Leora PInhas - Academia.edu (original) (raw)

Papers by Leora PInhas

International Journal of Eating Disorders, 2007

: The purpose of this article is to summarize major conceptual and clinical variables related to ... more : 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.

Journal of Adolescent Health, 1996

Trichotillomania, a syndrome described by the French dermatologist Hallopeau (1), is characterize... more Trichotillomania, a syndrome described by the French dermatologist Hallopeau (1), is characterized by recurrent hair pulling that results in noticeable hair loss. Trichotillomania has been associated with a number of psychiatric disorders (2-6). Of particular significance, approximately 20% of patients with trichotillomania suffer from an eating disorder, most commonly bulimia nervosa (7,8). To date, there have been no reported cases of adolescents with both anorexia nervosa (AN) and trichotillomania. We describe a female adolescent diagnosed with AN and trichotillomania, review the literature, and discuss diagnostic and therapeutic issues.

Eating Disorders, 2003

In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in... more In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in Newmarket Ontario, Canada created the Eating Disorders Program, which included a day treatment program for adolescents with eating disorders. When first conceived, this day treatment program was the first of its kind in Ontario. The multi-disciplinary team created a feminist-informed model centered on developing joint decision making relationships among team, client, and family through sustained and transparent communication and negotiation. This model for decision making has evolved through careful deliberation and ethical reflection in the planning and provision of care.

The previous issue of the Journal of Recovery in Mental Health focused on recovery around the wor... more The previous issue of the Journal of Recovery in Mental Health focused on recovery around the world. It highlighted the various global initiatives designed to inform recovery-oriented practice and system transformation. Our current themed issue is also associated with mental health service transformation and focuses on recovery through the lifespan. This theme is aligned with The Mental Health Commission of Canada's Guidelines of Recovery-Oriented Practice that outlines important core principles related to recovery at different points of an individual's life, experience and development. Upon reading the articles contained in this issue, it is apparent that while recovery is important throughout all stages of life, there are many distinct considerations that impact recovery for different groups of service users. For example, adolescents are at an earlier developmental stage than adults and are in the process of developing their identity and gaining independence rather than re-establishing theses recovery facets. In their article, Pinhas et al. have outlined the fine balance between ensuring adolescent service users are heard as participating members of their treatment collaborative yet at the same time, ensuring that teens are safe and take away learning and development from challenges and setbacks. As Goldstein et al. outline in their article, transitional aged youth face similar changes regarding independence, such as leaving the parental home and potentially shifting their occupational role from student to young professional.

European Eating Disorders Review, 2010

Childhood and adolescence are critical periods of neural development and physical growth. The mal... more 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.

Incidence/prevalence The term ‘eating disorder’, according to version IV of the Diagnostic and St... more Incidence/prevalence The term ‘eating disorder’, according to version IV of the Diagnostic and Statistical Manual (DSM-IV), includes anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (patients fulfilling some, but not all, of the diagnostic criteria for either anorexia nervosa or bulimia nervosa). While the issue of the most appropriate diagnostic criteria for eating disorders in children has been a matter of great debate, epidemiological studies suggest that the prevalence of anorexia nervosa (using DSM-IV criteria) in adolescents has been increasing over the last 50 years and document that it is now the third most common chronic illness affecting adolescent females. In fact, the age of onset of anorexia nervosa may be becoming even younger although very little incidence data is available for younger children with eating disorders (<13 years) and the few estimates that are available vary considerably. One retrospective population-based incidence stud...

OBJECTIVE To explore and describe philosophies and characteristics of intensive eating disorder (... more OBJECTIVE To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatment programs based in tertiary care institutions across Canada. METHOD A ninety-item survey examining ED services for adolescents was developed, piloted, and completed by 11 programs across Canada. Information pertaining to program characteristics and components, governance, staffing, referrals, assessments, therapeutic modalities in place, nutritional practices, and treatment protocols were collected. RESULTS The results highlight the diversity of programming available but also the lack of a unified approach to intensive eating disorder treatment in youth. CONCLUSIONS This report provides important baseline data that offers a framework that programs can use to come together to establish assessment and treatment protocols as well as a process for outcome evaluation. Continued collaboration will be essential moving forward to ensure Canadian youth, regardless of geographic locat...

