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Multiaxial classification system development (organising important and relevant clinical factors under multiple headings or ‘axes’) has a long history stretching back to the 1940s. The World Health Organization supported the development of a multiaxial system of classification for children from the 1960s and in the 1990s produced a comprehensive multiaxial system which could be used with ICD-10. Using the multiaxial approach provides for an atheoretical framework that can integrate factors from within the child and the environmental influences on the child. This article presents a variety of ways in which the ICD-10 multiaxial framework can be extended from its classic usage to provide clinicians with valuable tools to assist in a biopsychosocial clinical assessment. Using the multiaxial system in an extended format allows a more comprehensive diagnosis and planning of treatments and is helpful in the training and teaching of juniors. It is also useful in evaluating responses to medication when it is combined with a chronological analysis and can provide other useful ways of integrating information relevant to understanding clinical cases.
This chapter discusses eating disorder psychopathology and the prevalence of eating disorders diagnoses in boys. The key determinants in childhood eating disorders considered include psychological constructs such as body dissatisfaction and its influence on dieting and other weight loss strategies, biological factors such as height, weight, body mass index (BMI) and pubertal status. Recently boys have been included in epidemiological studies of eating disorders. Eating disorder psychopathology has most usually been reported as the dependent variable in risk factor research. Conclusions from the current literature highlight that boys do exhibit some of the psychological and biological factors that have been identified as eating disorders risk factors for girls. It is unlikely that an evidence-based treatment approach for boys and young men will be developed without multicentred trials that ensure adequate treatment sample sizes.
Individual psychotherapy in most instances, particularly with children, should occur following a thorough assessment of the patient's family and social context. This chapter describes individual therapies that have been applied in eating disorders, summarizes their evidence base, and concludes with a commentary on their appropriateness for children and adolescents. Psychodynamic therapies have the longest history in therapies for eating disorders. Cognitive-analytic therapy (CAT) is a treatment that combines elements of cognitive therapy (CT) and psychodynamic therapy. CAT integrates active symptom management, and has been recommended as a viable alternative to cognitive-behavior therapy (CBT). Self-help therapy is a modified form of CBT, in which a treatment manual is provided for people to proceed with treatment on their own, or with support from a non-professional. CBT and interpersonal psychotherapy (IPT) have been found to be effective in reviews that have included trials of eating disorder not otherwise specified (EDNOS) or binge-eating disorder.
Anorexia Nervosa and other eating disorders are arguably the most complex mental health problems that a child or adolescent may experience. Numbers seeking help are on the increase, and the complexity of these disorders challenges even the most experienced clinician. In this 2006 book, the experience of numerous practitioners with international reputations in the field is brought to bear on the broad range of issues a good clinician needs to know about, from the history of the disorder through to treatment, psychopharmacology, the psychotherapies, epidemiology, comorbidities, eating disorders in boys, and neuroimaging. The book is divided into parts detailing the scientific underpinnings, abnormal states, the evidence base for treatments, and finally public health issues, including service delivery models and perspectives on prognosis and outcomes. Clinicians encountering eating disorders will find this latest addition to the Cambridge Child and Adolescent Psychiatry series invaluable.
To test the hypothesis that children with suboptimal fetal growth have significantly poorer mental health outcomes than those with optimal growth, a population random sample survey of children aged 4 to 16 years in Western Australia in 1993 was conducted. The Child Behavior Checklist (Achenbach 1991a) and the Teacher Report Form (Achenbach 1991b) were used to define mental health morbidity. Survey data for 1775 children aged 4 to 13 years were available for linkage with original birth information. The percentage of expected birthweight (PEBW) was used as the measure of fetal growth. Children below the 2nd centile of PEBW who had achieved only 57% to 72% of their expected birthweight given their gestation at delivery were at significant risk of a mental health morbidity (OR 2.9, 95% CI 1.18, 7.12). In addition, they were more likely to be rated as academically impaired (OR 6.0, 95% CI 2.25, 16.06) and to have poor general health (OR 5.1, 95% CI 1.69, 15.52).
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