Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Few... more Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD. To determine the prevalence of suspected FASD, to establish a database as a starting point for epidemiological studies, and to develop FASD awareness for health, social, and educational services. A chart review was conducted at an educational facility for children and adolescents with behavioral and learning challenges. The following information was extracted: adoption status, history of alcohol/drug abuse in the biological mother, medical diagnoses, medication use, and information regarding impairment in 14 published neurobehavioral categories. Subjects were classified as: category 1 (highly likely FASD) - impairment in three or more neurobehavioral categories and evidence...
The Israel Medical Association journal : IMAJ, 2019
BACKGROUND Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in ... more BACKGROUND Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD. OBJECTIVES To determine the prevalence of suspected FASD, to establish a database as a starting point for epidemiological studies, and to develop FASD awareness for health, social, and educational services. METHODS A chart review was conducted at an educational facility for children and adolescents with behavioral and learning challenges. The following information was extracted: adoption status, history of alcohol/drug abuse in the biological mother, medical diagnoses, medication use, and information regarding impairment in 14 published neurobehavioral categories. Subjects were classified as: category 1 (highly likely FASD) - impairment in three or more neurobeha...
Http Dx Doi Org 10 1080 01926180490255756, Aug 17, 2010
ABSTRACT This paper introduces the Boundary-Control Model. The model provides an account of the e... more ABSTRACT This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a defense mechanism. Treatment involves stripping away the adolescent's false sense of power by creating a crisis and provoking the hidden anxieties. The development and maintenance of anorexia nervosa, as well as its treatment, will be discussed in light of the proposed model.
International Journal of Adolescent Medicine and Health, 2002
The objective was to propose and describe a new bio-psycho-social model of emergence and maintena... more The objective was to propose and describe a new bio-psycho-social model of emergence and maintenance of anorexia nervosa and bulimia nervosa, and demonstrate its application to treatment. An original model, based on literature review and our own clinical experience, was created. Therapeutic guidelines were derived from the theoretical model and applied in the treatment of 97 anorexia and bulimia nervosa patients presented at the eating disorders unit at Kaplan Hospital in Israel over 18 months. A team comprising a pediatrician, a child psychiatrist, a dietician, and trained nurses collaborated in a comprehensive systemic therapeutic approach involving parents, schools, and community agents. Ninety-one girls and six boys were treated in the eating disorder unit (55 had AN, 29 had BN and 13 had EDNOS). Thirty-seven patients were hospitalized and sixty were treated in the outpatient clinic. Mean hospitalization time of the first five patients was 108 days. Mean hospitalization time of the remaining 32 patients was reduced to 32 days. The mean number of outpatient clinic interventions was 12. At the one-year follow up, 74 patients were doing well in all respects. Fourteen patients still needed a lot of supervision in eating. Five are still hospitalized and four were lost to follow up. The proposed model proves to be more than just another theory in that it is successfully applied in treatment. Short systemic therapy is very effective. The longer the delay in drastic, aggressive treatment, the worse the prognosis. Extended hospitalization periods worsen the prognosis. Weakness of the parental unit is a strong indication for inpatient care. The longer the experience in treating eating disorders, the shorter the hospitalization and number of interventions.
Journal of the American Academy of Child & Adolescent Psychiatry, 1997
ObJectives: To evaluate the validity of two definitions of partial eating disorders, the Eating A... more ObJectives: To evaluate the validity of two definitions of partial eating disorders, the Eating Attitudes Test (EAT) and a combination of the EAT and relevant criteria of the DSM-III-R, and to examine their association with factors related to anorexia nervosa and bulimia nervosa. Method: Questionnaires on eating behaviors, depression, obsessionality, and impulsivity were distributed to 534 female high school students. Demographic. psychosocial. and physical parameters and the subjects' height and weight were also recorded. Results: EAT scores revealed maladaptive behaviors in 18% of the subjects; the combination of the EAT and DSM-III-R criteria identified 20.8% of the subjects as having partial anorexia nervosa and 11.3% as having partial bulimia nervosa. Both definitions were significantly associated with risk factors for clinical eating disorders: high weight, weight fluctuations. dieting. menstrual disturbances, high level of depression and obsessionality, and preoccupation with eating in the family. Partial bulimics fared worse on most of these parameters. Partial anorectics were not more psychologically distressed than normal subjects. Conclusions: The validity of both definitions of partial eating disorders is supported by their similar and significant associations with known risk factors for the development of the clinical syndromes. Partial bulimics are similar to patients with bulimia nervosa in the level of many eating-related disturbances and in depression, obsessionality, and impulsivity. Partial anorectics, like anorectic patients in clinical settings, tend to minimize their problems. The relevance of partial eating disorders to the later development of the full-blown clinical entity is still not established.