OBJECTIVE Preliminary research suggests that multiple family therapy (MFT) may be an effective in... more OBJECTIVE Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention for adolescent anorexia nervosa (AN). This study compared the extent of weight restoration for patients enrolled in one year of MFT compared to a matched control group receiving treatment as usual (TAU). METHOD A retrospective chart review was performed using data from 25 MFT cases matched to 25 controls on age, diagnosis and year of entry to the eating disorder program. RESULTS Both cases and controls experienced significant weight restoration, however patients enrolled in MFT were restored to a higher mean percent ideal body weight than the TAU group (99.6% (±7.27%) vs. 95.4 (±6.88); p<0.05). CONCLUSIONS MFT may be more effective than TAU in restoring weight in adolescents with AN.

This work is licensed under a Creative Commons Attribution 4.0 International License.

Eating Disorders, 2003

In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in... more In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in Newmarket Ontario, Canada created the Eating Disorders Program, which included a day treatment program for adolescents with eating disorders. When first conceived, this day treatment program was the first of its kind in Ontario. The multi-disciplinary team created a feminist-informed model centered on developing joint decision making relationships among team, client, and family through sustained and transparent communication and negotiation. This model for decision making has evolved through careful deliberation and ethical reflection in the planning and provision of care.

European Eating Disorders Review

The International journal of eating disorders, Jun 20, 2017

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eat... more This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged ≤ 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, ...

Http Dx Doi Org 10 1080 10640266 2013 761082, Feb 19, 2013

Healthy eating and weight initiatives have been incorporated into many schools to combat the grow... more Healthy eating and weight initiatives have been incorporated into many schools to combat the growing obesity problem. There is little research, however, on the effectiveness of these programs or any inadvertent harmful effects on children's mental health. Our aims were to report on how school-based healthy weights initiatives can trigger the adoption of unhealthy behaviours for some children. This is a case series of four children seen at specialized eating disorder clinics. Each child attributed eating pattern changes to information garnered from school-based healthy eating curricula. Unanticipated consequences of these initiatives are described and alternative approaches are discussed.

Oxford Handbooks Online, 2011

Eating Disorders in Children and Adolescents, 2001

11 Bingeing and bulimia nervosa in children and adolescents Leora Pinhas, Debra K. Katzman, Gina ... more 11 Bingeing and bulimia nervosa in children and adolescents Leora Pinhas, Debra K. Katzman, Gina Dimitropoulos and D. Blake Woodside Toronto General Research Institute, Toronto, ON, Canada Introduction The identification of children and adolescents with ...

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2014

Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention... more Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention for adolescent anorexia nervosa (AN). This study compared the extent of weight restoration for patients enrolled in one year of MFT compared to a matched control group receiving treatment as usual (TAU). A retrospective chart review was performed using data from 25 MFT cases matched to 25 controls on age, diagnosis and year of entry to the eating disorder program. Both cases and controls experienced significant weight restoration, however patients enrolled in MFT were restored to a higher mean percent ideal body weight than the TAU group (99.6% (±7.27%) vs. 95.4 (±6.88); p<0.05). MFT may be more effective than TAU in restoring weight in adolescents with AN.

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2013

To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatm... more To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatment programs based in tertiary care institutions across Canada. A ninety-item survey examining ED services for adolescents was developed, piloted, and completed by 11 programs across Canada. Information pertaining to program characteristics and components, governance, staffing, referrals, assessments, therapeutic modalities in place, nutritional practices, and treatment protocols were collected. The results highlight the diversity of programming available but also the lack of a unified approach to intensive eating disorder treatment in youth. This report provides important baseline data that offers a framework that programs can use to come together to establish assessment and treatment protocols as well as a process for outcome evaluation. Continued collaboration will be essential moving forward to ensure Canadian youth, regardless of geographic location, receive the necessary treatment ...

