_________________________________________________________________ VOLUME 6, ISSUE 1 PSYCHNEWS INTERNATIONAL May 2001 _________________________________________________________________ SECTION H: SPECIAL RESOURCE ARTICLE MILLENIAL LITERATURE ON ADOLESCENTS AND EATING DISORDERS: AN ANNOTATED BIBLIOGRAPHY Christy Valentine This annotated bibliography was developed for professionals, students, and the general public in an effort to ascertain the prevalence and impact of eating disorders in adolescents. Items researched for this bibliography were cited in electronic article and book indexes (i.e. Silver Platter/PsycLit; InfoTrac/Expanded Academic; FirstSearch Basic/Periodical Abstracts, ArticleFirst, Wilson Select, and BooksInPrint; and FirstSearch Premium/ HumanitiesAbs, SocialSciAbs, WilsonSelectPlus, and WorldCat). Inclusion was based on currency, new focuses, and new findings of eating disorders and adolescents in both scholarly and general works. A list of Internet resources accompanies the annotated bibliography. In addition to the items included in this bibliography, it is worth nothing several journals devoted to the research of eating disorders alone (i.e. Eating Disorders Journal of Treatment and Prevention, European Eating Disorders Review: The Journal of the Eating Disorders Association, and International Journal of Eating Disorders). There are also several nursing textbooks with in-depth coverage of diagnosis and treatment for disordered eating. A true gem published in the year two thousand is a book series entitled A Teen Eating Disorder Prevention Book. Written to adolescents, this series comprehensively covers prevention, detection, related factors, and treatment of eating disorders. What makes this series so valuable is the additional information and resources listed in the back of each book, allowing a teenager to seek help anonymously. It has been documented that anorexia nervosa has the highest mortality rate of all psychiatric illnesses. Most bulimics, who use self-induced vomiting to purge, only rid their body of one third the calories they take in during a high caloric binge, resulting in little weight loss if any at all. Traditional beliefs about eating disorders have been disproved by current longitudinal and cross-cultural studies. Eating disorders are not confined to western, middle-class, white-females but cross cultures, social economic status, and gender. In conclusion, it has been found that eating disorders are more complex than originally believed. Due to the frequent incidences of these disorders, there is a strong need to continue the study of eating disorders, particularly long-term physical effects, cross-culture differences, and the impact of prevention programs. A conscious effort to develop intervention strategies to stop eating disorders before they start, needs to be the responsibility of society as a whole. ********** American Psychiatric Association. (2000). Diagnostic criteria from DSM-IV-TR. Washington, DC: Author. The American Psychiatric Association provides diagnostic criteria for anorexia and bulimia nervosa (with their various sub types), and eating disorder not otherwise specified (including binge eating disorder). The outlined criteria is used to determine prognosis and treatment by medical personnel as well as psychologists and counselors. Antisdel, J.E., & Chrisler, J.C. (2000). Comparison of eating attitudes and behaviors among adolescent and young women with type 1 diabetes mellitus and phenylketonuria. Journal of Developmental Behavioral Pediatrics, 21, 81-86. In determining the effect of chronic diseases on eating attitudes and behavior, 84 women (ranging in age from 11-34) diagnosed with type 1 diabetes mellitus or phenylketonuria (PKU) were surveyed. Seven questionnaires were administered and analyzed. Results imply no difference between diseases in relation to the development of eating disorder symptoms, but there was a significant difference between diseases in eating patterns and behavior. Overall, chronic diseases may influence the pathology of eating disorders. Carruth, B. & Skinner, J. (2000). Bone mineral status in adolescent girls: Effects of eating disorders and exercise. Journal of Adolescent Health: Official Publication of the Society of Adolescent Medicine, 26, 322-329. Carruth and Skinner hypothesized measures for bone mineral density, energy levels, and body mass index would be significantly lower in adolescents with a history of an eating disorder. Based on their study of 25 adolescents with a history of an eating disorder and 50 without such a history, it was determined that except for body fat (one measure for BMD) there wasn’t a significant difference between the two groups of adolescents in respect to BMD, energy, and BMI. Therefore, teenage girls who have fully recovered from an eating disorder are capable of attaining