We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity diso... more We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in childhood, 35 male adolescents similarly diagnosed who were receiving methylphenidate (MPH), and 77 control boys. Both ADHD groups completed self-report questionnaires assessing sleep disturbances; weekday and holiday sleep duration; and symptoms of ADHD, anxiety, and depression. Parents and teachers rated the severity of the participants' ADHD. The control group completed self-report questionnaires assessing sleep disturbances. We found that nonmedicated participants and controls did not differ in the severity of sleep disturbance. In contrast, the medicated participants demonstrated a significantly greater severity of sleep disturbance compared with the nonmedicated participants and reported elevated levels of symptoms of ADHD, anxiety, and depression. Specific analyses showed that depressive symptoms contributed significantly to the degree of sleep disturbance when controlling for ADHD diagnosis and MPH treatment. These findings suggest that among adolescents with ADHD symptoms, the severity of symptoms of depression may contribute to the degree of sleep disturbance in addition to the effect of their primary disorder and MPH treatment.
Background: A possible connection between Mark Snyder's concept of selfmonitoring and anorexia ne... more Background: A possible connection between Mark Snyder's concept of selfmonitoring and anorexia nervosa (AN) has not previously been examined. Aims: We hypothesized that AN symptomatology correlates positively with the Other-Directedness aspect of Snyder's self-monitoring construct and negatively with its Extraversion aspect. Method: 194 women with a history of AN were classifi ed as currently ill (n = 17), partially recovered (n = 106) and recovered (n = 71). These women and 100 female controls with no history of an eating disorder completed Snyder's Self-Monitoring Scale (SMS) and the Eating Attitudes Test-26 (EAT-26). 'Other-Directedness' and 'Acting and Extraversion' subscales were derived from an exploratory factor analysis of the Hebrew version of the SMS. Mean total and subscale scores were compared across groups, and correlations were calculated between EAT-26 scores and SMS total and subscale scores. Results: Both subscales of the SMS correlated signifi cantly with total scores but not with one another. As expected, AN symptomatology and EAT-26 scores were associated positively with Other-Directedness yet negatively with Acting and Extraversion, rendering the correlation with total SMS scores insignifi cant. Conclusion: Different aspects of Snyder's self-monitoring construct correlate in opposite directions with eating pathology and AN symptomatology. AN appears to be associated with high Other-Directedness but low Acting and Extroversion.
This paper introduces the Boundary-Control Model. The model provides an account of the emergence,... more This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 2007
The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candida... more The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candidate for contributing risk to disordered eating and anorexia nervosa (AN). We tested association using UNPHASED for 5 DRD4 polymorphic loci, 3 promoter region SNPs (C-521T, C-616G, A-809G), the 120 bp promoter region tandem duplication and the exon III repeat, in 202 AN trios and 418 control families. Since perfectionism characterizes AN, we tested these five loci for association with the Child and Adolescent Perfectionism Scale (CAPS) in the AN and control groups. Single locus analysis showed significant association between the 'C' C-521T allele and AN. Haplotype analysis also showed significant association, particularly a 4-locus haplotype (exon III&120 bp repeat&C-521T&A-809G). Association was also observed between DRD4 and CAPS scores both for AN and control subjects. The insulin-like growth factor 2 (IGF2) and the arginine vasopressin 1a receptor (AVPR1a), previously shown to be associated with disordered eating, were also associated with CAPS scores. Three genes associated with AN were also associated with perfectionism. Personality traits are potential endophenotypes for understanding the etiology of eating disorders and one of the several pathways to eating pathology may be mediated by the impact of DNA sequences on perfectionism.
Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Few... more Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD. To determine the prevalence of suspected FASD, to establish a database as a starting point for epidemiological studies, and to develop FASD awareness for health, social, and educational services. A chart review was conducted at an educational facility for children and adolescents with behavioral and learning challenges. The following information was extracted: adoption status, history of alcohol/drug abuse in the biological mother, medical diagnoses, medication use, and information regarding impairment in 14 published neurobehavioral categories. Subjects were classified as: category 1 (highly likely FASD) - impairment in three or more neurobehavioral categories and evidence...