The International journal of eating disorders, 2006

The purpose of this article is to describe the content of pro-anorexia websites, both qualitative... more The purpose of this article is to describe the content of pro-anorexia websites, both qualitatively and quantitatively. An Internet search protocol was developed to identify pro-anorexia websites. A grounded theory approach was used to generate themes from Internet-based information. Basic descriptive analysis was employed to report on key website characteristics. Twenty pro-anorexia websites met inclusion criteria. Saturation of themes was achieved after review of 12 websites. Key website characteristics included purpose of website (75%), information about webmaster (67%), website disclaimers (58%), and information on "tips and tricks" (67%). Religious metaphors, lifestyle descriptions, and "thinspiration" (inspirational photo galleries and quotes that aim to serve as motivators for weight loss) were frequently present. A total of 10 themes were generated. The most prevalent themes included control, success, and perfection. Health-care providers and caregivers s...

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002

This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent ... more This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent girls. We designed a checklist and used it to perform a chart review. Gender-role conflict was associated with suicidal behaviour in 26.79% of the adolescent girls, and 2.68% of the adolescent boys, that we studied. Gender-role conflict plays an important role in the suicidal behaviour of girls. At present, there is no published research examining the impact of gender-role conflict on suicidal adolescents.

International Journal of Eating Disorders, 2007

: The purpose of this article is to summarize major conceptual and clinical variables related to ... more : 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.

Journal of Adolescent Health, 1996

Trichotillomania, a syndrome described by the French dermatologist Hallopeau (1), is characterize... more Trichotillomania, a syndrome described by the French dermatologist Hallopeau (1), is characterized by recurrent hair pulling that results in noticeable hair loss. Trichotillomania has been associated with a number of psychiatric disorders (2-6). Of particular significance, approximately 20% of patients with trichotillomania suffer from an eating disorder, most commonly bulimia nervosa (7,8). To date, there have been no reported cases of adolescents with both anorexia nervosa (AN) and trichotillomania. We describe a female adolescent diagnosed with AN and trichotillomania, review the literature, and discuss diagnostic and therapeutic issues.

Eating Disorders, 2003

In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in... more In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in Newmarket Ontario, Canada created the Eating Disorders Program, which included a day treatment program for adolescents with eating disorders. When first conceived, this day treatment program was the first of its kind in Ontario. The multi-disciplinary team created a feminist-informed model centered on developing joint decision making relationships among team, client, and family through sustained and transparent communication and negotiation. This model for decision making has evolved through careful deliberation and ethical reflection in the planning and provision of care.

The previous issue of the Journal of Recovery in Mental Health focused on recovery around the wor... more The previous issue of the Journal of Recovery in Mental Health focused on recovery around the world. It highlighted the various global initiatives designed to inform recovery-oriented practice and system transformation. Our current themed issue is also associated with mental health service transformation and focuses on recovery through the lifespan. This theme is aligned with The Mental Health Commission of Canada's Guidelines of Recovery-Oriented Practice that outlines important core principles related to recovery at different points of an individual's life, experience and development. Upon reading the articles contained in this issue, it is apparent that while recovery is important throughout all stages of life, there are many distinct considerations that impact recovery for different groups of service users. For example, adolescents are at an earlier developmental stage than adults and are in the process of developing their identity and gaining independence rather than re-establishing theses recovery facets. In their article, Pinhas et al. have outlined the fine balance between ensuring adolescent service users are heard as participating members of their treatment collaborative yet at the same time, ensuring that teens are safe and take away learning and development from challenges and setbacks. As Goldstein et al. outline in their article, transitional aged youth face similar changes regarding independence, such as leaving the parental home and potentially shifting their occupational role from student to young professional.

European Eating Disorders Review, 2010

Childhood and adolescence are critical periods of neural development and physical growth. The mal... more 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.