normal bone mass and body composition. Daigneault, S. D. (2000). Body talk: A school-based group intervention for working with disordered eating behaviors. Journal for Specialists in Group Work, 25, 191-213. Half of today’s teenagers believe they are overweight and diet without information on healthy weight and nutrition. Onset of eating disorders is occurring among younger youth than previously recorded. One high school has taken the initiative in developing a new intervention and counseling technique. By combining a narrative and feminist approach, Body Talk was created to recognize teens at risk, provide guidelines, develop personal agency and empower self. Structure and content of sessions are broken down and thoroughly explained. In the future, research will need to be conducted to determine the effectiveness of Body Talk. Dalzell, H.J. (2000). Whispers: The role of family secrets in eating disorders. Eating Disorders: The Journal of Treatment and Prevention, 8, 43-61. A review of literature on family secrets and their influence on familial communication and relationships is introduced. Both positive and negative components of secrets are provided. Families of anorexics and bulimics are compared and contrasted to determine the rationale of family secrets and their influence on the development of eating disorders. Counseling entails airing out secrets in order to establish healthy communication among family members needed to combat eating disorders. Dare, C., & Eisler, I. (2000). A multi-family group day treatment programme for adolescent eating disorder. European Eating Disorders Review, 8, 4-18. Dare and Eisler introduce a new treatment for teens suffering from eating disorders. They address the shortcomings of traditional family therapy, particularly the incidence of relapse upon therapy conclusion. An alternative therapy that integrates typical day treatment and family therapy is presented. Context and structure of a multi-family group day treatment is laid out for the reader. Currently, there is not enough data to draw any strong conclusions on the effectiveness of this new therapy, but it has been noted that patients have experienced improved symptom management, decreased family tension, and positive group exchange. Emans, S.J. (2000). Eating disorders in adolescent girls. Pediatrics International: Official Journal of the Japan Pediatric Society, 42, 1-7. It is difficult to measure the true incidence rate of eating disorders due to denial and secrecy associated with these conditions. They are multifactoral disorders characterized by psychological (comorbidity), biological (neurotransmission, low leptin levels), environmental (family and peer pressure), genetic (twin studies, disorder history), and social (media and the "ideal" image) components. Health concerns, related to eating disorders, range from dental erosion to sudden death. Comprehensive prevention programs that address the factors or components of eating disorders help to ensure partial and full recovery. Gullotta, T.P., Adams, G.R., & Markstrom, C.A. (2000). The adolescent experience (4th ed.). San Diego, CA: Academic Press. In the adolescent world, looks determine social status. Good looks are defined socially through the media as thin. The ideal is thinness but reality includes genetic and environmental factors that determine the normal weight of an individual. Losing weight to fit the ideal and gain social status can all to often become an obsession among teenagers. Five theories of eating disorders defined in this book include psychoanalytic, behavioral, family perspective, sociological, and genetic. Along with these theories, prevention and treatment programs are outlined. It is believed that increasing society’s knowledge on eating disorders will lead to a change in societal attitudes and behavior. Harrison, K. (2000). The body electric: thin-ideal media and eating disorders in adolescents. Journal of Communication, 50, 119-143. The purpose of this study was to determine the overall relationship between thin-ideal media exposure and eating disorders among adolescence. Three hundred sixty six teens (male and female from grades 6-12) were given a self-report survey of television viewing, magazine exposure, and body assessment. It was found that overall exposure to the thin-ideal via media predicted eating-disorder symptoms for older females and body dissatisfaction among younger males. It can be inferred that the media plays a strong role in perpetuating the thin-ideal notion among adolescents. Heinze, V., Wertheim, E.H., & Kashima, Y. (2000). An evaluation of the importance of message source and age of recipient in a primary prevention program for eating disorders. Eating Disorders: The Journal of Treatment and Prevention, 8, 131-145. Current prevention programs often increase adolescent knowledge of eating disorders