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Velkoff EA, Rubino LG, Liu J, Manasse SM, Juarascio AS. Early reduction in anxiety sensitivity predicts greater reduction in disordered eating and trait anxiety during treatment for bulimia nervosa. Int J Eat Disord 2024; 57:1791-1796. [PMID: 38578224 PMCID: PMC11343650 DOI: 10.1002/eat.24207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Anxiety sensitivity (AS), the trait-like fear of symptoms of anxiety, has been associated with eating disorder (ED) pathology broadly, bulimia nervosa (BN) symptoms specifically, and the anxiety disorders that are commonly comorbid with BN. AS, especially for physical symptoms specifically, maybe a risk and maintenance factor for BN and comorbid anxiety. METHOD Adult participants with BN (n = 44) in a clinical trial comparing CBT to mindfulness and acceptance-based treatment (MABT) reported ED symptoms, trait anxiety, and AS through treatment and follow-up. We predicted that greater early reduction (i.e., within the first month of treatment) in AS would predict greater reductions in ED symptoms and trait anxiety at post-treatment and follow-up. RESULTS Early reductions in AS for physical concerns predicted lower ED symptoms and trait anxiety at post-treatment but not follow-up. Exploratory analyses indicated that treatment groups did not differ in either early or total change in AS, controlling for baseline AS. DISCUSSION Early reductions in AS may be an important treatment target for BN, and may additionally support reductions in anxiety. Future research should identify which components of CBT and MABT best target AS, to deliver these components early in treatment, when they can have maximum effect. PUBLIC SIGNIFICANCE Anxiety sensitivity, the fear of symptoms of anxiety, is associated with eating disorders (ED). In this study, participants in treatment for bulimia nervosa reported ED symptoms, trait anxiety, and anxiety sensitivity through treatment and follow-up. Greater early reductions in anxiety sensitivity predicted lower ED symptoms and trait anxiety at post-treatment. Future research should identify which elements of treatment best target anxiety sensitivity, to deliver them early in treatment.
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Di Lodovico L, Al Tabchi A, Clarke J, Mancusi RL, Messeca D, Duriez P, Hanachi M, Gorwood P. Trajectories and predictive factors of weight recovery in patients with anorexia nervosa completing treatment. A latent class mixed model approach. EUROPEAN EATING DISORDERS REVIEW 2024; 32:758-770. [PMID: 38504499 DOI: 10.1002/erv.3088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Treatment of anorexia nervosa (AN) sometimes requires hospitalisation, which is often lengthy, with little ability to predict individual trajectory. Depicting specific profiles of treatment response and their clinical predictors could be beneficial to tailor inpatient management. The aim of this research was to identify clusters of weight recovery during inpatient treatment, and their clinical predictors. METHODS A sample of 181 inpatients who completed a treatment programme for AN was included in a retrospective study. A latent class mixed model approach was used to identify distinct weight-gain trajectories. Clinical variables were introduced in a multinomial logistic regression model as predictors of the different classes. RESULTS A four-class quadratic model was retained, able to correctly classify 63.7% of the cohort. It encompassed a late-rising, flattening, moderate trajectory of body mass index (BMI) increase (class 1), a late-rising, steady, high trajectory (class 2), an early-rising, flattening, high trajectory (class 3) and an early-rising, steady, high trajectory (class 4). Significant predictors of belonging to a class were baseline BMI (all classes), illness duration (class 2), and benzodiazepine prescription (class 3). CONCLUSION Predicting different kinetics of weight recovery based on routinely collected clinical indicators could improve clinician awareness and patient engagement by enabling shared expectations of treatment response.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Univ. Bordeaux, INSERM, Neurocentre Magendie, U1215, Bordeaux, France
- Université Paris Cité, INSERM, Institut de Psychiatrie et Neuroscience de Paris (IPNP), U1266, Paris, France
| | - Amir Al Tabchi
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Julia Clarke
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Rossella Letizia Mancusi
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Dylan Messeca
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Philibert Duriez
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université Paris Cité, INSERM, Institut de Psychiatrie et Neuroscience de Paris (IPNP), U1266, Paris, France
| | - Mouna Hanachi
- Clinical Nutrition Unit, Paul Brousse University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Villejuif, France
- UMR Micalis Institute, INRA, Paris Saclay University, Jouy-En-Josas, France
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université Paris Cité, INSERM, Institut de Psychiatrie et Neuroscience de Paris (IPNP), U1266, Paris, France
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Murray SB, Strober M, Le Grange D, Schauer R, Craske MG, Zbozinek TD. A multi-modal assessment of fear conditioning in adolescent anorexia nervosa. Int J Eat Disord 2024; 57:1499-1509. [PMID: 38415877 DOI: 10.1002/eat.24180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a pernicious psychiatric disorder which is principally characterized by a fear of weight gain. Notwithstanding the centrality of fear in the psychopathology of AN, controlled assessments of negative valence systems are lacking. Herein we assess fear conditioning in adolescent females with AN. METHOD Adolescent girls (Mage = 14.6 years, ±1.57) with DSM-5 diagnoses of AN (N = 25) and age-matched control girls (Mage = 14.8 years, ±1.46) with no DSM-5 diagnoses (N = 25) completed structured clinical interviews and participated in a classical three-phase Pavlovian fear conditioning paradigm. Participants with comorbid anxiety disorders were excluded. Skin conductance response (SCR) was measured, alongside self-reported fear, valence, and fear expectancy ratings. RESULTS Both groups demonstrated significant differential acquisition across all four measures. Regarding group comparisons, no differences emerged for self-reported fear, valence, and fear expectancy ratings during acquisition, although for SCR, those with AN demonstrated reduced physiological arousal relative to controls. Both groups demonstrated significant differential extinction for unconditioned stimuli (US) expectancy, self-report fear, and self-report valence. No statistically significant group differences were evident during extinction to the conditioned stimuli (CS)+, on any outcome measure. However, controls reported more positive valence to the CS- than those with AN. CONCLUSIONS Contrary to our hypotheses, our preliminary assessment did not find support for elevated fear responding among adolescent girls with AN with regards to fear acquisition or extinction. These data suggest that AN in adolescent girls may not be associated with a heightened propensity to acquire fear, but conversely, may suggest that exposure treatments for AN may be helpful, since extinction learning is intact in AN. PUBLIC SIGNIFICANCE AN is characterized by fear-related symptoms, including food and weight-related fear, and behavioral avoidance, yet controlled studies assessing fear learning are limited. Our preliminary assessment of adolescent AN indicates no abnormalities in fear learning among adolescents with AN. These findings may inform existing mechanistic models of AN psychopathology, and the development of exposure-based treatments for AN.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michael Strober
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
| | - Rebecca Schauer
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michelle G Craske
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
| | - Tomislav D Zbozinek
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, California, USA
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Lett TA, Vaidya N, Jia T, Polemiti E, Banaschewski T, Bokde ALW, Flor H, Grigis A, Garavan H, Gowland P, Heinz A, Brüh R, Martinot JL, Martinot MLP, Artiges E, Nees F, Orfanos DP, Lemaitre H, Paus T, Poustka L, Stringaris A, Waller L, Zhang Z, Robinson L, Winterer J, Zhang Y, King S, Smolka MN, Whelan R, Schmidt U, Sinclair J, Walter H, Feng J, Robbins TW, Desrivières S, Marquand A, Schumann G. A framework for a brain-derived nosology of psychiatric disorders. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.07.24306980. [PMID: 38766134 PMCID: PMC11100856 DOI: 10.1101/2024.05.07.24306980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Current psychiatric diagnoses are not defined by neurobiological measures which hinders the development of therapies targeting mechanisms underlying mental illness 1,2 . Research confined to diagnostic boundaries yields heterogeneous biological results, whereas transdiagnostic studies often investigate individual symptoms in isolation. There is currently no paradigm available to comprehensively investigate the relationship between different clinical symptoms, individual disorders, and the underlying neurobiological mechanisms. Here, we propose a framework that groups clinical symptoms derived from ICD-10/DSM-V according to shared brain mechanisms defined by brain structure, function, and connectivity. The reassembly of existing ICD-10/DSM-5 symptoms reveal six cross-diagnostic psychopathology scores related to mania symptoms, depressive symptoms, anxiety symptoms, stress symptoms, eating pathology, and fear symptoms. They were consistently associated with multimodal neuroimaging components in the training sample of young adults aged 23, the independent test sample aged 23, participants aged 14 and 19 years, and in psychiatric patients. The identification of symptom groups of mental illness robustly defined by precisely characterized brain mechanisms enables the development of a psychiatric nosology based upon quantifiable neurobiological measures. As the identified symptom groups align well with existing diagnostic categories, our framework is directly applicable to clinical research and patient care.
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Derissen M, Majid DSA, Tadayonnejad R, Seiger R, Strober M, Feusner JD. Testing anxiety and reward processing in anorexia nervosa as predictors of longitudinal clinical outcomes. J Psychiatr Res 2023; 167:71-77. [PMID: 37839390 DOI: 10.1016/j.jpsychires.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/05/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023]
Abstract
Anorexia nervosa (AN) is a psychiatric disorder with a tenuous longitudinal course marked by a high risk of relapse. Previous studies suggest that aberrant threat perception and reward processing operate in many with AN, and may produce obstacles to treatment engagement; therefore, these could potentially represent predictors for longitudinal clinical outcomes. In this study, anxiety and reward symptoms, behaviors, and neural circuit connectivity were measured in intensively treated AN-restrictive subtype patients (n = 33) and healthy controls (n = 31). Participants underwent an fMRI experiment using a monetary reward task in combination with either overlapping individually tailored anxiety-provoking words or neutral words. Behavioral/psychometric measures consisted of reaction times on the monetary reward task and self-ratings on anxiety symptoms at study entry. We tested multimodal, multivariate models based on neural, behavioral, and psychometric measures of reward and anxiety to predict physiological (Body Mass Index; BMI) and psychological (eating disorder symptom severity) longitudinal outcomes in AN over six months. Our results indicated that higher anxiety symptom psychometric scores significantly predicted BMI reductions at follow-up. Untreated anxiety after intensive treatment could put individuals with AN at heightened risk for weight loss. This represents a potentially modifiable risk factor that could be targeted more aggressively to help reduce the chance of future clinical worsening.
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Affiliation(s)
- M Derissen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - D-S A Majid
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - R Tadayonnejad
- Division of Neuromodulation, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, USA; Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - R Seiger
- General Adult Psychiatry and Health Systems, Centre for Addiction and Mental Health, Toronto, Canada
| | - M Strober
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - J D Feusner
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA; General Adult Psychiatry and Health Systems, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden.
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Tomba E, Tecuta L. The sequential approach in eating disorders: A scoping systematic review. EUROPEAN EATING DISORDERS REVIEW 2023; 31:874-893. [PMID: 37469129 DOI: 10.1002/erv.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs. METHOD Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded. RESULTS A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines. CONCLUSIONS The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
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Cadwallader JS, Orri M, Barry C, Falissard B, Hassler C, Huas C. Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression. J Eat Disord 2023; 11:185. [PMID: 37858179 PMCID: PMC10585727 DOI: 10.1186/s40337-023-00901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs. METHODS Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs. RESULTS 1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs. CONCLUSIONS Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.
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Affiliation(s)
- Jean Sébastien Cadwallader
- School of Medicine, Department of General Practice, Sorbonne Université, Paris, France.
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France.
