Findings: Although several individual psychotherapies for adults with eating disorders are empirically supported, with family-based treatment (FBT) being the leading recommended empiric treatment in adolescents, patients with eating disorders are still difficult to treat, and outcomes are often poor. In some countries, the clinical services for adolescents and adults are separate, and it is common for patients to receive treatments that differ in terms of both theory and content when they are switched from adolescent to adult services. Changes in the nature of treatment also often occur when patients move from less intensive types of care to more intensive treatment, and vice versa. These transitions may create a discontinuity in the care pathway and disorient patients and their significant others about the strategies and procedures used for addressing eating problems. However, the observation that younger and older patients essentially share the same eating-disorder psychopathology has led to evidencebased enhanced cognitiveebehavioral therapy (CBT-E) being adapted for use in adolescents. Originally an evidence-based treatment for adults with eating disorders, CBT-E has yielded promising results in trials in cohorts of adolescent outpatients and inpatients, and is recommended as an alternative to FBT in adolescent patients.Implications: With a unified treatment such as CBT-E, several issues that plague conventional eating-disorder services could be partially overcome, as patients can move seamlessly from adolescence to adulthood and through different levels of care, with no change in the nature of the treatment itself. Future randomized, controlled trials should compare FBT to CBT-E to better clarify the specific therapeutic needs of subgroups of adolescents and adult patients with eating disorders.

This systematic review analysed published data on the effectiveness of enhanced cognitive behaviour therapy (CBT-E) for adolescents with eating disorders. Of the 28 papers retrieved, eight (6 case series, 1 prospective cohort study, and 1 non-randomized effectiveness trial) met the inclusion criteria and revealed the following five findings. First, outpatient CBT-E is well accepted by adolescent patients with anorexia nervosa; it is completed by about two-thirds of participants, and produces improvements in eating-disorder and general psychopathology. Remission from anorexia nervosa is achieved by about 50% of patients at 12-month follow-up. Second, outpatient CBT-E seems more effective for adolescents than adults. Third, inpatient CBT-E for adolescents with anorexia nervosa seems particularly effective — about 80% of patients achieve normal weight by 12-month follow-up. Fourth, CBT-E also seems promising for adolescents who are not underweight. Fifth, CBT-E appears to yield similar outcomes to FBT in terms of weight regain and eating-disorder and general psychopathology improvements at 6- and 12-month follow-up. The fourth and fifth findings derive from a single study and require confirmation. In conclusion, CBT-E is a viable and promising treatment for adolescents with eating disorders.

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Introduzione. I sintomi da malnutrizione presenti nelle persone con anoressia nervosa determinano profonde modificazioni della personalità e contribuiscono a mantenere la psicopatologia del disturbo dell'alimentazione. Scopo di questo studio è descrivere il processo di costruzione e validazione della versione italiana dello Starvation Symptom Inventory (SSI).Metodi. Sono stati reclutati 150 pazienti di sesso femminile con anoressia nervosa, 30 pazienti con disturbo dell'alimentazione non sottopeso, 15 pazienti con disturbo bipolare in fase depressiva e 341 controlli sani. I pazienti con anoressia nervosa hanno completato l'Eating Disorder Examination Questionnaire e il Brief Symptoms Inventory, mentre tutti i partecipanti hanno valutato i loro sintomi da malnutrizione in una scala Likert (0-6) riportando il numero di giorni in cui hanno sperimentato tali sintomi negli ultimi 28 giorni.Risultati. L'analisi fattoriale dello SSI sul campione di pazienti con anoressia nervosa ha individuato un singolo fattore che spiega circa la metà della varianza. Il questionario ha dimostrato una buona consistenza interna (a = 0,91) e affidabilità test-retest (r = 0,90). Il punteggio globale dello SSI è risultato significativamente correlato con la psicopatologia dei disturbi dell'alimentazione e la psicopatologia generale, dimostrando una buona validità convergente. I punteggi dello SSI sono risultati significativamente più elevati nei pazienti affetti da anoressia nervosa rispetto ai controlli sani, ai pazienti non sottopeso con disturbi dell'alimentazione e ai pazienti con disturbo bipolare in fase depressiva. Conclusioni.La versione italiana dello SSI è promettente per valutare i sintomi da malnutrizione e le loro modificazioni durante il recupero ponderale nei pazienti con anoressia nervosa e può essere facilmente integrata nella pratica clinica.

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