but has little if any impact on negative eating attitudes and behavior. In looking at the influence of four different presenters on 191 girls from the 7th and 10th grade, a pre and post questionnaire was used to measure eating disorder knowledge, nutrition, eating attitudes, and intentional behavior. The results indicate that primary prevention was more effective on the younger students based on the four variables measured, but the identity of the presenter had no impact. Huon, G. (2000). The gender and ses context of weight-loss dieting among adolescent females. Eating Disorders: The Journal of Treatment and Prevention, 8, 147-155. This study was performed to determine contextual differences among female teenagers of various dieting levels. In an effort to locate adolescents at high-risk for eating disorders, 311 girls representing four social groups (upper-middle class of single sex schools, upper-middle class of coed schools, working-middle class of single sex schools, and working-middle of coed schools) were studied. Results implied that more "serious" dieters existed among females in the working-middle class of coed schools group. These findings can be used to target preventive measures to those most at risk. Irving, L.M., & Cannon, R. (2000). Starving for hope: Goals, agency, and pathways in the development and treatment of eating disorder. In C.R. Snyder (Ed.), Handbook of hope: Theory, measures, and applications (pp. 261-283). San Diego, CA: Academic Press. Irving and Cannon provide a thorough description of various eating disorders and their subtypes. A treatment is devised by combining cognitive behavior therapy (positive reinforcement techniques targeting distorted thoughts about food, eating, weight, and body shape) and feminist therapy (identifies factors that perpetuate eating disorders) into hope therapy. Hope therapy uses goals, agency, and pathways to develop and maintain treatment for and recovery of eating disorders. Karwautz, A., & Treasure, J. (2000). Eating disorders. In P. Aggleton, J. Hurry, & I. Warwick (Eds.), Young people and mental health (pp.73-90). Chichester, England: John Wiley & Sons, LTD. This chapter provides distinctive definitions for anorexia, bulimia, and binge eating, as well as alarming statistics associated with each eating disorder. Compounding factors, early childhood characteristics, and comorbidity associated with each disorder are discussed in an effort to determine teens at risk for an eating disorder. Intervention tactics ranging from self-help books and techniques to inpatient care are broken down based on the intensity of the eating disorder. It is suggested that prevention programs should address risk factors related to specific disorders more thoroughly to achieve a higher success rate. Katzman, D.K., Golden, N.H., Neumark-Sztainer, D., Yager, J., & Strober, M. (2000). From prevention to prognosis: Clinical research update on adolescent eating disorders. Pediatric Research, 47, 709-712. Based on the biopsychosocial model, professionals in the field of psychology report on the characteristics, prevention models, and intervening possibilities of eating disorders. Characteristics, or factors of disordered eating, covered in this article include genetics, brain structure, and the possible role of leptin influencing eating behavior. Widespread prevention at an individual, school, community, and societal level is highly emphasized. The potential of full recovery as a result of intervention concludes this report. Kendall, P.C. (2000). Childhood disorders. Hove, East Sussex, UK: Psychology Press. Eating disorders are described as an abnormal desire to be thin. The emotional, behavioral, and physical components of anorexia nervosa and bulimia nervosa are explained in the text. In an effort to understand anorexia and bulimia, a diathesis-stress model is applied. A multifaceted treatment that focuses on family, behavior, and cognitive factors is prescribed. Lask, B., & Bryant-Waugh, R. (2000). Anorexia nervosa and related eating disorders in childhood and adolescence (2nd ed.). Hove, East Sussex, UK: Psychology Press. Various eating disorders of adolescents are studied in depth. Key characteristics that distinguish this book from any other include thorough explanations of epidemiology, aetiology, and clinical therapy techniques. A complete description of physical assessment and complications of eating disorders are also provided. Miller, K.J., & Mizes J.S. (Eds.). (2000). Comparative treatments for eating disorders. New York, NY: Springer Publishing Company, Incorporated. Miller and Mize provide an in-depth comparison of treatments developed from various psychological perspectives. Clinicians were asked to describe their diagnosis and therapy for a given case study. Professionals representing numerous fields of psychology defined their