Incidence/prevalence The term ‘eating disorder’, according to version IV of the Diagnostic and St... more Incidence/prevalence The term ‘eating disorder’, according to version IV of the Diagnostic and Statistical Manual (DSM-IV), includes anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified (patients fulfilling some, but not all, of the diagnostic criteria for either anorexia nervosa or bulimia nervosa). While the issue of the most appropriate diagnostic criteria for eating disorders in children has been a matter of great debate, epidemiological studies suggest that the prevalence of anorexia nervosa (using DSM-IV criteria) in adolescents has been increasing over the last 50 years and document that it is now the third most common chronic illness affecting adolescent females. In fact, the age of onset of anorexia nervosa may be becoming even younger although very little incidence data is available for younger children with eating disorders (<13 years) and the few estimates that are available vary considerably. One retrospective population-based incidence stud...

OBJECTIVE To explore and describe philosophies and characteristics of intensive eating disorder (... more OBJECTIVE To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatment programs based in tertiary care institutions across Canada. METHOD A ninety-item survey examining ED services for adolescents was developed, piloted, and completed by 11 programs across Canada. Information pertaining to program characteristics and components, governance, staffing, referrals, assessments, therapeutic modalities in place, nutritional practices, and treatment protocols were collected. RESULTS The results highlight the diversity of programming available but also the lack of a unified approach to intensive eating disorder treatment in youth. CONCLUSIONS This report provides important baseline data that offers a framework that programs can use to come together to establish assessment and treatment protocols as well as a process for outcome evaluation. Continued collaboration will be essential moving forward to ensure Canadian youth, regardless of geographic locat...

OBJECTIVE Preliminary research suggests that multiple family therapy (MFT) may be an effective in... more OBJECTIVE Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention for adolescent anorexia nervosa (AN). This study compared the extent of weight restoration for patients enrolled in one year of MFT compared to a matched control group receiving treatment as usual (TAU). METHOD A retrospective chart review was performed using data from 25 MFT cases matched to 25 controls on age, diagnosis and year of entry to the eating disorder program. RESULTS Both cases and controls experienced significant weight restoration, however patients enrolled in MFT were restored to a higher mean percent ideal body weight than the TAU group (99.6% (±7.27%) vs. 95.4 (±6.88); p<0.05). CONCLUSIONS MFT may be more effective than TAU in restoring weight in adolescents with AN.

This work is licensed under a Creative Commons Attribution 4.0 International License.

Eating Disorders, 2003

In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in... more In 1997 the Child and Family Clinic treatment team at Southlake Regional Health Centre (SLRHC) in Newmarket Ontario, Canada created the Eating Disorders Program, which included a day treatment program for adolescents with eating disorders. When first conceived, this day treatment program was the first of its kind in Ontario. The multi-disciplinary team created a feminist-informed model centered on developing joint decision making relationships among team, client, and family through sustained and transparent communication and negotiation. This model for decision making has evolved through careful deliberation and ethical reflection in the planning and provision of care.

European Eating Disorders Review

The International journal of eating disorders, Jun 20, 2017

This study tested the hypothesis that latent class analysis (LCA) would successfully classify eat... more This study tested the hypothesis that latent class analysis (LCA) would successfully classify eating disorder (ED) symptoms in children into categories that mapped onto DSM-5 diagnoses and that these categories would be consistent across countries. Childhood onset ED cases were ascertained through prospective active surveillance by the Australian Paediatric Surveillance Unit, the Canadian Paediatric Surveillance Program, and the British Paediatric Surveillance Unit for 36, 24, and 14 months, respectively. Pediatricians and child psychiatrists reported symptoms of any child aged ≤ 12 years with a newly diagnosed restrictive ED. Descriptive analyses and LCA were performed separately for all three countries and compared. Four hundred and thirty-six children were included in the analysis (Australia n = 70; Canada n = 160; United Kingdom n = 206). In each country, LCA revealed two distinct clusters, both of which presented with food avoidance. Cluster 1 (75%, 71%, 66% of the Australian, ...