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Caroline Barry
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Bruno Falissard
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Christine Hassler
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Caroline Huas
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
- Fondation Santé des Etudiants de France (FSEF), Service Hospitalo-Universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte (SAMAJA), Paris, France
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180, Montigny le Bretonneux, France
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Paszynska E, Hernik A, Rangé H, Amaechi BT, Gross GS, Pawinska M. Diet Traps during Eating Disorders among Dentate Patients at an Oral Health Glance. Nutrients 2023; 15:4414. [PMID: 37892489 PMCID: PMC10610111 DOI: 10.3390/nu15204414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/04/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023] Open
Abstract
Persons suffering from eating disorders (ED) may often experience a recurrence/persistence symptoms despite the completion of psychiatric therapy. In most cases, their general health status is linked to current nutritional behaviors. Medical professionals, general practitioners (GPs), dieticians, and dentists may see those patients in their practices. At the same time, due to low sense of illness, some patients may delay or never seek professional medical care. The aim of this article is to analyze the main ED types according to dietary behaviors causing oral health problems and discuss oral health complications in affected dentate patients. The second objective is to update oral preventive measures and technological innovations together with active agents for oral hygiene care that might effectively support oral health maintenance during the presence of long-term symptoms. The research method involved a review of clinical reports as a synthesis of the electronic research in the Pubmed, Web of Science, and Google Scholar databases. Based on the research, ED patients were found to present related incidences of oral complications. Studies have reported that the possible course of an ED and comorbidities may be an imbalance in the oral environment. The results showed an association between biological (malnutrition, etc.), behavioral (binge eating episodes, vomiting, acidic diet, poor oral hygiene), and pharmacotherapeutic (addiction, hyposalivation) factors that may threaten oral health. Early diagnosis of the past and present symptoms is essential to eliminate and take control of destructive behaviors. Oral changes need to be tackled with medical insight, and additionally, the perception of dietary interactions is recommended.
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Affiliation(s)
- Elzbieta Paszynska
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), 60-812 Poznan, Poland
| | - Amadeusz Hernik
- Department of Integrated Dentistry, Poznan University of Medical Sciences (PUMS), 60-812 Poznan, Poland
| | - Hélène Rangé
- Department of Periodontology, Faculty of Odontology, University of Rennes, CHU de Rennes, F-35000 Rennes, France
- Institut NUMECAN (Nutrition Metabolism and Cancer), INSERM, INRAE, University of Rennes, F-35000 Rennes, France
| | - Bennett T. Amaechi
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Georgiana S. Gross
- Department of Comprehensive Dentistry, School of Dentistry, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Malgorzata Pawinska
- Department of Integrated Dentistry, Medical University in Bialystok, 15-276 Bialystok, Poland
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Bazo Perez M, Hayes TB, Frazier LD. Beyond generalized anxiety: the association of anxiety sensitivity with disordered eating. J Eat Disord 2023; 11:173. [PMID: 37784155 PMCID: PMC10544544 DOI: 10.1186/s40337-023-00890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Anxiety and eating disorders (EDs) are rising at alarming rates. These mental health disorders are often comorbid, yet the factors associated with their comorbidity are not well understood. The present study examined a theoretical model of the pathways and relative associations of anxiety sensitivity (AS) with different dimensions of ED risk, controlling for generalized anxiety. METHODS Participants (N = 795) were undergraduate students with an average age of 21 (SD = 4.02), predominantly female (71%), and Hispanic (71.8%). Participants completed an online survey with established measures of AS (i.e., Anxiety Sensitivity Index-3; ASI-3), general anxiety (i.e., Beck Anxiety Inventory; BAI), and eating behaviors (i.e., Eating Attitudes Test-26; EAT-26). RESULTS The results of our structural equation models indicated that AS subscales were significantly associated with dimensions of the EAT-26, even when controlling for generalized anxiety. Specifically, the ASI-3 factors reflecting cognitive and social concerns provided the most consistent significant associations with EDs. Whereas reporting higher cognitive concerns was associated with higher ED symptoms (e.g., reporting the urge to vomit after a meal), reporting higher social concerns was associated with fewer ED symptoms. These differential results may suggest risk and resilience pathways and potential protective or buffering effects of social concerns on ED risk. DISCUSSION Findings advance understanding of the role of AS in the comorbidity of anxiety and EDs, demonstrating the strong association of AS with ED pathology. These findings provide cognitive indicators for transdiagnostic therapeutic intervention in order to reduce the risk of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Timothy B Hayes
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Hübel C, Birgegård A, Johansson T, Petersen LV, Isomaa R, Herle M. Latent anxiety and depression dimensions differ amongst patients with eating disorders: A Swedish nationwide investigation. Int J Methods Psychiatr Res 2023; 32:e1961. [PMID: 36775941 PMCID: PMC10485306 DOI: 10.1002/mpr.1961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Anxiety and depression symptoms are common in individuals with eating disorders. To study these co-occurrences, we need high-quality self-report questionnaires. The 19-item self-rated Comprehensive Psychopathological Rating Scale for Affective Syndromes (CPRS-S-A) is not validated in patients with eating disorders. We tested its factor structure, invariance, and differences in its latent dimensions. METHOD Patients were registered by 45 treatment units in the Swedish nationwide Stepwise quality assurance database for specialised eating disorder care (n = 9509). Patients self-reported their anxiety and depression symptoms on the CPRS-S-A. Analyses included exploratory and confirmatory factor analyses (CFA) in split samples, and testing of invariance and differences in subscales across eating disorder types. RESULTS Results suggested a four-factor solution: Depression, Somatic and fear symptoms, Disinterest, and Worry. Multigroup CFA indicated an invariant factor structure. We detected the following differences: Patients with anorexia nervosa binge-eating/purging subtype scored the highest and patients with unspecified feeding and eating disorders the lowest on all subscales. Patients with anorexia nervosa or purging disorder show more somatic and fear symptoms than individuals with either bulimia nervosa or binge-eating disorder. CONCLUSION Our four-factor solution of the CPRS-S-A is suitable for patients with eating disorders and may help to identify differences in anxiety and depression dimensions amongst patients with eating disorders.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental HealthSouth London and Maudsley HospitalLondonUK
- National Centre for Register‐based ResearchAarhus BSS Business and Social SciencesAarhus UniversityAarhusDenmark
- Department of Pediatric NeurologyCharité Universitätsmedizin BerlinBerlinGermany
| | - Andreas Birgegård
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Therese Johansson
- Department of Immunology, Genetics and PathologyScience for Life LaboratoryUppsala UniversityUppsalaSweden
- Centre for Women's Mental Health During the Reproductive Lifespan—WomherUppsala UniversityUppsalaSweden
| | - Liselotte V. Petersen
- National Centre for Register‐based ResearchAarhus BSS Business and Social SciencesAarhus UniversityAarhusDenmark
| | - Rasmus Isomaa
- The Wellbeing Services County of OstrobothniaAboFinland
- Faculty of Education and Welfare StudiesÅbo Akademi UniversityVasaFinland
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Department of Biostatistics & Health InformaticsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Flaudias V, Samalin L, Godin O, Gard S, Brousse G, Loftus J, Aubin V, Belzeaux R, Dubertret C, Le Strat Y, Mazer N, de Prémorel A, Roux P, Polosan M, Schwitzer T, Aouizerate B, Llorca PM, Biseul I, Etain B, Moirand R, Olié E, Haffen E, Leboyer M, Courtet P, Icick R, Guillaume S. Crossed clinical features between eating disorders and types of bipolar disorder: Results from the FondaMental Advanced Centers of Expertise - Bipolar Disorder cohort. J Affect Disord 2023; 335:177-185. [PMID: 37178826 DOI: 10.1016/j.jad.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Eating disorders (EDs) are liable to alter the disease course of bipolar disorder (BD). We explored the crossed clinical features between EDs and BD, particularly as a function of BD type (BD1 vs. BD2). METHODS 2929 outpatients attending FondaMental Advanced Centers of Expertise were assessed for BD and lifetime EDs with a semi-structured interview, and their sociodemographic, dimensional and clinical data were collected according to a standardized procedure. For each ED type, bivariate analyses were used to investigate associations between these variables and the type of BD type followed by multinomial regressions with the variables associated with EDs and BDs after Bonferroni correction. RESULTS Comorbid EDs were diagnosed in 478 (16.4 %) cases, and were more prevalent in patients with BD2 than in those with BD1 (20.6 % vs. 12.4 %, p < 0.001). Regression models showed no difference according to the subtype of bipolar disorder on the characteristics of patients with anorexia nervosa (AN), bulimia nervosa (BN) or binge eating disorder (BED). After multiple adjustments, the factors differentiating BD patients with versus without ED were primarily age, gender, body mass index, more affective lability and comorbidity with anxiety disorders. BD patients with BED also scored higher regarding childhood trauma. BD patients with AN also showed higher risk of past suicide attempts than those with BED. CONCLUSIONS In a large sample of patients with BD, we found a high prevalence of lifetime EDs, especially for the BD2 type. EDs were associated with several severity indicators, but not with BD type-specific characteristics. This should prompt clinicians to carefully screen patients with BD for EDs, regardless of BD and ED types.
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Affiliation(s)
- Valentin Flaudias
- Nantes Université, Univ Angers, Laboratoire de psychologie des Pays de la Loire, LPPL, UR 4638, Nantes, France; CHU Clermont-Ferrand, Department of Psychiatry, Clermont-Ferrand, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France.