assessment, conceptualization, therapy, client-patient relationship, treatment implementation, and expected outcome. It was concluded an integrative approach that understood a client’s interpersonal relationships, core beliefs about self and other, and cognitive processes could be implemented to increase client’s motivation to overcome a given eating disorder. Mitchell, K., & Carr, A. (2000). Anorexia and bulimia. In A. Carr (Ed.), What works for children and adolescents? A critical review of psychological interventions with children (pp. 233-257). London: Routledge. Provided in this chapter, are definitions and diagnostic criteria for eating disorders based on the DSM IV and ICD 10. Key physical deterioration linked to anorexia nervosa and bulimia nervosa are examined. Yet the main aspect of the chapter is to relate key findings of a study performed to rank the success rate of various treatments. Intervention programs that are included in this research are family therapy, individual psychotherapy, family and individual therapy combined, cognitive behavioral therapy, multimodal inpatient treatment, and concurrent group therapy. The pros and cons of each treatment are laid out in a clear format, including tables, for the reader’s interpretation. Mizes, J.S., & Miller, K.J. (2000). Eating disorders. In M. Hersen & R.T. Ammerman (Eds.), Advanced Abnormal Child Psychology (2nd ed., pp. 441-465). Mahwah, NJ: Lawrence Erlbaum Associates. In the Western World there is an unrealistic weight ideal that young women strive to meet. Women feel emotional, depressed, ineffective, and body distress as they repeatedly fail to meet this ideal. Eating disorders become a coping tool for their immense psychological stress. Mizes and Miller examine the onset, treatment, lapses, and recovery of those who suffer from anorexia nervosa, bulimia nervosa, and binge eating disorder. Social, psychological, and biological factors at each stage are provided as a guide for disorder prediction and progression. Moreno, J.K., Selby, M.J., Aved, K., & Besse, C. (2000). Differences in family dynamics among anorexic, bulimic, obese and normal women. Journal of Psychotherapy in Independent Practice, 1, 75-87. Past research indicates a significant relationship between poor family communication and eating disorders. Two studies were performed in an effort to eliminate interfering methodological procedures and determine true family dynamics of anorexic, bulimic, obese, and normal women. The first study used FACES (Family Adaptability and Cohesion Scales) and the second used PACS (Parent-Adolescent Communication Scale) to measure family communication among the various groups of women. Both studies indicated bulimic and obese women reported more family dysfunctional communication than anorexic women, who continually reported normal family cohesion. Researchers provide a thorough explanation for their results and suggest areas for further research. Mussell, M.P., Binford, R.B., & Fulkerson, J.A. (2000). Eating disorders: Summary of risk factors, prevention programming, and prevention research. Counseling Psychologist, 28, 164-196. Studying prevention programs is essential to develop an effective intervention for eating disorders. Current programs have demonstrated the ability to increase adolescents’ knowledge but has little impact, if any, on their attitudes towards eating. By focusing on factors associated with disordered eating (i.e. socioculture, personality, athletics, trauma, family, and physiology), programs can be implemented to address the environment eating disorders thrive within. The ideal prevention program not only increases an adolescent’s knowledge, but also promotes a positive attitude towards food and supports modifying one’s environment to discourage disordered eating. Neumaerker, K. (2000). Mortality rates and causes of death. European Eating Disorders Review, 8, 181-187. Although the origin or cause of an eating disorder is unclear, it is still possible to gather statistics on the mortality rate of eating disorders. It has been well documented that anorexia nervosa carries the highest death rate of all psychiatric illnesses. There are many health complications associated to anorexia and bulimia making it difficult to determine cause of death, but it is believed that complications related to starvation and/or cahexia as well as suicide are the main causes of death. Still a high percentage of unexplained deaths exist among individuals who suffered from an eating disorder. Nicholls, D., & Stanhope, R. (2000). Medical complications of anorexia nervosa in children and young adults. European Eating Disorders Review, 8, 170-180. Bridging the physical and psychological aspects of anorexia nervosa, Nicholls and Stanhope describe the medical complications of this eating disorder. Suggestions for intervention and weight gain are also provided. Medical