Http Dx Doi Org 10 1080 10640266 2013 761082, Feb 19, 2013

Healthy eating and weight initiatives have been incorporated into many schools to combat the grow... more Healthy eating and weight initiatives have been incorporated into many schools to combat the growing obesity problem. There is little research, however, on the effectiveness of these programs or any inadvertent harmful effects on children's mental health. Our aims were to report on how school-based healthy weights initiatives can trigger the adoption of unhealthy behaviours for some children. This is a case series of four children seen at specialized eating disorder clinics. Each child attributed eating pattern changes to information garnered from school-based healthy eating curricula. Unanticipated consequences of these initiatives are described and alternative approaches are discussed.

Oxford Handbooks Online, 2011

Eating Disorders in Children and Adolescents, 2001

11 Bingeing and bulimia nervosa in children and adolescents Leora Pinhas, Debra K. Katzman, Gina ... more 11 Bingeing and bulimia nervosa in children and adolescents Leora Pinhas, Debra K. Katzman, Gina Dimitropoulos and D. Blake Woodside Toronto General Research Institute, Toronto, ON, Canada Introduction The identification of children and adolescents with ...

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2014

Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention... more Preliminary research suggests that multiple family therapy (MFT) may be an effective intervention for adolescent anorexia nervosa (AN). This study compared the extent of weight restoration for patients enrolled in one year of MFT compared to a matched control group receiving treatment as usual (TAU). A retrospective chart review was performed using data from 25 MFT cases matched to 25 controls on age, diagnosis and year of entry to the eating disorder program. Both cases and controls experienced significant weight restoration, however patients enrolled in MFT were restored to a higher mean percent ideal body weight than the TAU group (99.6% (±7.27%) vs. 95.4 (±6.88); p<0.05). MFT may be more effective than TAU in restoring weight in adolescents with AN.

Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Académie canadienne de psychiatrie de l'enfant et de l'adolescent, 2013

To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatm... more To explore and describe philosophies and characteristics of intensive eating disorder (ED) treatment programs based in tertiary care institutions across Canada. A ninety-item survey examining ED services for adolescents was developed, piloted, and completed by 11 programs across Canada. Information pertaining to program characteristics and components, governance, staffing, referrals, assessments, therapeutic modalities in place, nutritional practices, and treatment protocols were collected. The results highlight the diversity of programming available but also the lack of a unified approach to intensive eating disorder treatment in youth. This report provides important baseline data that offers a framework that programs can use to come together to establish assessment and treatment protocols as well as a process for outcome evaluation. Continued collaboration will be essential moving forward to ensure Canadian youth, regardless of geographic location, receive the necessary treatment ...

The International journal of eating disorders, 2006

The purpose of this article is to describe the content of pro-anorexia websites, both qualitative... more The purpose of this article is to describe the content of pro-anorexia websites, both qualitatively and quantitatively. An Internet search protocol was developed to identify pro-anorexia websites. A grounded theory approach was used to generate themes from Internet-based information. Basic descriptive analysis was employed to report on key website characteristics. Twenty pro-anorexia websites met inclusion criteria. Saturation of themes was achieved after review of 12 websites. Key website characteristics included purpose of website (75%), information about webmaster (67%), website disclaimers (58%), and information on "tips and tricks" (67%). Religious metaphors, lifestyle descriptions, and "thinspiration" (inspirational photo galleries and quotes that aim to serve as motivators for weight loss) were frequently present. A total of 10 themes were generated. The most prevalent themes included control, success, and perfection. Health-care providers and caregivers s...

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2002

This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent ... more This study examined whether gender-role conflict influenced the suicidal behaviour of adolescent girls. We designed a checklist and used it to perform a chart review. Gender-role conflict was associated with suicidal behaviour in 26.79% of the adolescent girls, and 2.68% of the adolescent boys, that we studied. Gender-role conflict plays an important role in the suicidal behaviour of girls. At present, there is no published research examining the impact of gender-role conflict on suicidal adolescents.