID 9691703
A primer on homophobia for the child and adolescent psychiatrist 42nd Annual Meeting of the American-Academy-of-Child-and-Adolescent-Psychiatry Lock, J., Kleis, B. N. LIPPINCOTT WILLIAMS & WILKINS. 1998: 671–73
View details for Web of Science ID 000073978700020

View details for PubMedID 9628089
Anorexia nervosa and bulimia nervosa in children and adolescents: A review of the past 10 years JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Steiner, H., Lock, J. 1998; 37 (4): 352-359
Abstract

To critically review the research in juvenile anorexia nervosa and bulimia nervosa over the past 10 years and highlight recent advances in normal development as it pertains to these disorders and their diagnosis, prevention, and treatment.Computerized search methods were combined with manual searches of the literature. A detailed review of the most salient articles is provided. Preference was given to studies involving children and adolescents that approached the subject from a developmental perspective.The information from these studies is presented in a developmental framework. Research in eating disorders has progressed, but definitive longitudinal data are still absent from the literature. Research specific to treatment of child and adolescent eating disorders remains rare.Data approaching eating disorders from a developmental perspective are available in only a few studies. Research is needed addressing normative data on the development of eating behavior and specific risk and resilience factors for pathology in specific developmental periods. Especially lacking are studies regarding the continuities and discontinuities of eating disturbances across the life span. Best documented are epidemiological studies of prevalence and incidence, long-term outcome in anorexia nervosa, and short-term treatment response in bulimia.

View details for Web of Science ID 000072657600011

View details for PubMedID 9549954
Treatment of homophobia in a gay male adolescent AMERICAN JOURNAL OF PSYCHOTHERAPY Lock, J. 1998; 52 (2): 202-214
Abstract

Gay teenagers experience normal adolescent developmental processes, but need assistance negotiating the effect of homophobia on their development. Homophobia in the early phase may increase reliance upon the family. This can make it difficult to extricate oneself from family sufficiently to develop peer relationships. Supportive individual and interpretative family work can help modify these problems. Problems in the middle phase are associated with societal homophobia in the institutions where adolescents develop. High school social dynamics support homophobia and make opportunities to develop a peer network difficult. Therapeutic interventions that support a gay teen's efforts through fantasy and symbolic action are key to success in to this period. Referral to gay teen support groups are more likely to be successful during this phase. During the late phase of adolescence, homophobia complicates the quest for an acceptable social role and the need for more intimate relationships as plans for work and pairing become the focus. The therapist helps the gay teen overcome stereotypes and see themselves as individuals and as a members of a group called "gay." This makes it possible to integrate personal aspects of the self with gay-group identity.

View details for Web of Science ID 000074445100006

View details for PubMedID 9656056
Report of eroticized vomiting Psychosomatic Medicine Lock, J. 1998; 38: 661
The coming out process: Develomental stages for sexual minority youth Clinical Child Psychology and Psychiatry Carrion, V., Lock, J 1997; 2: 369-377
Developmental considerations in the treatment of school-age boys with ADHD: An example of a group treatment approach JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Lock, J. 1996; 35 (11): 1557-1559
View details for Web of Science ID A1996VN95400026

View details for PubMedID 8936924
Acting out and the narrative function: Reconsidering Peter Blos's concept of the second individuation process AMERICAN JOURNAL OF PSYCHOTHERAPY Lock, J. 1995; 49 (4): 548-557
Abstract

The role and meaning of narratives in psychoanalytically oriented psychotherapy has begun to be explored over the past few years. Little, if any, of this material has been related to adolescent psychotherapy and it is the purpose of this paper to make some preliminary inquiries into how narratives might operate in this sphere. To explore this hypothesis, Peter Blos's ideas on adolescent acting out are related to a theory of narrative developed by the French philosopher Paul Ricoeur. Blos conceives of adolescent acting out as a part of attempts by adolescents to develop a coherent identity in what he refers to as a second individuation process. A link is proposed between adolescent acting out and Ricoeur's notion of narrative as the structure that undergirds the process of identity formation.