complications should be considered in the evaluation of adolescents with eating disorders and used as a tool to educate those who are found to be anorexic. O’Dea, J. (2000). School-based interventions to preventing eating problems: First do no harm. Eating Disorders: The Journal of Treatment and Prevention, 8, 123-130. Prevention of eating disorders among adolescents is a key focus of health educators today. This article suggests that traditional information-based programs inadvertently promote poor body image that leads to eating problems and/or eating disorders. It is recommended that a self-esteem approach to improve body image, create healthy eating habits, and introduce regular physical activity will result in a higher success rate of deterring eating disorders without harmful or adverse effects. Pearce, J. (2000). Eating disorders. In P. Aggleton, J. Hurry, & I. Warwick (Eds.), Young people and mental health (pp. 73-90). New York, NY: J. Wiley. Pearce focuses on the demographics of eating disorders and describes compounding factors found in teens at risk. Genetics, early characteristics, comorbidity, and intervention programs are discussed. It is believed that most prevention programs today increase one’s knowledge about eating disorders but is ineffective in changing attitudes towards eating. In this chapter and example of a program that addresses the development of risk factors is offered as an alternative. Pike, K.M., Wolk, S.L., Gluck, M., & Walsh, B.T. (2000). Eating disorders measures. In American Psychiatric Association (Ed.), Handbook of psychiatric measures (pp.647-671). Washington, DC: American Psychiatric Association. Currently there are seven main instruments used to measure eating disorders, eating pathology, behavior, and attitudes in relation to assessment. Six self-report measures include Eating Disorder Inventory, Body Shape Questionnaire, Three Factor Eating Questionnaire, Mizes Anorectic Cognitions Questionnaire, Bulimia Test-Revised, and Questionnaire on Eating and Weight Patterns. The final measure is an interview. A guide to selecting the appropriate measure is provided along with a full description, practical issues in interpretation, psychometric properties, clinical use, and suggested readings related to each measure. Rossier, V., Bolognini, M., Plancherel, B., & Halfon, O. (2000). Sensation seeking: A personality trait characteristic of adolescent girls and young women with eating disorders? European Eating Disorders Review, 8, 245-252. This study was performed to determine the relationship between sensation seeking and eating disorder in all its forms. Believing that binge eaters would have high sensation seeking and restrictive anorexics would have low sensation seeking, researchers interviewed 141 subjects and analyzed their self-report sessions. No significant difference was found between the various forms of binge eaters but there was a significant difference in sensation seeking between the bulimic, anorexic, and control group. Bulimics scored unusually high on Thrill and Adventure Seeking while anorexics scored particularly low on Experience seeking. The implications of these results include criteria for diagnosis, psychological trait for aetiology and new techniques for therapy. Schebendach, J., & Reichert-Anderson, P. (2000). Nutrition in eating disorders. In L.K. Mahan, & S. Escott-Stump (Eds.), Krause’s food, nutrition, & diet therapy (pp. 516-533). Philadelphia, PA: W.B. Saunders. Traditional topics, such as history, diagnostic criteria, epidemiology, and cormorbidity are defined. Yet, the main focus is the pathophysiological aspect of eating disorders. Before treating the emotional and mental symptoms of eating disorders, the physical component must be addressed. A nutritional assessment based on diet history, eating behavior, and lab work is needed. Nutrition management can be achieved through behavior modification but will not be maintained unless an individual is educated about healthy nutrition. A successful outcome of an eating disorder is based on improvements in weight and diet habits, menstruation, as well as in sexual, psychological, and social attitudes. Sobanski, E., & Schmidt, M.H. (2000). Body dysmorphic disorder: A review of current knowledge. Child Psychology and Psychiatry Review, 5, 17-24. Body dysmorphic disorder and eating disorders are related in that they are characterized by a distorted body image. The difference lies in that eating disorders distort the whole body where body dysmorphic disorder distorts a single aspect of the body. It is possible that eating disorders proceed BDD as a solution or treatment to improve one's appearance. Steinhausen, H.C., Boyadjieva, S., Grigoroiu-Serbanescu, M., Seidel, R., & Winkler-Metzke, C. (2000). A transcultural outcome study of adolescent eating disorders. Acta Psychiatrica Scandinavica, 