| | - Ludovic Samalin
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | | | - Sébastien Gard
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie Générale et Universitaire, Center Hospitalier Charles Perrens, France NutriNeuro, INRAE UMR 1286, University of Bordeaux, Bordeaux F-33076, France
| | - Georges Brousse
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Joséphine Loftus
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Center Hospitalier Princesse Grace, Monaco
| | - Valérie Aubin
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Center Hospitalier Princesse Grace, Monaco
| | - Raoul Belzeaux
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Caroline Dubertret
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Yann Le Strat
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Nicolas Mazer
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Alix de Prémorel
- FondaMental Foundation, Créteil F-94000, France; Université de Paris, INSERM UMR1266, AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, service de Psychiatrie et Addictologie, Hôpital Louis Mourier, Colombes, France
| | - Paul Roux
- FondaMental Foundation, Créteil F-94000, France; Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Le Chesnay, Université Paris-Saclay, Université de Versailles Saint-Quentin-En-Yvelines, DisAP-DevPsy-CESP, INSERM UMR1018, Villejuif, France
| | - Mircea Polosan
- FondaMental Foundation, Créteil F-94000, France; Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U 1216, Grenoble, France
| | - Thomas Schwitzer
- FondaMental Foundation, Créteil F-94000, France; Université de Lorraine, Inserm U 1254, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes et d'Addictologie CPN, Laxou, France
| | - Bruno Aouizerate
- FondaMental Foundation, Créteil F-94000, France; Pôle de Psychiatrie Générale et Universitaire, Center Hospitalier Charles Perrens, France NutriNeuro, INRAE UMR 1286, University of Bordeaux, Bordeaux F-33076, France
| | - Pierre-Michel Llorca
- FondaMental Foundation, Créteil F-94000, France; CHU Clermont-Ferrand, Department of Psychiatry, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, 63000 Clermont-Ferrand, France
| | - Isabelle Biseul
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France
| | - Bruno Etain
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France; INSERM UMRS 1144, Université de Paris Cité, Paris F-75006, France
| | - Remi Moirand
- FondaMental Foundation, Créteil F-94000, France; INSERM U1028, CNRS UMR5292, University Lyon 1, Villeurbanne F-69000, France; Lyon Neuroscience Research Center, Psychiatric Disorders: from Resistance to Response ΨR2 Team, Centre Hospitalier Le Vinatier, F-69678, France
| | - Emilie Olié
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Emmanuel Haffen
- Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Recherche Intégratives en Neurosciences et Psychologie Cognitive, Université de Franche-Comté, Besançon, France
| | - Marion Leboyer
- FondaMental Foundation, Créteil F-94000, France; AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d'Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Université Paris Est Créteil, INSERM U955, F-94010, France
| | - Philippe Courtet
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France
| | - Romain Icick
- FondaMental Foundation, Créteil F-94000, France; AP-HP.Nord, Groupe Hospitalo-universitaire Lariboisière-Fernand Widal, DMU Neurosciences, Département de Psychiatrie et de Médecine Addictologique, Paris F-75010, France; INSERM UMRS 1144, Université de Paris Cité, Paris F-75006, France
| | - Sébastien Guillaume
- FondaMental Foundation, Créteil F-94000, France; Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital CHU, Montpellier, France; Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
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12
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Yilmaz Z, Schaumberg K, Halvorsen M, Goodman EL, Brosof LC, Crowley JJ, Mathews CA, Mattheisen M, Breen G, Bulik CM, Micali N, Zerwas SC. Predicting eating disorder and anxiety symptoms using disorder-specific and transdiagnostic polygenic scores for anorexia nervosa and obsessive-compulsive disorder. Psychol Med 2023; 53:3021-3035. [PMID: 35243971 PMCID: PMC9440960 DOI: 10.1017/s0033291721005079] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Clinical, epidemiological, and genetic findings support an overlap between eating disorders, obsessive-compulsive disorder (OCD), and anxiety symptoms. However, little research has examined the role of genetics in the expression of underlying phenotypes. We investigated whether the anorexia nervosa (AN), OCD, or AN/OCD transdiagnostic polygenic scores (PGS) predict eating disorder, OCD, and anxiety symptoms in a large developmental cohort in a sex-specific manner. METHODS Using summary statistics from Psychiatric Genomics Consortium AN and OCD genome-wide association studies, we conducted an AN/OCD transdiagnostic genome-wide association meta-analysis. We then calculated AN, OCD, and AN/OCD PGS in participants from the Avon Longitudinal Study of Parents and Children to predict eating disorder, OCD, and anxiety symptoms, stratified by sex (combined N = 3212-5369 per phenotype). RESULTS The PGS prediction of eating disorder, OCD, and anxiety phenotypes differed between sexes, although effect sizes were small. AN and AN/OCD PGS played a more prominent role in predicting eating disorder and anxiety risk than OCD PGS, especially in girls. AN/OCD PGS provided a small boost over AN PGS in the prediction of some anxiety symptoms. All three PGS predicted higher compulsive exercise across different developmental timepoints [β = 0.03 (s.e. = 0.01) for AN and AN/OCD PGS at age 14; β = 0.05 (s.e. = 0.02) for OCD PGS at age 16] in girls. CONCLUSIONS Compulsive exercise may have a transdiagnostic genetic etiology, and AN genetic risk may play a role in the presence of anxiety symptoms. Converging with prior twin literature, our results also suggest that some of the contribution of genetic risk may be sex-specific.
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Affiliation(s)
- Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Schaumberg
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Matthew Halvorsen
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Erica L. Goodman
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Leigh C. Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - James J. Crowley
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Carol A. Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Manuel Mattheisen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, Aarhus, Denmark
- The Lundbeck Foundation Initiative of Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London, London, UK
- National Institute for Health Research Biomedical Research Centre, South London and Maudsley National Health Service Trust, London, UK
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, HUG, Geneva, Switzerland
- Institute of Child Health, University College London, London, UK
- Department of Paediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, HUG, Geneva, Switzerland
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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13
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Datta N, Matheson BE, Citron K, Van Wye EM, Lock JD. Evidence Based Update on Psychosocial Treatments for Eating Disorders in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:159-170. [PMID: 35950931 DOI: 10.1080/15374416.2022.2109650] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Eating disorders (EDs) are life-threatening psychiatric illnesses that occur in adolescents. Unfortunately, limited randomized controlled trials exist to address EDs in this vulnerable population. The current review updates a prior Journal of Clinical Child and Adolescent Psychology review from 2015. The recommendations in this review build upon those that were previously published. This update was completed through a systematic search of three major scientific databases (PsychInfo, Pubmed, and Cochrane) from 2015 to 2022 (inclusively) from three databases, employing relevant medial subject headings. Additionally, expert colleagues were asked for additional literature to include. Thirty-one new studies were added to this review. Psychosocial treatments included family therapies, individual therapy, cognitive-behavioral therapy, interpersonal psychotherapy, cognitive training, dialectical behavioral therapy, and more recently, virtual or telehealth-based practices and guided self-help modalities for carers of youth with EDs. Using the Journal of Clinical Child and Adolescent Psychology's methodological review criteria, this update found behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa and bulimia nervosa met well-established treatment criteria. To date, there were no well-established treatments found for child and adolescent avoidant-restrictive food intake disorder, or binge eating disorder. Internet facilitated cognitive-behavioral therapy and family-based therapy were found to be possibly efficacious for binge eating disorder. Family-based treatment was found to be possibly efficacious for avoidant restrictive food intake disorder, with other clinical trials for cognitive treatment modalities under way. Ongoing research examining treatments for eating disorders in children and adolescents broadly is needed.
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Affiliation(s)
- Nandini Datta
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine
| | - Brittany E Matheson
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine
| | - Kyra Citron
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine
| | | | - James D Lock
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine
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14
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Clausen L, Semark BD, Helverskov J, Bulik CM, Petersen LV. Pharmacotherapy in anorexia nervosa: A Danish nation-wide register-based study. J Psychosom Res 2023; 164:111077. [PMID: 36379077 PMCID: PMC10853671 DOI: 10.1016/j.jpsychores.2022.111077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE No medications have been indicated for the treatment of anorexia nervosa (AN). Nonetheless, individuals with AN are frequently treated pharmacologically. The present study maps nationwide pharmacotherapy two years before to five years after first AN diagnosis. METHODS We identified all medication prescriptions in a national register-based study of patients with a first diagnosis of AN between 1998 and 2011, and age and gender matched controls (1:10). Medication classes were compared using odds ratios (OR) between patients and controls; between patients below and above 15 years; between patients with and without comorbidity; and between those diagnosed before or after 2005. RESULTS The odds of pharmacotherapy were increased in patients for all classes of medication except a small residual class. Highest odds were found for alimentary (OR 2.8, p < 0.001) and psychopharmacological (OR 5.5, p < 0.001) medication. The former peaked one year prior to first diagnosis and the latter one year after. Older patients had increased risk of almost all medication classes with cardiovascular medication showing a fivefold OR (p < 0.001). Patients with psychiatric comorbidity had a threefold OR for psychopharmacological medication (p < 0.001) compared to patients without psychiatric comorbidity. Calendar year showed few and small differences. CONCLUSION The extended use of all medication classes both prior to and after first diagnosis of AN highlights the severe cause and complexity of AN. The results encourage clinical caution of pharmacotherapy, highlight the need for pharmacotherapy guidelines for AN, and emphasize the urgency of research in pharmacotherapy in AN.
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Affiliation(s)
- Loa Clausen
- Department of Child and Adolescent Psychiatry Aarhus University Hospital, Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Birgitte D Semark
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Janne Helverskov
- Department of Child and Adolescent Psychiatry Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark Aarhus University, Aarhus, Denmark
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15
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Longo P, Toppino F, Martini M, Panero M, De Bacco C, Marzola E, Abbate-Daga G. Diagnostic Concordance between Research and Clinical-Based Assessments of Psychiatric Comorbidity in Anorexia Nervosa. J Clin Med 2022; 11:jcm11247419. [PMID: 36556034 PMCID: PMC9782669 DOI: 10.3390/jcm11247419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The literature has reported poor concordance in the assessment of psychiatric conditions, and inhomogeneity in the prevalence of psychiatric comorbidities in Anorexia Nervosa (AN). We aimed to investigate concordance level between clinicians' and researchers' diagnoses of psychiatric comorbidity in AN and differences in eating and general psychopathology between patients with and without psychiatric comorbidity assessed by clinicians versus researchers. A clinical psychiatrist interviewed 122 patients with AN; then a researcher administered the Structured and Clinical Interview for DSM-5 (SCID-5). Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). The agreement between clinicians and researchers was poor for all diagnoses but obsessive-compulsive disorder and substance use disorder. Patients with comorbid disorders diagnosed by researchers reported more severe eating and general psychopathology than those without SCID-comorbidity. The differences between patients with and without comorbidities assessed by a clinician were smaller. Two approaches to psychiatry comorbidity assessment emerged: SCID-5 diagnoses yield a precise and rigorous assessment, while clinicians tend to consider some symptoms as secondary to the eating disorder rather than as part of another psychiatric condition, seeing the clinical picture as a whole. Overall, the study highlights the importance of carefully assessing comorbidity in AN.
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16
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Heywood L, Conti J, Hay P. Paper 1: a systematic synthesis of narrative therapy treatment components for the treatment of eating disorders. J Eat Disord 2022; 10:137. [PMID: 36076272 PMCID: PMC9461296 DOI: 10.1186/s40337-022-00635-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs. METHOD Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs. CONCLUSION This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview. There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention.
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Affiliation(s)
- Lauren Heywood
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Janet Conti
- School of Psychology, Western Sydney University, Sydney, Australia. .,Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, Australia.,School of Medicine, Western Sydney University, Sydney, Australia
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17
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Weibert E, Hofmann T, Elbelt U, Rose M, Stengel A. NUCB2/nesfatin-1 is associated with severity of eating disorder symptoms in female patients with obesity. Psychoneuroendocrinology 2022; 143:105842. [PMID: 35752057 DOI: 10.1016/j.psyneuen.2022.105842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Nesfatin-1 has been described as an anorexigenic peptide. Comprehensive evidence also points towards an involvement of nesfatin-1 in the modulation of emotional pathways with a sex-specific regulation of nesfatin-1 in association with anxiety. Although the implication of nesfatin-1 in the regulation of food intake is well-established in animals, data in humans are lacking. Therefore, we investigated a possible association of circulating NUCB2/nesfatin-1 with eating disorder symptoms in female and male patients displaying a wide range of body weight. METHODS We enrolled 243 inpatients (177 female, 66 male) hospitalized due to anorexia nervosa (n = 66) or obesity (n = 144) or with normal weight and suffering from somatoform, adjustment, depressive or anxiety disorders (n = 33). Plasma samples (NUCB2/nesfatin-1 levels measured by ELISA) and measures of eating disorder symptoms (by EDI-2, range 0-100) were obtained within three days after admission. RESULTS The study population displayed a distinct prevalence of eating disorder symptoms with female patients with anorexia nervosa (+ 77.0%, p < 0.001) and obesity (+ 87.9%, p < 0.001) reported significantly higher EDI-2 scores than normal weight patients of the same sex. Accordingly, males with anorexia nervosa (+ 39.7%, p < 0.05) and obesity (+ 51.7%, p < 0.001) had significantly higher EDI-2 scores than males with normal weight. Within the same BMI group, women displayed significantly higher scores than men (+ 21.4%, p < 0.05 in patients with anorexia nervosa, + 18.8%, p < 0.001 in participants with obesity). We observed a positive correlation between NUCB2/nesfatin-1 levels and EDI-2 total scores in female patients with obesity (r = 0.285, p = 0.015), whereas no associations were found in other subgroups. A positive correlation between NUCB2/nesfatin-1 levels and BMI was only observed in the male study population (r = 0.315, p = 0.018). CONCLUSIONS NUCB2/nesfatin-1 plasma levels were positively associated with EDI-2 total scores in women with obesity, while no association was observable in men. The lacking association of NUCB2/nesfatin-1 and EDI-2 total scores in female patients with anorexia nervosa might be due to already low NUCB2/nesfatin-1 plasma levels. Whether NUCB2/nesfatin-1 is selectively involved in eating behavior in women with obesity will have to be further investigated.