The Israel Medical Association journal : IMAJ, 2019
BACKGROUND Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in ... more BACKGROUND Fetal alcohol spectrum disorder (FASD) may be under-recognized and under-diagnosed in Israel. Fewer than 10 FASD diagnoses were reported between 1998 and 2007; however, several hundred diagnoses have been made since. Furthermore, less than 10% of surveyed Israeli pediatricians reported adequate knowledge of FASD. OBJECTIVES To determine the prevalence of suspected FASD, to establish a database as a starting point for epidemiological studies, and to develop FASD awareness for health, social, and educational services. METHODS A chart review was conducted at an educational facility for children and adolescents with behavioral and learning challenges. The following information was extracted: adoption status, history of alcohol/drug abuse in the biological mother, medical diagnoses, medication use, and information regarding impairment in 14 published neurobehavioral categories. Subjects were classified as: category 1 (highly likely FASD) - impairment in three or more neurobeha...
Http Dx Doi Org 10 1080 01926180490255756, Aug 17, 2010
ABSTRACT This paper introduces the Boundary-Control Model. The model provides an account of the e... more ABSTRACT This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a defense mechanism. Treatment involves stripping away the adolescent's false sense of power by creating a crisis and provoking the hidden anxieties. The development and maintenance of anorexia nervosa, as well as its treatment, will be discussed in light of the proposed model.
International Journal of Adolescent Medicine and Health, 2002
The objective was to propose and describe a new bio-psycho-social model of emergence and maintena... more The objective was to propose and describe a new bio-psycho-social model of emergence and maintenance of anorexia nervosa and bulimia nervosa, and demonstrate its application to treatment. An original model, based on literature review and our own clinical experience, was created. Therapeutic guidelines were derived from the theoretical model and applied in the treatment of 97 anorexia and bulimia nervosa patients presented at the eating disorders unit at Kaplan Hospital in Israel over 18 months. A team comprising a pediatrician, a child psychiatrist, a dietician, and trained nurses collaborated in a comprehensive systemic therapeutic approach involving parents, schools, and community agents. Ninety-one girls and six boys were treated in the eating disorder unit (55 had AN, 29 had BN and 13 had EDNOS). Thirty-seven patients were hospitalized and sixty were treated in the outpatient clinic. Mean hospitalization time of the first five patients was 108 days. Mean hospitalization time of the remaining 32 patients was reduced to 32 days. The mean number of outpatient clinic interventions was 12. At the one-year follow up, 74 patients were doing well in all respects. Fourteen patients still needed a lot of supervision in eating. Five are still hospitalized and four were lost to follow up. The proposed model proves to be more than just another theory in that it is successfully applied in treatment. Short systemic therapy is very effective. The longer the delay in drastic, aggressive treatment, the worse the prognosis. Extended hospitalization periods worsen the prognosis. Weakness of the parental unit is a strong indication for inpatient care. The longer the experience in treating eating disorders, the shorter the hospitalization and number of interventions.
Journal of the American Academy of Child & Adolescent Psychiatry, 1997
ObJectives: To evaluate the validity of two definitions of partial eating disorders, the Eating A... more ObJectives: To evaluate the validity of two definitions of partial eating disorders, the Eating Attitudes Test (EAT) and a combination of the EAT and relevant criteria of the DSM-III-R, and to examine their association with factors related to anorexia nervosa and bulimia nervosa. Method: Questionnaires on eating behaviors, depression, obsessionality, and impulsivity were distributed to 534 female high school students. Demographic. psychosocial. and physical parameters and the subjects' height and weight were also recorded. Results: EAT scores revealed maladaptive behaviors in 18% of the subjects; the combination of the EAT and DSM-III-R criteria identified 20.8% of the subjects as having partial anorexia nervosa and 11.3% as having partial bulimia nervosa. Both definitions were significantly associated with risk factors for clinical eating disorders: high weight, weight fluctuations. dieting. menstrual disturbances, high level of depression and obsessionality, and preoccupation with eating in the family. Partial bulimics fared worse on most of these parameters. Partial anorectics were not more psychologically distressed than normal subjects. Conclusions: The validity of both definitions of partial eating disorders is supported by their similar and significant associations with known risk factors for the development of the clinical syndromes. Partial bulimics are similar to patients with bulimia nervosa in the level of many eating-related disturbances and in depression, obsessionality, and impulsivity. Partial anorectics, like anorectic patients in clinical settings, tend to minimize their problems. The relevance of partial eating disorders to the later development of the full-blown clinical entity is still not established.