101, 60-66. Studying eating disorders across three cultures to compare and contrast amount of treatment, disorder outcome and psychosocial functioning, and predictability of clinical variables was the purpose of this study. Based on the eating disorder criteria of the ICD-10, 156 patients from Berlin, Sofia, and Burcharest were interviewed in a 5-year follow up study. As a result, it was found that eating disorders are similar across cultures but psychosocial functioning differed according to cultural background. Most patients spent a great deal of time in treatment with a 68% recovery rate. The younger the patient is at onset, the better the prognosis. Unfortunately, clinical features had a low predictable value meaning that the prognosis of a patient is individualistic and problematic. Striegel-Moore, R.H., & Smolak, L. (2000). The influence of ethnicity on eating disorders in women. In R.M. Eisler, M. Hersen (Eds.), Handbook of gender, culture, and health (pp. 227-253). Mahwah, NJ: Lawrence Erlbaum Associates. The chapter focuses on a correlation between ethnicity and eating disorders. Generalities of eating disorders are based on studies of white middle class young women. Currently there is little research to draw conclusions about ethnic impact on eating disorders, not to mention levels of impact between various ethnic groups. It has been documented that minorities experience greater stressful life conditions due to discrimination, identification, and acculturation. What is not known is whether or not such conditions are associated with eating disorders among minorities. Teaching students with mental health disorders: Resources for teachers. (2000). [Victoria]: British Columbia, Ministry of Education, Special Programs Branch. The goal of this book is to promote an understanding of eating disorders among teachers. Information about students and disorders can be used to identify students at risk and develop support strategies. The book is divided into five sections that define eating disorders, suggest identification and referral tactics, provide teaching techniques for the topic of eating disorders, present intervention strategies, and offers a lengthy list of resources for additional information. Thomsen, P.H. (2000). Obsessions: The impact and treatment of obsessive-compulsive disorder in children and adolescents. Journal of Psychopharmacology, 14, s31-s37. Obsessive-compulsive disorder can be broken down into two characteristics, obsession and compulsion. The obsession is explained as distressful reoccurring thoughts and/or mental images. Compulsions are repetative and somewhat ritualistic behavior. Two percent of the population meets the criteria for obsessive-compulsive disorder and of that 2%, females are at a high risk for developing comorbid eating disorders. Tomori, M., & Rus-Makovec, M. (2000). Eating behavior, and self-esteem in high school students. Journal of Adolescent Health, 26, 361-367. In studying the eating habits of the general high school population and diagnosed high school population, researchers reported significant findings. Four thousand seven hundred teens completed a self-report questionnaire that categorized them as satisfied or dissatisfied with their current weight. Next they completed Zung’s Self-rating Depression Scale and Rosenberg’s Self-Esteem Scale. Data Analysis suggests that teens that are dissatisfied with their weight are more likely to demonstrate pathological eating habits. The frequency of dysfunctional families, low self-esteem, depression, suicidal thoughts, and drug use are also more common among adolescents dissatisfied with their weight. Whether weight dissatisfaction leads to poor mental and physical health or vice versa is debatable. Turner, J., Batik, M., Palmer, L.J., Forbes, D., & McDermott, B.M. (2000). Detection and importance of laxative use in adolescents with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 378-385. Abusing laxatives is one form of purging found among bulimics resulting in severe physical complications due to electrolyte imbalances. This study focuses on the relationship of laxative use among anorexics and psychopathology, physical condition, and role of urinary screening in assessment. Forty-three patients suffering from anorexia nervosa were assessed via interviews, self report questionnaires, physical exams, and urinary screenings. It was found that laxative use (1) was associated with longer duration and severity of disorder, (2) resulted in medical complications, and (3) determined largely by urinary screening in contradiction to self-report. Tyrka, A.R., Graber, J.A., & Brooks-Gunn, J. (2000). The development of disordered eating: Correlates and predictors of eating problems in the context of adolescence. In A.J. Sameroff, M. Lewis, & S.M. Miller (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 