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Affiliation(s)
- Elena Weibert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Tobias Hofmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Ulf Elbelt
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Medicine, Department of Gastroenterology, Metabolism and Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School, Neuruppin, Germany; Endokrinologikum Berlin, Berlin, Germany
| | - Matthias Rose
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Andreas Stengel
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
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Isham EA, Lomayesva S, Teng J. Time estimation and passage of time judgment predict eating behaviors during COVID-19 lockdown. Front Psychol 2022; 13:961092. [PMID: 36081727 PMCID: PMC9444799 DOI: 10.3389/fpsyg.2022.961092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
Poor eating habits often lead to health concerns. While mental health conditions such as stress and anxiety have been linked as predictors for eating behaviors, cognitive factors may also contribute to eating practices during the early stages of the mandatory COVID-19 lockdown. In the current study, participants responded to a survey that asked them to judge the passing of time (PoTJ) and to produce short intervals (via a time production task) as an index of the internal clock speed. Additionally, they responded to questions about snacking frequency and the tendency to overeat during lockdown. We observed that those who judged time to pass slowly also reported a greater tendency to snack and overeat during the pandemic. Additional analysis also revealed that the effect of PoTJ on snacking is moderated by the internal clock speed such that those who felt time was passing by slowly, and in combination with a faster internal clock (as indexed by shorter duration production), had a greater tendency to snack. The results suggest that different aspects of temporal cognition play potential roles in influencing different types of eating behaviors. Our findings therefore have implications for eating disorders, along with the potential of time-based intervention or behavioral modification approaches.
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A network approach can improve eating disorder conceptualization and treatment. NATURE REVIEWS PSYCHOLOGY 2022; 1:419-430. [PMID: 36330080 PMCID: PMC9624475 DOI: 10.1038/s44159-022-00062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.
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20
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Exploring risk factors of food and alcohol disturbance (FAD) in U.S. college students. Eat Weight Disord 2022; 27:1739-1749. [PMID: 34622393 DOI: 10.1007/s40519-021-01313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Current research examining mental health and history of childhood trauma as risk factors of food and alcohol disturbance (FAD) is limited. College students may be at greater risk to engage in FAD behaviors because of the common co-occurrence of alcohol misuse and disordered eating behaviors within college populations. Therefore, the current study examined anxiety, depression, and adverse childhood experiences as possible risk factors of FAD behaviors in a college student sample. METHODS Two-hundred and seven undergraduate students from a large Midwest university completed a cross-sectional survey assessing history of adverse childhood experiences, depressive symptoms, anxiety symptoms, FAD behaviors, and frequency of alcohol use. RESULTS Current symptoms of generalized anxiety were significantly associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.13, F(1, 204) = 4.10, p = 0.04; Bulimia subscale, β = 0.17, F(1, 204) = 6.19, p = 0.01; Diet and Exercise subscale, β = 0.19, F(1, 204) = 9.05, p < 0.01). Adverse childhood experiences were associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.14, F(1, 204) = 4.27, p = 0.04). Current depressive symptoms were not significantly associated with FAD behaviors. CONCLUSIONS Study findings suggest that students who experience greater current symptoms of anxiety are at a greater risk to engage in FAD behaviors. Further understanding the role of anxiety in the development and maintenance of FAD behaviors may provide clinically useful information for the prevention and treatment of FAD behaviors. These findings highlight the need for further research to examine psychological distress as a risk factor for engagement in FAD behaviors longitudinally, in a larger, more diverse study sample. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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21
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Novack K, Dufour R, Picard L, Booij L, Chadi N. An Intensive Ambulatory Care Program for Adolescents with Eating Disorders Combining In-Person and Virtual Care: Protocol for a Single-Site Naturalistic Trial (Preprint). JMIR Res Protoc 2022; 11:e37420. [DOI: 10.2196/37420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
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22
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Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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Thai H, Davis CG, Stewart N, Gunnell KE, Goldfield GS. The Effects of Reducing Social Media Use on Body Esteem Among Transitional-Aged Youth. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2021. [DOI: 10.1521/jscp.2021.40.6.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction. Social media use (SMU) and body image concerns are highly prevalent in youth. Although several studies have shown that high SMU is crosssectionally associated with lower body esteem, experimental evidence is lacking. This pilot study experimentally evaluated the effects of reducing SMU on body esteem among transitional aged youth (TAY) with emotional distress. Methods. Thirty-eight undergraduate students presenting with elevated symptoms of anxiety/depression were randomly assigned to the intervention (n = 16), where SMU was restricted to 60 minutes/day, or to the control group (n = 22), where SMU was not restricted. SMU was monitored via screen-time trackers in participants’ smartphone submitted daily during baseline (1-week) and intervention (3-week) periods. Baseline and post-intervention measurements were taken to assess appearance and weight esteem as well as symptoms of anxiety and depression as secondary outcomes. Results. A significant group × time interaction emerged indicating that the intervention participants showed a significantly greater increase in appearance esteem over the 4 weeks compared to controls. There was no significant between-group difference on change in weight esteem. A significant group × time interaction emerge on anxiety indicating that intervention participants showed a significantly greater improvement in anxiety over the study period compared to controls. There was no significant between-group difference on change in depressive symptoms. Discussion. Reducing SMU may be a feasible and effective method of improving appearance esteem and reducing anxiety in a high-risk population of TAY with emotional distress; however, more high-quality randomized controlled trials are needed to confirm findings.
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Peláez-Fernández MA, Romero-Mesa J, Extremera N. From Deficits in Emotional Intelligence to Eating Disorder Symptoms: A Sequential Path Analysis Approach Through Self-Esteem and Anxiety. Front Psychol 2021; 12:713070. [PMID: 34484070 PMCID: PMC8416284 DOI: 10.3389/fpsyg.2021.713070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Past studies have reported emotional intelligence (EI) as a relevant factor in development and maintenance of eating disorders (ED), as well as in increasing self-esteem and reducing anxiety. Similarly, research has showed that anxiety and self-esteem are positively and negatively associated to ED criteria, respectively. However, no prior studies have yet tested the multiple intervening roles of both self-esteem and anxiety as potential mediators of the association between EI and ED symptomatology. The present study aims to bridge these gaps by testing a sequential path model. Specifically, we examine the potential sequential mediation effects of self-esteem-anxiety on the link between EI and ED. A sample composed of 516 Spanish undergraduate students and community adults completed measures of EI, self-esteem, anxiety, and ED symptomatology. The results show that high levels of EI were positively associated with self-esteem and negatively associated with anxiety and ED symptoms. Anxiety was positively associated to ED symptoms, while self-esteem levels were negatively linked to ED symptoms. Moreover, path analyses showed that self-esteem and anxiety fully mediated the relationship between EI and ED symptoms in sequence. These findings suggest that EI plays a key role in reducing symptomatology of ED through increased self-esteem and reduced anxiety symptoms, providing novel evidence regarding psychological mechanisms through which EI contributes to a reduction of ED symptomatology. Implications for assessing and improving these psychological resources in ED preventive programs are discussed.
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Affiliation(s)
- María Angeles Peláez-Fernández
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Juana Romero-Mesa
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Natalio Extremera
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
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25
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Riquin E, Raynal A, Mattar L, Lalanne C, Hirot F, Huas C, Duclos J, Berthoz S, Godart N. Is the Severity of the Clinical Expression of Anorexia Nervosa Influenced by an Anxiety, Depressive, or Obsessive-Compulsive Comorbidity Over a Lifetime? Front Psychiatry 2021; 12:658416. [PMID: 34279519 PMCID: PMC8280337 DOI: 10.3389/fpsyt.2021.658416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: The relationship between anxiety or depressive comorbidities, their chronology of onset, and the severity of anorexia nervosa (AN) is not well-studied. We hypothesize that the existence of a comorbidity, particularly before the onset of AN, is associated with greater severity of AN. Methods: One hundred seventy-seven subjects were assessed. The prevalence of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), generalized anxiety disorder (GAD), and social phobia (SP) as well as their chronology of onset were studied. The assessment criteria of AN severity were the overall clinical condition, body mass index (BMI) on admission, lowest BMI, intensity of the eating symptoms, age at the onset of AN, illness duration, number of hospitalizations, and quality of life. Results: Patients with AN had the greatest clinical severity when they had a comorbid disorder over their lifetime, such as MDD, GAD, or SP. These comorbidities along with OCD were associated with a higher level of eating symptoms and a more altered quality of life. A profile of maximum severity was associated with a higher prevalence of MDD and GAD. Concerning the chronology of onset, the age at the start of AN was later in cases of MDD or GAD prior to AN. Conclusion: There seems to be an association between severity of AN and both MDD and GAD. The chronology of onset of the comorbidity did not seem to be associated with the severity.
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Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers [Angers University Hospital], Angers, France
- Laboratory of Psychology, LPPL EA4638, University of Angers, Angers, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Centre Pierre Daguet, Sablé-sur-Sarthe, France
| | - Agathe Raynal
- Department of Child and Adolescent Psychiatry, CH du Rouvray-CHU de Rouen, Rouen, France
| | - Lama Mattar
- Nutrition Division, Department of Natural Sciences, School of Arts and Sciences-Lebanese American University, Beirut, Lebanon
| | - Christophe Lalanne
- Université Paris Diderot [Paris Diderot University], Paris Sorbonne Cité, Paris, France
| | - France Hirot
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Caroline Huas
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
| | - Jeanne Duclos
- Univ. Lille, CNRS, CHU Lille, UMR 9193—SCALab—Cognitive and Affective Sciences, Lille, France
- Hôpital Saint Vincent de Paul, GHICL, Département de Psychiatrie, Paris, France
| | - Sylvie Berthoz
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Univ. Bordeaux INCIA CNRS UMR 5287, Bordeaux, France
| | - Nathalie Godart
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Paris, France
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
- Adolescent and Young Adult University Hospital Department of the Health Foundation of Students of France, Paris, France
- UFR des Sciences de la Santé Simone Veil [Simone Veil Health Science Training and Research Unit], Université de Versailles Saint-Quentin-en-Yvelines [Versailles Saint-Quentin-en-Yvelines University], Versailles, France
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26
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Chapelon E, Barry C, Hubert T, Com-Ruelle L, Duclos J, Mattar L, Falissard B, Huas C, Godart N. Health in adulthood after severe anorexia nervosa in adolescence: a study of exposed and unexposed women. Eat Weight Disord 2021; 26:1389-1397. [PMID: 32572843 DOI: 10.1007/s40519-020-00940-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/04/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the global health status, frequency of somatic and psychological problems, and alcohol use in adulthood among women hospitalized in adolescence for severe anorexia nervosa (AN), with a matched control sample from the general population. METHOD Women (n = 86) who had been hospitalized for AN 9.31 ± 1.82 years previously were compared with 258 controls matched for gender, age, and socio-professional category. Data were retrieved from a French survey on health and social insurance coverage, and was mainly collected by self-report, except for the assessment of current eating disorders for those previously hospitalized for AN (assessed with the MINI). RESULTS The women who had been hospitalized for AN reported significantly poorer current health status compared to controls (OR 2.9, 95% CI 1.5-5.79). According to the MINI, 13 women previously hospitalized with severe AN still presented an eating disorder (ED). Women with past AN reported more frequent acute throat infections (OR 4.9, 95% CI 1.81-13.51), gastralgia (OR 3.6, 95% CI 1.9-6.83), gastro-oesophageal reflux (OR 5.279, 95%CI 2.11-13.22), excess blood cholesterol or triglyceride levels (OR 2.55, 95% CI 1.03-6.33), anxiety (OR 8.7, 95% CI 3.48-21.8) and depression (OR 5.02 (2.8-9.01). These differences remained significant and of the same order of magnitude in sensitivity analyses among subjects with previous AN but without current ED, except for perceived health status and excess cholesterol and triglyceride levels. DISCUSSION Women who had been hospitalized for severe AN reported more symptoms 10 years after treatment, implies psychological and somatic follow-up in the long term. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Emeline Chapelon
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France.,Psychiatry Department for Adolescent and Young Adults, Institut Mutualiste Montsouris, Paris, France.,Pediatrics Department, Jean Verdier Hospital, avenue du 14 Juillet, Bondy, France
| | - Caroline Barry
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
| | - Tamara Hubert
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
| | - Laure Com-Ruelle
- Institute for Research and Information in Health Economics (Institut de Recherche et de Documentation en Economie de la Santé), Paris, France
| | - Jeanne Duclos
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France.,Psychiatry Department for Adolescent and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Lama Mattar
- Nutrition Division, Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Bruno Falissard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France
| | - Caroline Huas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France. .,Fondation santé des étudiants de France, 8, rue Emile Deutsch de la Meurthe, 75014, Paris, France.
