What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis

Understanding catastrophic worry in eating disorders: process and content characteristics

BACKGROUND AND OBJECTIVES

The majority of people with eating disorders (ED) experience high levels of comorbid anxiety and depression, yet the maintenance processes of these in ED remain largely unknown. Worry, a defining cognitive feature and important maintenance factor of anxiety, has not been well-studied amongst people with ED. This is the first study to explore both the process and content characteristics of catastrophic worry in ED.

METHODS

Twenty-nine patients with anorexia nervosa (AN), 15 patients with bulimia nervosa (BN) and 37 healthy controls (HC) completed measures assessing anxiety, depression, worry and eating disorder pathology. Catastrophic worry was assessed using the Catastrophizing Interview and catastrophic worry content was explored using qualitative Thematic Analysis.

RESULTS

Compared to HCs, ED groups had higher levels of anxiety, depression and worry and they generated a greater number of catastrophic worry steps. Worry was further found associated with depressive symptomatology in those with ED. Worry content for the ED groups included ED themes, but also themes reflecting broader inter and intrapersonal concerns.

LIMITATIONS

The degree to which worry is driven by depressive versus anxious symptomatology remains unclear. The current study does not include an anxious or depressed control group, and results should be considered in the light of relatively small samples sizes.

CONCLUSION

Findings indicate that interventions that target worry processes may be a useful adjunct to treatment for those ED patients with clinical worry levels.

Worry and Rumination in Anorexia Nervosa

Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.

Identity and eating disorders (IDEA): a questionnaire evaluating identity and embodiment in eating disorder patients

BACKGROUND

In this paper we tested the hypothesis that persons with eating disorders (EDs) are affected by disturbances of the way they experience their own body (embodiment) and shape their personal identity, assuming that the various kinds of anomalies of eating behavior are consequences thereof.

SAMPLING AND METHODS

We developed and validated a new self-reported questionnaire named IDEA (IDentity and EAting disorders), which was administered to 147 ED patients and 187 healthy controls. Test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity were evaluated. A factor analysis was performed to verify the distribution of items into subscales.

RESULTS

The questionnaire showed good test-retest reliability, and internal consistency. IDEA scores were specifically associated with ED psychopathology, and they did not show any correlation with sociodemographic and general clinical variables. Four factors were extracted, which were related to the following phenomena: 'feeling oneself only through the gaze of the other and defining oneself only through the evaluation of the other', 'feeling oneself only through objective measures', 'feeling extraneous from one's own body', and 'feeling oneself through starvation'.

CONCLUSIONS

IDEA represents a multidimensional, brief, versatile, easy-to-perform instrument for clinical evaluation, assessing abnormalities in lived corporeality, and of personal identity, which appeared to be specifically associated with the core features of ED psychopathology. The main limitations of the study are the cross-sectional design. Also, it is impossible to ascertain whether the domains we assessed are specific traits of patients with EDs, or state-related features. To answer this question, a longitudinal study is needed.

A meta-analysis of circulating BDNF concentrations in anorexia nervosa

OBJECTIVES

Brain derived neurotrophic factor (BDNF) is involved in neuroplasticity, and in the homeostatic regulation of food intake and energy expenditure. It also has a role in stress responsivity and reward processing. On the basis of its involvement in these various processes, BDNF can be hypothesized to be an important factor in the development and maintenance of anorexia nervosa (AN). This study meta-analytically summarizes investigations of serum BDNF concentrations in people currently ill with AN, in comparison to healthy controls.

METHODS

Seven studies measuring BDNF in serum of individuals with AN (n=155) and healthy controls (n=174) were identified and included in the meta-analysis of the mean differences between case and control groups.

RESULTS

This study confirms that AN is associated with decreased serum BDNF concentrations, in comparison to healthy controls. The combined effect size (standardized mean difference, SMD) was large (SMD=-0.96; 95% CI -1.33 to -0.59; P<0.001). Significant heterogeneity of effect sizes was identified (I(2)=58.3%; P<0.001), which emerged as being primarily attributable to the first published study on the investigated association.

CONCLUSIONS

The present meta-analytical summary of studies measuring circulating BDNF concentrations in women with AN and healthy controls confirms that it is significantly reduced in this patient group. Difficulties associated with the measurement of BDNF have been identified and potential confounding factors have been discussed. Current data do not allow inferences to be made about causal links between levels of circulating BDNF and AN. However, possible explanations for the relationship between BDNF and AN have been presented.

An experimental exploration of behavioral and cognitive-emotional aspects of intolerance of uncertainty in eating disorder patients

OBJECTIVE

Intolerance of uncertainty (IU) is an important concept in eating disorders (ED). Cognitive, emotional, and behavioral features of IU amongst individuals with and without ED were investigated.

METHOD

Participants completed the intolerance of uncertainty scale (IUS) and four versions of a data-gathering task varying in difficulty/uncertainty, and rated their Beads task experience.

RESULTS

ED groups had significantly higher IUS scores than healthy controls (HC). Bulimia Nervosa (BN) participants requested more cues than HC and Anorexia Nervosa (AN) participants before making decisions. ED groups found the task more distressing than HC participants, with those with BN feeling more uncertain and less confident in their decisions, and those with AN attributing greater importance in making the correct decision.

DISCUSSION

While both ED groups reported raised IUS scores only BN participants engaged in an elevated evidence requirement data gathering style. Future research might benefit from further exploration of the role of perseverative processes in BN.

Translating experimental neuroscience into treatment of eating disorders: two examples

Anorexia nervosa (AN) is a serious mental disorder with impaired functioning including not only the cognitive and socio-emotional but also physical domains. Improved treatments, especially for adults with AN, are urgently needed. The insights gained from basic research in experimental animal models and the advent of cognitive neuroscience have produced major advances in our understanding of the condition, but translating these into clinical research or practice remains a challenge. We describe here what the eating disorders field can gain from schizophrenia research in this area. We use the example of socio-emotional impairments in AN to describe the iterative process between basic research and intervention development for neurobiologically informed and based treatments for this condition and briefly touch on some other examples that stem from translational science.