View details for Web of Science ID A1995TY47600007

View details for PubMedID 8669499
CAN EXPERTS AGREE WHEN TO HOSPITALIZE ADOLESCENTS JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Strauss, G., Chassin, M., Lock, J. 1995; 34 (4): 418-424
Abstract

Rates of psychiatric hospitalization and lengths of stay for adolescents have been a focus of recent controversy. With the advent of managed care, hospital systems and third-party payers are looking for ways to decide when hospitalization is indicated. The authors sought to determine whether experts could agree on the appropriateness of putative indicators for hospitalization of adolescents for conduct disorder or substance abuse.Using a methodology developed at the Rand Corporation and previously applied to procedures in medicine and surgery, the authors developed a list of possible indications for hospitalization of adolescents with conduct disorder and/or substance abuse. A nine-member panel of experts in these areas, balanced by geography, academics/clinical practice, and whether the expert was in charge of a hospital unit, then rated the appropriateness of each indication twice under a modified Delphi procedure.Using prespecified definitions for agreement, after the initial rating the panel had low levels of disagreement (11%) and moderate levels of agreement (28%) on more than 1,900 possible indications for hospitalization. Despite an expanded number of indications, the panel reduced disagreement to less than 5% and increased agreement to more than 55% after the second round of ratings.The consensus achieved compared favorably with the results of similar panels judging the appropriateness of procedures in medicine and surgery. The methodology is applicable to studies of the appropriateness of pharmacological or psychotherapeutic interventions in both child and adult psychiatry. The results of such studies can form the basis for rational utilization review and treatment authorization decisions.

View details for Web of Science ID A1995QP33500010

View details for PubMedID 7751255
PSYCHIATRIC-HOSPITALIZATION OF ADOLESCENTS FOR CONDUCT DISORDER HOSPITAL AND COMMUNITY PSYCHIATRY Lock, J., Strauss, G. D. 1994; 45 (9): 925-928
Abstract

The authors' goal was to review current published literature on the psychiatric hospitalization of adolescents with a diagnosis of conduct disorder.The English-language literature from 1980 to 1991 cited in the MEDLINE database was searched using the key words conduct disorder, adolescent psychiatric hospitalization, psychiatric hospitalization criteria, adolescent psychiatric inpatient hospitalization, and adolescent psychiatric admissions.A diagnosis of conduct disorder or presenting symptoms and behaviors consistent with that diagnosis are commonly reported for adolescent psychiatric admissions. Estimates of the percentage of admissions to psychiatric inpatient treatment facilities of adolescents with conduct disorder or symptoms consistent with that disorder range from 30 to 70 percent. There are no research-based criteria for hospitalization of adolescents for conduct disorder, and systematic studies of the outcome of psychiatric hospitalization for this group have not been published. Comorbid psychiatric diagnoses and similar behavioral symptoms in conduct disorder and comorbid disorders complicate inpatient treatment of adolescents with conduct disorder.Studies of the outcome of psychiatric hospitalization of adolescents for conduct disorder are needed to determine the appropriate use of this modality.

View details for Web of Science ID A1994PE81900016

View details for PubMedID 7989027
Can experts agree on when to hospitalize adolescents? Journal of the American Academy of Child and Adolescent Psychiatry Strauss, G., Chassin, M, Lock, J 1994; 34: 418-424
Psychiatric hospitalization of adolescents for conduct disorder Hospital and Community Psychiatry Lock, J., Strauss, G 1994; 45: 925-928
The role and function of residents' organizations in psychiatry education. Academic psychiatry Lock, J., Kleis, B., Strouse, T., Jacobson, S., Yager, J., Servis, M. 1993; 17 (1): 26-31
Abstract

Psychiatry residents' organizations have been poorly studied and variously portrayed as facilitative or regressive. A telephone survey of 19 residency programs of differing sizes in all major geographic regions revealed that 89% had some form of residents' organization. The groups are characterized by a wide range of structures, and they undertake a variety of tasks. The most common tasks are support, problem solving, and venting dissatisfaction. Problems frequently faced by such groups include changing resident constituencies, personality conflicts, authorization disputes, and representation and consensus problems. Strengths of such groups include their ability to help foster a sense of group identity; to provide a safe place to ventilate, work on problems, and fashion a consensus for the residents' input to the institution; and to offer training opportunities f or future psychiatric managers.

View details for DOI 10.1007/BF03341502

View details for PubMedID 24443193
The role and function of residents' organizations in psychiatric education Academic Psychiatry Lock, J., Kleis, B, Strouse, T, Jacobson, S, Yager, J, Servis, M 1993; 17: 26-30
Dissociative symptoms and disorders in patients with eating disorders Dissociation Journal McCallum, K., Lock, J, Kulla, M, Rorty, M, Wetzel, R 1992; 5: 227-235
Possible adverse interactions between fluoxetine and other psychotropics Journal of Clinical Psychopharmacology Lock, J., Gwirtzman, H, Targ, G. 1990; 10: 283
Some aspects of medical hermeneutics: The role of dialectic and narrative Theoretical Medicine Lock, J. 1990: 41

Professor of Psychiatry and Behavioral Sciences and, by courtesy, of Pediatrics

Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry

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