| | - Nathalie Godart
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Paris, France.,Fondation santé des étudiants de France, 8, rue Emile Deutsch de la Meurthe, 75014, Paris, France.,UFR Simone Veil, UVSQ, Montigny le Bretonneux, France
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Exploring the association between psychological distress and drunkorexia behaviors in non-clinical adolescents: the moderating role of emotional dysregulation. Eat Weight Disord 2021; 26:797-806. [PMID: 32356142 DOI: 10.1007/s40519-020-00912-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Although drunkorexia seems to represent a new form of eating disorder, it shares several features with traditional eating disorders. However, very little is known about the association between drunkorexia and a widely studied correlate of eating disorders, such as psychological distress and about mechanisms underlying this association. The present study aimed to investigate the relation between symptoms of anxiety and depression and drunkorexia, and to explore the role of emotional dysregulation as moderator of this relationship. METHODS The sample was composed of 402 adolescents (222 females, 180 males; range 15-21) who completed self-reported measures: Drunkorexia Motives and Behaviors Scale, which assesses different behaviors and motivations associated with drunkorexia, Emotional dysregulation scale from the Eating Disorder Inventory-3, reflecting difficulties regulating emotions, and Anxiety and Depression scales from the Symptom CheckList-90 Revised, assessing general signs of anxious and depressive symptoms. RESULTS Anxious symptomatology resulted a significant statistical predictor of drunkorexia behaviors (β = .28, p = .001). Furthermore, emotional dysregulation moderated the relation between anxiety and drunkorexia; specifically, a positive relation was found both at medium levels (β = .22, p = .007) and at higher levels of emotional dysregulation (β = .38, p = .000), whereas at lower levels of emotional dysregulation, this association became nonsignificant. CONCLUSIONS Findings suggest that adolescents who experience both elevated anxiety and emotional dysregulation may be more likely to turn to drunkorexia to reduce their unregulated negative affect in the absence of more adaptive emotion regulation strategies. Implications for intervention and prevention programs are discussed. LEVEL OF EVIDENCE Level V, descriptive study.
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28
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Sander J, Moessner M, Bauer S. Depression, Anxiety and Eating Disorder-Related Impairment: Moderators in Female Adolescents and Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052779. [PMID: 33803367 PMCID: PMC7967486 DOI: 10.3390/ijerph18052779] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/12/2021] [Accepted: 03/02/2021] [Indexed: 12/20/2022]
Abstract
Adolescents and young adults, particularly females, are highly vulnerable to the development of anxiety disorders, depression, and eating disorders. Comorbid anxiety disorder or depression in eating disorders are associated with greater symptom severity, poorer prognosis, and burden of illness. Nonetheless, studies on what affects the relationship between anxiety, depression, and eating disorders in female at-risk samples are scarce. Using hierarchical linear modeling, the present study examined potential moderators to explain between-person differences in the association between anxiety, depression, and eating disorder-related impairment within 12- to 25-year-old females (N = 320). High impairment in anxiety/depression was associated with more severe eating disorder symptoms. Older age as well as greater impairment in mood dysregulation, self-esteem, and perfectionism were linked to more severe eating disorder symptomatology. Whereas mood dysregulation, self-esteem, and perfectionism had no statistically significant moderating effects, younger age appeared to augment the association of anxiety/depression and eating disorder symptomatology. Preventive care in particular needs to consider age-related effects as eating disorder symptoms are associated more strongly with symptoms of anxiety and depression in early adolescence.
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Anorexia nervosa and gut microbiota: A systematic review and quantitative synthesis of pooled microbiological data. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110114. [PMID: 32971217 DOI: 10.1016/j.pnpbp.2020.110114] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alterations of gut microbiota may play a role in Anorexia Nervosa (AN) through perturbations of the gut-brain axis. Some studies found differences in the gut microbiota of patients with AN compared to healthy controls, but results are heterogeneous. The aim of this work was to systematically review the existing studies comparing gut microbial composition in AN and healthy controls, and to perform a quantitative synthesis of the pooled clinical and microbiological data, when available. METHODS A comprehensive literature search was performed to identify human studies investigating relationships between AN and gut microbiota. Microbiome datasets from studies were pooled and analysed focusing on alpha and beta-diversity and the relative abundance of microbial species in patients' gut microbiota compared to healthy controls. RESULTS Nine studies were eligible for the systematic review, of which 4 were included in the quantitative synthesis. Preserved alpha-diversity and decreased beta-diversity in AN emerged from the qualitative synthesis, while a slight increase of alpha-diversity (d < 0.4) and comparable beta-diversity were reported by the quantitative synthesis. Out of the 46 common species compared, three had a large combined effect size (d ≥ 0.9) to differentiate patients from controls, namely Alistipes, Parabacterioides and Roseburia. The latter was also correlated with BMI (ρ = 0.29). CONCLUSIONS The decrease of butyrate-producing species and the increase of mucine-degrading species may represent hallmarks of the gut microbiota alterations in AN, and therefore potentially interesting therapeutic targets. The heterogeneity of clinical and methodological characteristics hampers the generalizability of the results. Standardized research methods could improve comparability among studies to better identify the alterations of gut microbiota in AN.
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Pipe A, Patterson B, Van Ameringen M. Binge eating disorder hidden behind a wall of anxiety disorders. J Psychiatry Neurosci 2021; 46:E208-E209. [PMID: 33667054 PMCID: PMC8061740 DOI: 10.1503/jpn.200235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Amy Pipe
- From the School of Medicine, University College Cork, Cork, Ireland (Pipe); the MacAnxiety Research Centre, McMaster University, Hamilton, Ont., Canada (Patterson); and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ont., Canada (Van Ameringen)
| | - Beth Patterson
- From the School of Medicine, University College Cork, Cork, Ireland (Pipe); the MacAnxiety Research Centre, McMaster University, Hamilton, Ont., Canada (Patterson); and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ont., Canada (Van Ameringen)
| | - Michael Van Ameringen
- From the School of Medicine, University College Cork, Cork, Ireland (Pipe); the MacAnxiety Research Centre, McMaster University, Hamilton, Ont., Canada (Patterson); and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ont., Canada (Van Ameringen)
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Nutritional status and anxious and depressive symptoms in anorexia nervosa: a prospective study. Sci Rep 2021; 11:771. [PMID: 33436652 PMCID: PMC7804178 DOI: 10.1038/s41598-020-79410-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive-compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.
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Bryant E, Miskovic-Wheatley J, Touyz S, Crosby RD, Koreshe E, Cao L, Maguire S. Transitioning to digital first line intervention - validation of a brief online screener for early identification of a suspected eating disorder: study protocol. J Eat Disord 2020; 8:60. [PMID: 33292579 PMCID: PMC7657667 DOI: 10.1186/s40337-020-00339-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Only one in four people with eating disorders seeks treatment, and of those who do seek treatment, 20% go on to experience a chronic course. Early intervention has been associated with better prognosis, with those seeking specialised intervention in the early stages of their illness more than twice as likely to achieve remission. Current screening measures typically require expert administration and are rarely validated across a spectrum of DSM-5 eating disorder presentations or for online use. In light of COVID-19 and increasing reliance on telehealth technologies in the intervention and delivery of mental health services, online assessments suitable for self-referral are likely to be the first step to seeking care. InsideOut Institute has developed a 6-item online screening tool for the purposes of identifying eating disorder risk and symptomatology, aimed specifically at increasing help-seeking behaviour in subsyndromal and early presentations. METHODS This study investigates the reliability and validity of the InsideOut Institute Screener (IOI-S), using a cross-sectional survey research design. Participants aged 14 and over will complete an extensive baseline survey battery for evaluation. 50% of participants will be randomly selected for one follow-up re-test of the IOI-S only, 2 weeks post initial testing. The IOI-S will be analysed for statistical reliability on two parameters: internal consistency and test re-test reliability, and for statistical validity on four parameters: concurrent validity, sensitivity and specificity, convergent and discriminant validity. DISCUSSION The rapid and ongoing shift to digital intervention has highlighted gaps and opportunities in our pathways to care. Adequate screening for eating disorders is a major gap. This study aims to validate an online screening tool for use in telehealth early intervention, designed for users seeking information for a suspected eating disorder. The screener meets those at risk 'where they are' (i.e. online) and may improve timely referrals to relevant services. This is of particular salience as face-to-face healthcare and traditional frontline interventions are disrupted, and we are challenged to re-design our practices to deliver diagnostic and treatment services in highly adaptive digital contexts.
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Affiliation(s)
- Emma Bryant
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Eyza Koreshe
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
| | - Li Cao
- Sanford Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
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Dubois JS, Altieri T, Schembri A. Thinking yourself fat: The perceived relationship between thoughts and body shape. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Juliett S. Dubois
- School of Health Sciences, Discipline of Psychology, RMIT University, Bundoora Campus, Bundoora, Victoria, Australia,
| | - Trish Altieri
- School of Health Sciences, Discipline of Psychology, RMIT University, Bundoora Campus, Bundoora, Victoria, Australia,
| | - Adrian Schembri
- School of Health Sciences, Discipline of Psychology, RMIT University, Bundoora Campus, Bundoora, Victoria, Australia,
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Kern L, Morvan Y, Mattar L, Molina E, Tailhardat L, Peguet A, De Tournemire R, Hirot F, Rizk M, Godart N, Fautrelle L. Development and evaluation of an adapted physical activity program in anorexia nervosa inpatients: A pilot study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:687-700. [PMID: 32969104 DOI: 10.1002/erv.2779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND CONTEXT Problematic use of physical activity is frequent in subjects with anorexia nervosa (AN). Although it increases resistance to therapeutic treatment, paradoxically, physical activity in AN can also improve mental and physical health. Based on the literature review we hypothesized that adding an adapted physical activity (APA) program to treatment programs could be more beneficial than a total suppression of physical activities. We designed this open study to evaluate the outcome of AN inpatients after an APA program implementation as well as the perceived effect of APA. METHOD Forty-one women with AN (17.2 (±2.5) years old, BMI of 16.86 (±2.0)) were included. An eight-session (1 h30/session/week) standardized APA program was delivered and evaluated by structured questionnaires assessing exercise dependence, perceived physical activity, eating disorder (ED) symptoms, body mass index (BMI), along with an interview before and after the APA program. RESULTS Twenty-nine women complete the PA program and evaluation. BMI and perceived PA score significantly increased, ED and exercise dependence scores significantly decreased (p < .01). Participants appreciated the program. DISCUSSION/CONCLUSION The inpatient program which included APA program helped AN inpatients in decreasing their ED symptoms and their dependence to PA, without any deleterious effect on BMI. Furthermore, APA was appreciated by participants.