607-624). New York, NY: Kluwer Academic/Plenum Publishers. When the predisposing factors associated with eating disorders are plotted on a continuum or course of an eating disorder, it is found that severity corresponds with disordered eating. Adolescence is a critical period of rapid physical, social, and psychological change. An individual’s inability to cope with the changes associated with puberty can be represented on a continuum that measures eating patterns. Interpreting the continuum is useful in defining the subtypes of disordered eating and predicting full-scaled eating disorders. Vincent M.A., & McCabe, M.P. (2000). Gender differences among adolescents in family, and peer influences on body dissatisfaction, weight loss, and binge eating behaviors. Journal of Youth and Adolescence, 29, 205-221. Studying the influence of family and peers on adolescent body dissatisfaction, weight loss, and binge eating behavior, researchers surveyed 306 teens. Survey analysis was performed to determine whether the nature of interaction or quality of relationship could predict an eating disorder. In boys it was found that encouragement to lose weight from parents and friends was a leading variable to developing an eating disorder. Among girls, discussion about weight loss with parents and peers was a strong variable. Therefore the nature of interaction is a stronger variable than quality of relationship in teens developing an eating disorder. Wassenaar, D., le Grange, D., Winship, J., & Lachenicht, L. (2000). The prevalence of eating disorder pathology in a cross-ethnic population of females students in South Africa. European Eating Disorders Review, 8, 225-236. A small percentage of teens are used in this study of ethnicity and social economic status in relation to eating disorder pathology and body mass index. Marked differences were found among various ethnic groups from various economic classes. These findings contradict the widely accepted theory of eating disorders being a Western societal illness. Weeramanthri, T., & Keaney, F. (2000). What do inner city general practitioners want from a child and adolescent mental health service? Psychiatric Bulletin, 24, 258-160. It is estimated one in five children suffer from a psychological disorder, yet only a small percentage see a mental health specialist. Since most disorders carry a physical component, general practitioners are sought out first for treatment and have an opportunity to diagnose disorders. Most practitioners though have little or no training in children and adolescent mental health. An interview of 25 general practitioners revealed that few referrals were made to mental health centers and training in diagnosing child abuse and eating disorders was desirable as well as quick access to centers. Suggestions for improving communication between primary and secondary care are included in this research. Wright, K. (2000). The secret and all-consuming obsessions: Eating disorders. In D. Capuzzi, & D.R. Gross (Eds.), Youth risk: A prevention resource for counselors, teachers, and parents (3rd ed., pp. 197-242). Alexandria, VA: American Counseling Association. Historically, society has influenced the body image of the ideal women from voluptuous to emaciated. Today the media defines feminine self-worth based on thinness and attractiveness. A longitudinal study of Playboy and Miss America has concluded that models and contestants are decreasing in weight and size while increasing in height. The goal of this article is to explore the occurrence of eating disorders among diverse populations of ethnicity, gender, sexuality, and athletics. Net Resources: Academy for Eating Disorders http://www.acadeatdis.org American Anorexia Bulimia Association, Inc. http://www.aabainc.org American Psychiatric Association http://www.psych.org Eating Disorders Association http://www.edauk.com Eating Disorders Association (QLD) Resource Center http://www.uq.net.au/eda/documents/about.html Eating Disorders Awareness and Prevention http://www.edap.org Internet Mental Health http://www.mentalhealth.com Medem - Healthcare Information from National Medical Societies http://medem.com Mind (National Association for Mental Health) http://www.min.org.uk National Institute of Mental Health http://www.nimh.nig.gov - - - Christy Valentine currently works as a reference librarian in the Science Library at the University of Wyoming in Laramie, Wyoming. Her main interests lie in accessing information pertinent to the study of human nature. Christy is affiliated with the American Library Association, Association of College and Research Library, Mountain Plains Library Association, and Wyoming Library Association. In the future, Christy intents to continue a study of information resources related to adolescent development. _________________________________________________________________