We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity diso... more We evaluated 32 nonmedicated male adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in childhood, 35 male adolescents similarly diagnosed who were receiving methylphenidate (MPH), and 77 control boys. Both ADHD groups completed self-report questionnaires assessing sleep disturbances; weekday and holiday sleep duration; and symptoms of ADHD, anxiety, and depression. Parents and teachers rated the severity of the participants' ADHD. The control group completed self-report questionnaires assessing sleep disturbances. We found that nonmedicated participants and controls did not differ in the severity of sleep disturbance. In contrast, the medicated participants demonstrated a significantly greater severity of sleep disturbance compared with the nonmedicated participants and reported elevated levels of symptoms of ADHD, anxiety, and depression. Specific analyses showed that depressive symptoms contributed significantly to the degree of sleep disturbance when controlling for ADHD diagnosis and MPH treatment. These findings suggest that among adolescents with ADHD symptoms, the severity of symptoms of depression may contribute to the degree of sleep disturbance in addition to the effect of their primary disorder and MPH treatment.
Background: A possible connection between Mark Snyder's concept of selfmonitoring and anorexia ne... more Background: A possible connection between Mark Snyder's concept of selfmonitoring and anorexia nervosa (AN) has not previously been examined. Aims: We hypothesized that AN symptomatology correlates positively with the Other-Directedness aspect of Snyder's self-monitoring construct and negatively with its Extraversion aspect. Method: 194 women with a history of AN were classifi ed as currently ill (n = 17), partially recovered (n = 106) and recovered (n = 71). These women and 100 female controls with no history of an eating disorder completed Snyder's Self-Monitoring Scale (SMS) and the Eating Attitudes Test-26 (EAT-26). 'Other-Directedness' and 'Acting and Extraversion' subscales were derived from an exploratory factor analysis of the Hebrew version of the SMS. Mean total and subscale scores were compared across groups, and correlations were calculated between EAT-26 scores and SMS total and subscale scores. Results: Both subscales of the SMS correlated signifi cantly with total scores but not with one another. As expected, AN symptomatology and EAT-26 scores were associated positively with Other-Directedness yet negatively with Acting and Extraversion, rendering the correlation with total SMS scores insignifi cant. Conclusion: Different aspects of Snyder's self-monitoring construct correlate in opposite directions with eating pathology and AN symptomatology. AN appears to be associated with high Other-Directedness but low Acting and Extroversion.
This paper introduces the Boundary-Control Model. The model provides an account of the emergence,... more This paper introduces the Boundary-Control Model. The model provides an account of the emergence, maintenance, and treatment of anorexia nervosa, with particular emphasis on the role of boundaries and control. The model delineates four basic emotional needs, which shape the adolescent's sense of self-worth. It assumes that when those needs are damaged, anxiety is induced and anorexia emerges as a
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 2007
The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candida... more The dopamine D4 receptor (DRD4), a well-characterized, polymorphic gene, is an attractive candidate for contributing risk to disordered eating and anorexia nervosa (AN). We tested association using UNPHASED for 5 DRD4 polymorphic loci, 3 promoter region SNPs (C-521T, C-616G, A-809G), the 120 bp promoter region tandem duplication and the exon III repeat, in 202 AN trios and 418 control families. Since perfectionism characterizes AN, we tested these five loci for association with the Child and Adolescent Perfectionism Scale (CAPS) in the AN and control groups. Single locus analysis showed significant association between the 'C' C-521T allele and AN. Haplotype analysis also showed significant association, particularly a 4-locus haplotype (exon III&120 bp repeat&C-521T&A-809G). Association was also observed between DRD4 and CAPS scores both for AN and control subjects. The insulin-like growth factor 2 (IGF2) and the arginine vasopressin 1a receptor (AVPR1a), previously shown to be associated with disordered eating, were also associated with CAPS scores. Three genes associated with AN were also associated with perfectionism. Personality traits are potential endophenotypes for understanding the etiology of eating disorders and one of the several pathways to eating pathology may be mediated by the impact of DNA sequences on perfectionism.
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