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Affiliation(s)
- Laurence Kern
- EA 2931, LINP2-APSA, Université Paris Nanterre, Nanterre, France.,EA 4430 CLIPSYD Clinique Psychanalyse Développement, Université Paris Nanterre, Nanterre, France
| | - Yannick Morvan
- EA 4430 CLIPSYD Clinique Psychanalyse Développement, Université Paris Nanterre, Nanterre, France.,IPNP-INSERM UMR 1266, LPMP, Université de Paris, Paris, France.,SHU-C3RP, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Lama Mattar
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
| | - Estelle Molina
- EA 4430 CLIPSYD Clinique Psychanalyse Développement, Université Paris Nanterre, Nanterre, France
| | - Laura Tailhardat
- EA 2931, LINP2-APSA, Université Paris Nanterre, Nanterre, France
| | - Amandine Peguet
- EA 2931, LINP2-APSA, Université Paris Nanterre, Nanterre, France
| | | | - France Hirot
- Service hospitalo-universitaire de santé mentale de l'adolescent et du jeune adulte de la FSEF Paris, Paris, France
| | - Melissa Rizk
- INSERM U1178, Maison de Solenn, Paris, France.,Université Paris-Sud and Université Paris Descartes, Ecole Doctorale des 3C (Cerveau, Cognition, Comportement), UMR-S0669, Paris, France.,Psychiatry Unit, Institut Mutualiste Montsouris 42, Paris, France
| | - Natalie Godart
- Service hospitalo-universitaire de santé mentale de l'adolescent et du jeune adulte de la FSEF Paris, Paris, France.,CESP, INSERM, UVSQ, Université Paris-Saclay, Villejuif, France.,UFR sciences de la santé Simone Veil UVSQ, Montigny le Bretonneux, France
| | - Lilian Fautrelle
- Institut National Universitaire Champollion, STAPS, Équipe Interdisciplinaire en Activités Physiques, Rodez, France.,Laboratoire ToNIC, Toulouse NeuroImaging Center, UMR 1214, INSERM, CHU Purpan, UPS, Toulouse, France
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Yilmaz Z, Halvorsen M, Bryois J, Yu D, Thornton LM, Zerwas S, Micali N, Moessner R, Burton CL, Zai G, Erdman L, Kas MJ, Arnold PD, Davis LK, Knowles JA, Breen G, Scharf JM, Nestadt G, Mathews CA, Bulik CM, Mattheisen M, Crowley JJ. Examination of the shared genetic basis of anorexia nervosa and obsessive-compulsive disorder. Mol Psychiatry 2020; 25:2036-2046. [PMID: 30087453 PMCID: PMC6367065 DOI: 10.1038/s41380-018-0115-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/16/2018] [Accepted: 05/25/2018] [Indexed: 12/22/2022]
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are often comorbid and likely to share genetic risk factors. Hence, we examine their shared genetic background using a cross-disorder GWAS meta-analysis of 3495 AN cases, 2688 OCD cases, and 18,013 controls. We confirmed a high genetic correlation between AN and OCD (rg = 0.49 ± 0.13, p = 9.07 × 10-7) and a sizable SNP heritability (SNP h2 = 0.21 ± 0.02) for the cross-disorder phenotype. Although no individual loci reached genome-wide significance, the cross-disorder phenotype showed strong positive genetic correlations with other psychiatric phenotypes (e.g., rg = 0.36 with bipolar disorder and 0.34 with neuroticism) and negative genetic correlations with metabolic phenotypes (e.g., rg = -0.25 with body mass index and -0.20 with triglycerides). Follow-up analyses revealed that although AN and OCD overlap heavily in their shared risk with other psychiatric phenotypes, the relationship with metabolic and anthropometric traits is markedly stronger for AN than for OCD. We further tested whether shared genetic risk for AN/OCD was associated with particular tissue or cell-type gene expression patterns and found that the basal ganglia and medium spiny neurons were most enriched for AN-OCD risk, consistent with neurobiological findings for both disorders. Our results confirm and extend genetic epidemiological findings of shared risk between AN and OCD and suggest that larger GWASs are warranted.
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Affiliation(s)
- Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julien Bryois
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Dongmei Yu
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- UCL Institute of Child Health, UCL, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rainald Moessner
- Department of Psychiatry and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Christie L Burton
- Genetics & Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gwyneth Zai
- Neurogenetics Section, Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lauren Erdman
- Genetics & Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martien J Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul D Arnold
- Genetics & Genome Biology, The Hospital for Sick Children, Toronto, ON, Canada
- Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James A Knowles
- SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | - Gerome Breen
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jeremiah M Scharf
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Science, Johns Hopkins University, Baltimore, MD, USA
| | - Carol A Mathews
- Department of Psychiatry, Genetics Institute, University of Florida, Gainesville, FL, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Manuel Mattheisen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- The Lundbeck Foundation Initiative of Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - James J Crowley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Sternheim L, Danner U, van Elburg A, Harrison A. Do anxiety, depression, and intolerance of uncertainty contribute to social problem solving in adult women with anorexia nervosa? Brain Behav 2020; 10:e01588. [PMID: 32270602 PMCID: PMC7303378 DOI: 10.1002/brb3.1588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/09/2019] [Accepted: 01/18/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Inefficient problem solving in the social domain may be one of the difficulties underlying the interpersonal challenges thought to maintain anorexia nervosa (AN). However, past studies have neglected to control for depression, anxiety, and intolerance of uncertainty (IU), which are known to contribute to social problem solving. METHODS This study aimed to investigate whether adults with AN would show differences in social problem solving on an experimental task (Means-End Problem Solving; MEPS) and report differences in their attitudes (positive, negative) toward social problem solving and their use of social problem-solving styles (rational, impulsive-careless, avoidant) on the Social Problem-Solving Inventory Revised (SPSRI) compared to a non-AN control group. RESULTS Seventy-four adult women took part (30 with AN and 44 non-AN controls), and data show that those with AN generated significantly less effective solutions on the MEPS (d = 1.96) reported overall poorer social problem solving on the SPSRI (d = 0.58), reporting more negative and less positive attitudes toward social problem solving, and less impulsive and more avoidant social problem-solving styles. However, those with AN did not differ from controls in being able to rationalize social problems. Once depression (Beck Depression Inventory: BDI), state anxiety (State-Trait Anxiety Inventory: STAI), and IU (Intolerance of Uncertainty Scale-12; IUS-12) were included as covariates, these differences were no longer significant, suggesting that comorbid depression, anxiety, and IU symptoms may contribute to social problem solving in AN. CONCLUSIONS There was no specific effect of depression. Treating anxiety and IU might help to improve social problem solving and enable people with AN to be able to better access social support to aid their recovery.
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Affiliation(s)
- Lot Sternheim
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
| | - Unna Danner
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
- Altrecht Eating Disorders RintveldZeistThe Netherlands
| | - Annemarie van Elburg
- Department of Clinical PsychologyUniversiteit UtrechtUtrechtThe Netherlands
- Altrecht Eating Disorders RintveldZeistThe Netherlands
- Trimbos Institute NetherlandsUtrechtThe Netherlands
| | - Amy Harrison
- Department of Psychology and Human DevelopmentInstitute of EducationUniversity College LondonLondonUK
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Binge eating and social anxiety in treatment-seeking adolescents with eating disorders or severe obesity. Eat Weight Disord 2020; 25:787-793. [PMID: 31020481 DOI: 10.1007/s40519-019-00689-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/09/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Binge eating is a common behavior in children and adolescents who suffer from either eating disorders (EDs) or from severe obesity. The purpose of the current study was to explore the association between social anxiety and binge eating and compare prevalence rates of social anxiety between youth with severe obesity or EDs who did or did not engage in binge eating. METHODS Retrospective data on treatment-seeking youth's (n = 490) eating behaviors and social anxiety at assessment were analyzed. RESULTS Results indicate that those who engage in binge eating have higher rates of social anxiety; frequency of binges does not predict severity of social anxiety, though social anxiety predicts presence of binge eating. Adolescents with EDs had higher rates of social anxiety than those with obesity, and for both groups, rates of social anxiety were highest in those who binge. CONCLUSIONS Clinicians who treat youth with EDs and with obesity should be aware of the relationship between binge eating and social anxiety and of the need for treatment to address both these disorders. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Reid M, Wilson-Walsh R, Cartwright L, Hammersley R. Stuffing down feelings: Bereavement, anxiety and emotional detachment in the life stories of people with eating disorders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:979-987. [PMID: 31840343 DOI: 10.1111/hsc.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to explore the life stories of people with eating disorders (EDs) in order to better understand possible contributing factors to their development. It used a qualitative Life Story method, in order to reduce the tendency to focus on the negative in the lives of people with EDs. Sixteen people in contact with an EDs charity participated. Data were analysed using a thematic analysis. Despite the attempt to elicit both positive and negative information, most themes from the life stories were negative. Here, the focus is on the three most common themes reported, which are less often reported in previous research: (a) substantial bereavement and loss; (b) major issues with anxiety and (c) difficulties coping with emotions. A model is proposed whereby major losses and the resultant anxiety can lead to emotional deadening and 'stuffing down feelings' with food, leading on to an ED. This model implies that interventions need to consider psychological factors in an ED, especially the use of it as a dysfunctional coping strategy, as well as the behavioural and physiological aspects of an ED.
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Affiliation(s)
- Marie Reid
- Department of Psychology, University of Hull, Hull, UK
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Lee EB, Barney JL, Twohig MP, Lensegrav-Benson T, Quakenbush B. Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes. Eat Behav 2020; 37:101386. [PMID: 32388080 DOI: 10.1016/j.eatbeh.2020.101386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
Obsessive Compulsive Disorder (OCD) is among the most common psychiatric comorbidities with eating disorders (EDs) and most studies have only examined this relationship at a diagnostic level. More research is needed to determine whether specific symptom domains and cognitive patterns commonly observed in OCD are most salient among individuals with clinically significant EDs, and whether these symptoms appear to change and/or influence treatment outcomes. Thought Action Fusion (TAF) is one cognitive pattern that may underlie OCD-ED comorbidity. The current study assessed 112 adolescent and adult female patients at a residential ED treatment facility on levels of ED severity, OCD symptom severity, and TAF at pre- and post-treatment. All OCD symptom dimensions were positively correlated with ED severity at pretreatment, with Obsessing, Neutralizing and Ordering OCD symptoms being most elevated. TAF was also positively correlated with ED severity at pre-treatment, and higher levels of TAF at pretreatment significantly predicted greater ED severity at post-treatment after controlling for all other OCD symptoms. Improvements in TAF specific to thoughts about others also predicted improvements in ED severity after controlling for changes in OCD symptoms. Clinically, these results indicate that efforts targeting specific OCD symptom dimensions and TAF in addition to ED-focused treatment as usual may be beneficial for enhancing overall treatment outcomes.
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Affiliation(s)
- Eric B Lee
- Utah State University, United States of America
| | | | | | | | - Benita Quakenbush
- Avalon Hills Residential Treatment Facility, United States of America
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Schaumberg K, Wonderlich S, Crosby R, Peterson C, Le Grange D, Mitchell JE, Crow S, Joiner T, Bardone-Cone AM. Impulsivity and anxiety-related dimensions in adults with bulimic-spectrum disorders differentially relate to eating disordered behaviors. Eat Behav 2020; 37:101382. [PMID: 32247895 PMCID: PMC7259439 DOI: 10.1016/j.eatbeh.2020.101382] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023]
Abstract
While facets of both anxiety and impulsivity appear central to the development and maintenance of bulimia nervosa (BN), specific BN behaviors may be propagated by differing profiles of risk. The current study examined associations between dimensions of anxiety and impulsivity and BN symptoms (binge eating, vomiting, laxative misuse, driven exercise), both in terms of the presence of such behaviors and their frequency. Two hundred and four women (Mage = 25.7 years) who met DSM-IV criteria for full or subthreshold BN completed self-report measures of perfectionism (Frost Multidimensional Perfectionism Scale), anxiety (Spielberger Trait Anxiety Inventory), impulsivity (Barratt Impulsiveness Scale-11; Impulsive Behavior Scale), eating disordered behaviors (Eating Disorder Examination - Questionnaire), and associated psychiatric symptoms (Michigan Assessment Screening Test/Alcohol-Drug; Maudsley Obsessive-Compulsive Inventory). Factor analysis revealed multidimensional impulsive and anxiety-related traits (5 anxiety-related factors; 7 impulsivity-related factors). In zero-sensitive regression models, different facets of impulsivity evidenced association with the presence of binge eating (risk taking), laxative misuse (impulsive spending), and fasting (difficulty concentrating), along with the frequency of vomiting (long-term planning difficulties). In contrast, anxiety-related dimensions were only associated with driven exercise (high standards) and fasting (concern over mistakes, high standards, parental expectations). Overall, impulsive and anxiety-related factors and symptoms showed distinct associations with specific eating disorder behaviors, even among those with the same diagnosis.
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Affiliation(s)
| | | | - Ross Crosby
- Biobehavioral Research Institute, Sanford Health
| | | | - Daniel Le Grange
- University of California, San Francisco,The University of Chicago
| | | | - Scott Crow
- University of Minnesota, Department of Psychiatry
| | | | - Anna M. Bardone-Cone
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience
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Marzola E, Porliod A, Panero M, De-Bacco C, Abbate-Daga G. Affective temperaments and eating psychopathology in anorexia nervosa: Which role for anxious and depressive traits? J Affect Disord 2020; 266:374-380. [PMID: 32056902 DOI: 10.1016/j.jad.2020.01.142] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/09/2019] [Accepted: 01/25/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe mental illness. Personality traits and comorbidity with affective and anxiety disorders are key-aspects of its pathogenesis but little attention has been paid so far to affective temperaments in AN. Also, childhood anxiety is proposed to impact on AN clinical severity. Therefore, we aimed to investigate if affective temperaments could be related to AN eating psychopathology also clarifying if those with low versus high scores on depressive and anxious temperaments could differ in AN clinical current and lifetime severity. METHODS One-hundred and forty-seven inpatients with AN were consecutively recruited. All participants completed: Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire, Eating Disorder Examination Questionnaire, State Trait Anxiety Inventory, Beck Depression Inventory. Clinical data were collected upon admission. RESULTS Regression models showed that all affective temperaments were associated with eating psychopathology (eating restraint and eating, shape, and weight concerns); however, when controlling for confounders, only the anxious temperament remained significant. Also, those patients with higher scores on depressive and anxious temperaments reported higher current and lowest lifetime body mass index (BMI). LIMITATIONS Only inpatients were recruited; self-report assessments were used and follow-up data are lacking. CONCLUSIONS Results from this study support the association between affective (anxious in particular) temperament traits and the presence of altered eating psychopathology in AN. Also, higher traits of depressive and anxious temperaments reported higher current and lowest lifetime BMI. Should these findings be confirmed, the assessment of the anxious temperament could fruitfully inform prevention and treatment interventions for AN.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Alain Porliod
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Carlotta De-Bacco
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Bang L, Kristensen UB, Wisting L, Stedal K, Garte M, Minde Å, Rø Ø. Presence of eating disorder symptoms in patients with obsessive-compulsive disorder. BMC Psychiatry 2020; 20:36. [PMID: 32000754 PMCID: PMC6993325 DOI: 10.1186/s12888-020-2457-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is common in patients with eating disorders (EDs). There is a lack of research investigating the presence of ED symptoms among patients with OCD, despite concerns that many of these patients may be at high risk for EDs. Our objective was to assess the presence of ED symptoms in patients receiving treatment for OCD. METHODS Adult patients with OCD (n = 132, 71% females) and controls (n = 260, 90% females) completed the Eating Disorder Examination-Questionnaire (EDE-Q) at admission to a specialized OCD outpatient unit. A small subset of patients (n = 22) also completed the EDE-Q 3-months after end of treatment. RESULTS At the group-level, mean EDE-Q scores did not differ significantly between female patients and controls. However, female patients compared to controls were significantly more likely to score above the EDE-Q cut-off (23% vs. 11%) and have a probable ED (9% vs. 1%), indicating elevated rates of ED symptoms in the clinical range. There was no evidence of elevated rates of ED symptoms in male patients, though sample sizes were small. Preliminary follow-up data showed that certain ED symptoms improved significantly from admission to 3-month follow-up. CONCLUSIONS Our findings suggest that while ED symptoms are not generally elevated in female patients with OCD, a considerable subset of female patients may have a clinical ED or be at high risk of developing one. Clinicians should be alert to ED symptoms in female patients with OCD, and our findings raise the issue of whether ED screening of female patients with OCD is warranted.
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Affiliation(s)
- Lasse Bang
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424, Oslo, Norway.
| | - Unn Beate Kristensen
- 0000 0004 0389 8485grid.55325.34Specialized out-patient unit for OCD-spectrum Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Line Wisting
- 0000 0004 0389 8485grid.55325.34Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Kristin Stedal
- 0000 0004 0389 8485grid.55325.34Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Marianne Garte
- 0000 0004 0389 8485grid.55325.34Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway
| | - Åse Minde
- 0000 0004 0389 8485grid.55325.34Specialized Outpatient Unit for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- 0000 0004 0389 8485grid.55325.34Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway ,0000 0004 1936 8921grid.5510.1Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Lock J, Nicholls D. Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa. Front Psychiatry 2020; 10:968. [PMID: 32038319 PMCID: PMC6993050 DOI: 10.3389/fpsyt.2019.00968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/09/2019] [Indexed: 01/30/2023] Open
Abstract
Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT.
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Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Melissa R, Lama M, Laurence K, Sylvie B, Jeanne D, Odile V, Nathalie G. Physical Activity in Eating Disorders: A Systematic Review. Nutrients 2020; 12:nu12010183. [PMID: 31936525 PMCID: PMC7019575 DOI: 10.3390/nu12010183] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022] Open
Abstract
Abnormally high levels of physical activity have been documented throughout the literature in patients with eating disorders (ED), especially those diagnosed with anorexia nervosa (AN). Yet no clear definition, conceptualization, or treatment of the problematic use of physical activity (PPA) in ED patients exists. The aim of this review is to propose a new classification of PPA, report the prevalence, triggers, predictors, maintainers and other related factors of PPA in ED patients, in addition to proposing a comprehensive model of the development of PPA in AN. A total of 47 articles, retrieved from Medline and Web of Science, met the inclusion criteria and were included in the analysis. As a result, the new approach of PPA was divided into two groups (group 1 and group 2) according to the dimension (quantitative vs qualitative approach) of physical activity that was evaluated. The prevalence of PPA in ED was reported in 20 out of 47 studies, the comparison of PPA between ED versus controls in 21 articles, and the links between PPA and psychological factors in ED in 26 articles, including depression (16/26), anxiety (13/26), obsessive–compulsiveness (9/26), self-esteem (4/26), addictiveness (1/26), regulation and verbal expression of emotions (1/26) and anhedonia (1/26). The links between PPA and ED symptomatology, PPA and weight, body mass index (BMI) and body composition in ED, PPA and age, onset, illness duration and lifetime activity status in ED, PPA and ED treatment outcome were reported in 18, 15, 7, 5 articles, respectively. All of the factors have been systematically clustered into group 1 and group 2. Results focused more on AN rather than BN due to the limited studies on the latter. Additionally, a model for the development of PPA in AN patients was proposed, encompassing five periods evolving into three clinical stages. Thus, two very opposite components of PPA in AN were suggested: voluntarily PPA increased in AN was viewed as a conscious strategy to maximize weight loss, while involuntarily PPA increased proportionally with weight-loss, indicating that exercise might be under the control of a subconscious biological drive and involuntary cognition.
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Affiliation(s)
- Rizk Melissa
- INSERM U1178, Maison de Solenn, 97 Boulevard De Port Royal, 75014 Paris, France;
- Université Paris-Sud and Université Paris Descartes, Ecole Doctorale des 3C (Cerveau, Cognition, Comportement), UMR-S0669, 75006 Paris, France
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
- Correspondence: ; Tel.: +33-787-483626
| | - Mattar Lama
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut 1102, Lebanon;
| | - Kern Laurence
- Laboratoire EA 29 31, LINP2-APSA, et Laboratoire EA 4430 CLIPSYD Université Paris Nanterre UFR-STAPS, 200, Avenue de la République, 92001 Nanterre CEDEX, France
| | - Berthoz Sylvie
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
- INCIA UMR-5287 CNRS, Université de Bordeaux, 33076 Bordeaux, France
| | - Duclos Jeanne
- Sciences Cognitives et Sciences Affectives, Université de Lille, CNRS, UMR 9193—SCALab, 59045 Lille, France;
- Département de Psychiatrie, Hôpital Saint Vincent de Paul, GHICL, F-59000 Lille, France
| | - Viltart Odile
- Institute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, 75014 Paris, France;
- Department of Biology, University of Lille, 59000 Lille, France
| | - Godart Nathalie
- INSERM U1178, Maison de Solenn, 97 Boulevard De Port Royal, 75014 Paris, France;
- Psychiatry Unit, Institut Mutualiste Montsouris 42, Boulevard Jourdan, 75014 Paris, France;
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45
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Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis. J Clin Psychol Med Settings 2019; 28:40-52. [DOI: 10.1007/s10880-019-09685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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46
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Kinnaird E, Sedgewick F, Stewart C, Tchanturia K. Exploring Self-Reported Eating Disorder Symptoms in Autistic Men. AUTISM IN ADULTHOOD 2019; 1:306-310. [PMID: 36601317 PMCID: PMC8992817 DOI: 10.1089/aut.2019.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although research suggests a relationship between restrictive eating disorders (EDs) and autism, there is a lack of research in this area from the perspective of autistic men. Our aim was to explore whether ED symptoms are heightened in autistic men compared with nonautistic men. Methods We recruited 103 autistic and nonautistic participants through an online study. We assessed ED symptoms, autistic features, anxiety, depression, and body mass index (BMI) using self-report measures. Results Autistic men (n = 54) exhibited significantly higher levels of ED symptoms in the areas of eating (p < 0.001), shape (p = 0.005), and weight (p = 0.001) concerns, and the global score (p = 0.046) than nonautistic men (n = 49). However, autistic men scored significantly lower in the area of dietary restraint (p = 0.032). Global ED scores did not correlate with autistic traits, but did correlate with anxiety (p < 0.001) and BMI (p < 0.001) in the autistic group. Conclusions This exploratory study suggests that heightened ED symptoms in autistic men may be related to heightened levels of anxiety and higher BMIs, rather than autistic traits. It also highlights that autistic men may experience symptoms not relating to dietary restraint. Future research should consider further exploring the relationship between anxiety, BMI, and disordered eating in autism. Lay Summary Why was this study done?: There is a lot of interest in the relationship between autism and eating disorders (EDs). Research suggests that as many as one in four people with anorexia could be autistic. However, most research has been done (1) on women and (2) looking at autistic traits in women with anorexia. There is less research looking at the relationship from the perspective (1) of men and (2) looking at ED symptoms in autistic people.What was the purpose of this study?: We aimed to explore whether autistic men experience more ED symptoms than nonautistic men.What did the researchers do?: This was an online study. We asked participants to fill out self-report measures of autistic traits and ED symptoms. We also asked participants to self-report whether they were autistic, and whether they had been previously diagnosed with an ED. We included 54 autistic men and 49 nonautistic men.What were the results of the study?: We found that although autistic men did experience higher levels of ED symptoms than nonautistic men, this did not appear to be related to autistic traits. Instead ED symptoms were related to anxiety and higher rates of being overweight or obese. In addition, autistic men in fact experienced significantly lower levels of ED symptoms associated with dietary restraint than nonautistic men.What do these findings add to what was already known?: Our findings reflect some previous research findings that ED symptoms may be heightened in autistic people. They also suggest that these symptoms are related to higher levels of anxiety or body mass indexes (BMIs) in autistic people, rather than autistic traits themselves. Also, most previous research has focused on symptoms of restraint in EDs and autism, for example, limiting the amount you eat or not eating certain foods. In our study, restraint was not found to be heightened, suggesting that focusing on restraint symptoms might be less relevant to autistic men.What are potential weaknesses in the study?: One key weakness is our use of self-report measures, particularly asking participants to self-report their autism diagnosis. An additional limitation is the small sample size, which makes it hard to generalize findings.How will these findings help autistic adults now or in the future?: More research is needed to understand the relationship between anxiety, BMI, autism, and ED symptoms. Our findings could help our understanding of disordered eating in autistic adults as they suggest we need to pay more attention to autistic adults experiencing ED symptoms that are not related to dietary restriction, such as binge eating.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Felicity Sedgewick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Catherine Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Illia State University, Tbilisi, Georgia
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47
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Kimball A, Schorr M, Meenaghan E, Bachmann KN, Eddy KT, Misra M, Lawson EA, Kreiger-Benson E, Herzog DB, Koman S, Keane RJ, Ebrahimi S, Schoenfeld D, Klibanski A, Miller KK. A Randomized Placebo-Controlled Trial of Low-Dose Testosterone Therapy in Women With Anorexia Nervosa. J Clin Endocrinol Metab 2019; 104:4347-4355. [PMID: 31219558 PMCID: PMC6736210 DOI: 10.1210/jc.2019-00828] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Anorexia nervosa (AN) is a psychiatric illness with considerable morbidity and no approved medical therapies. We have shown that relative androgen deficiency in AN is associated with greater depression and anxiety symptom severity. OBJECTIVE To determine whether low-dose testosterone therapy is an effective endocrine-targeted therapy for AN. DESIGN Double-blind, randomized, placebo-controlled trial. SETTING Clinical research center. PARTICIPANTS Ninety women, 18 to 45 years, with AN and free testosterone levels below the median for healthy women. INTERVENTION Transdermal testosterone, 300 μg daily, or placebo patch for 24 weeks. MAIN OUTCOME MEASURES Primary end point: body mass index (BMI). Secondary end points: depression symptom severity [Hamilton Depression Rating Scale (HAM-D)], anxiety symptom severity [Hamilton Anxiety Rating Scale (HAM-A)], and eating disorder psychopathology and behaviors. RESULTS Mean BMI increased by 0.0 ± 1.0 kg/m2 in the testosterone group and 0.5 ± 1.1 kg/m2 in the placebo group (P = 0.03) over 24 weeks. At 4 weeks, there was a trend toward a greater decrease in HAM-D score (P = 0.09) in the testosterone vs placebo group. At 24 weeks, mean HAM-D and HAM-A scores decreased similarly in both groups [HAM-D: -2.9 ± 4.9 (testosterone) vs -3.0 ± 5.0 (placebo), P = 0.72; HAM-A: -4.5 ± 5.3 (testosterone) vs -4.3 ± 4.4 (placebo), P = 0.25]. There were no significant differences in eating disorder scores between groups. Testosterone therapy was safe and well tolerated with no increase in androgenic side effects compared with placebo. CONCLUSION Low-dose testosterone therapy for 24 weeks was associated with less weight gain-and did not lead to sustained improvements in depression, anxiety, or disordered eating symptoms-compared with placebo in women with AN.
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Affiliation(s)
- Allison Kimball
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Katherine N Bachmann
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kamryn T Eddy
- Harvard Medical School, Boston, Massachusetts
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Seda Ebrahimi
- Cambridge Eating Disorder Center, Cambridge, Massachusetts
| | - David Schoenfeld
- Harvard Medical School, Boston, Massachusetts
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Karen K. Miller, MD, Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 457B, Boston, Massachusetts 02114. E-mail:
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48
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Bezzina L, Touyz S, Young S, Foroughi N, Clemes S, Meyer C, Arcelus J, Madden S, Attia E, Pike KM, Hay P. Accuracy of self-reported physical activity in patients with anorexia nervosa: links with clinical features. J Eat Disord 2019; 7:28. [PMID: 31463050 PMCID: PMC6706937 DOI: 10.1186/s40337-019-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND High levels of physical activity (PA) have long been described in patients with Anorexia Nervosa (AN). Despite the importance of measuring PA in this population, there are two important factors that remain unknown. First, it is not clear how accurate self-report measures of PA are among patients. Second, little is known about how clinical characteristics are associated with the accuracy of self-reported PA. Therefore, this study aimed to examine the accuracy of self-reported PA compared to an objective measure of PA in patients with AN. It also investigated whether levels of accuracy/inaccuracy were associated with compulsive exercise, motivation to change, and psychological distress. METHOD Data were analysed from 34 adult outpatients with AN. Patients wore an accelerometer device (ActiGraph) for 4 days and completed a retrospective self-report measure of exercise (Exercise Participation Screening Questionnaire). They also completed measures of compulsive exercise (Compulsive Exercise Test), motivation to change (The Anorexia Nervosa Stages of Change Questionnaire), and psychological distress (Kessler-10). RESULTS On the self-report measure, patients accurately reported their time spent in moderate and vigorous intensity PA, however, they significantly under-reported their light physical activity (compared to the accelerometer data). Accurate reporting of total PA was positively associated with higher levels of compulsive exercise. There was evidence to suggest that clinical features, such as motivation to change and psychological distress, may be associated with inaccurate reporting at some levels of PA intensity and not others. CONCLUSIONS Results indicate that patients with AN are likely to under-report their light intensity PA. We also found preliminary evidence for how compulsive exercise, motivation to change, and distress are associated with self-reported PA accuracy. Clinical implications and directions for future research are considered. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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Affiliation(s)
| | | | | | - Nasim Foroughi
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | | | | | | | | | | | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, South NSW 2715 Australia
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49
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Tomba E, Tecuta L, Crocetti E, Squarcio F, Tomei G. Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta-analysis. Int J Eat Disord 2019; 52:759-776. [PMID: 31169332 DOI: 10.1002/eat.23095] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In psychiatry, the presence of residual symptoms after treatment is linked to the definitions of remission and recovery. To identify the presence of residual eating disorder (ED) symptoms and associated non-ED clinical features in remitted and recovered EDs, the current systematic review with meta-analysis was performed. METHOD A systematic review was conducted on residual ED symptoms and non-ED clinical features including comorbid psychopathology, neurophysiological functioning, cognitive functioning, and quality of life in ED patients considered remitted or recovered. To examine residual ED symptoms, meta-analyses were performed while considering age, study quality, remission, and recovery criteria strictness as moderators. Sensitivity, publication bias, and heterogeneity analyses were also conducted. RESULTS The 64 studies selected for the systematic review underscored the presence of residual ED symptoms in anorexia nervosa (AN) and bulimia nervosa (BN), and impairments and deficits in the additional features examined. From the 64 studies, 31 were selected regarding residual ED symptoms in AN for meta-analysis. Large effect sizes indicated that remitted/recovered AN patients reported significantly lower body mass index (Hedges' g = -0.62[-0.77, -0.46]) and significantly greater symptomatology in terms of ED examination-questionnaire (Hedges'g = 0.86 [0.48,1.23]) and ED inventory (Hedges' g = 0.94[0.64,1.24]) than healthy controls, independently of remission and recovery criteria strictness, age, and study quality. DISCUSSION The presence of residual ED symptoms in AN is quantitatively supported, whereas the presence of residual ED symptoms in BN should be further investigated. Data on binge-eating disorder are missing. Future research should use consistent, multicomponent, and standardized comparable indicators of recovery.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Fabio Squarcio
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuliano Tomei
- Oxford Health NHS Foundation Trust, Department of Psychiatry, University of Oxford, Oxford, UK
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50
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Carrot B, Duclos J, Barry C, Radon L, Maria AS, Kaganski I, Jeremic Z, Barton-Clegg V, Corcos M, Lasfar M, Gerardin P, Harf A, Moro MR, Blanchet C, Godart N. Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study. Trials 2019; 20:249. [PMID: 31039797 PMCID: PMC6492384 DOI: 10.1186/s13063-019-3347-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/03/2019] [Indexed: 12/16/2022] Open
Abstract
Background Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. Methods One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. Discussion We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. Trial registration ClinicalTrials.gov, NCT03350594. Registered on 22 November 2017. IDRCB number 2016-A00818-43. Electronic supplementary material The online version of this article (10.1186/s13063-019-3347-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Carrot
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Jeanne Duclos
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Cognitive and Affective Sciences, F-59000 Lille, France.
| | - Caroline Barry
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Leslie Radon
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Addiction, Eating Disorders Unit, Paul Brousse Hospital, Villejuif, France
| | - Anne-Solène Maria
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France
| | - Irène Kaganski
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Zorica Jeremic
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | | | - Maurice Corcos
- Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France
| | - Malaïka Lasfar
- Department of Medical Pediatrics and Child and Adolescent Psychiatry, Rouen University Hospital and Rouvray Hospital, University of Rouen, Rouen, France
| | - Priscille Gerardin
- Department of Medical Pediatrics and Child and Adolescent Psychiatry, Rouen University Hospital and Rouvray Hospital, University of Rouen, Rouen, France
| | - Aurélie Harf
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Marie-Rose Moro
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Corinne Blanchet
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France.,Maison de Solenn, Maison des Adolescents, Hôpital Cochin, Paris, France
| | - Nathalie Godart
- CESP, INSERM, UMR 1018, University Paris-Sud, UVSQ, University Paris-Saclay, Villejuif, France.,UFR des Sciences de la Santé Simone Veil (UVSQ), Versailles, France.,Fondation de Santé des Etudiants de France, Paris, France
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