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Katznelson H, Daniel SIF, Poulsen S, Lunn S, Buhl-Nielsen B, Sjögren JM. Disturbances in the experiences of embodiment related to attachment, mentalization and self-objectification in anorexia nervosa. J Eat Disord 2021; 9:137. [PMID: 34688309 PMCID: PMC8542305 DOI: 10.1186/s40337-021-00463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Body image disturbance is central to both the understanding and treatment of anorexia nervosa (AN); however, the underlying psychological processes involved are still not well understood. One way towards a better understanding of these mechanisms may be to explore the sense of embodiment in these patients in an attempt at integrating the role of the body in our understanding of the development of self in AN. It is hypothesized that difficulties in affective experiences of embodiment is related to insecure attachment, deficits in mentalization and self-objectification. METHODS Sixteen inpatients with AN were interviewed with the Mirror Interview (MI). In the interview, the individual is asked a set of questions related to thoughts and feelings about the body while standing in front of a full-length mirror. Furthermore, all patients were assessed with the Adult Attachment Interview, which was coded for both attachment and mentalization (operationalized by the Reflective Functioning scale; RF). Self-objectification was measured with the Objectified Body Consciousness Scale (OBCS). RESULTS Results from a multiple regression analysis showed that Global MI scores were significantly associated with Coherence of mind as an indicator of attachment, RF and scores on the OBCS. CONCLUSIONS The study suggests that affective experiences of embodiment in patients with AN are associated with negative attachment representations, mentalizing impairments and objectified body consciousness. Body image disturbance is a key diagnostic feature in anorexia nervosa but the underlying psychological processes are poorly understood. Recently, there has been a growing interest in how disturbances in the more psychological experience of the body (embodiment) in anorexia nervosa is related to both attachment, how individuals make sense of both themselves and others and the degree to which they tend to experience ourselves from the outside. In this pilot study, this was assessed with an innovative interview, the Mirror Interview, where the individual is asked a set of question while standing in front of a full length mirror. Results showed that difficulties in embodied experiences in patients with anorexia nervosa were related to more fundamental representations of self and self-objectification. This has potential implications for both the understanding and treatment of anorexia nervosa, as disturbances in body image may be seen as an underlying factor in the development of an eating disorder.
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Affiliation(s)
- Hannah Katznelson
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | | | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Bernadette Buhl-Nielsen
- Psychotherapy Clinic, Department of Child and Adolescent Psychiatry, Region Zealand, Denmark
| | - Jan Magnus Sjögren
- Unit for Eating Disorders, Capital Region of Copenhagen, Psychiatric Centre Ballerup, Ballerup, Denmark
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Sleep Quality and Eating Disorder-Related Psychopathologies in Patients with Night Eating Syndrome and Binge Eating Disorders. J Clin Med 2021; 10:jcm10194613. [PMID: 34640635 PMCID: PMC8509793 DOI: 10.3390/jcm10194613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: The sample was composed of 170 women, aged 18–68, who were referred for an ED assessment from 2011 to 2020. The participants were divided into three subgroups: NES-NI only (n = 30), NES+ binge eating (BE) (including binge eating disorders or bulimia nervosa (n = 52), and BE-only (n = 88). The measures consisted of a psychiatric evaluation, objective sleep monitoring measured by an actigraph for 1 week, a subjective sleep self-report, and ED-related psychopathology questionnaires. Results: Objective sleep monitoring revealed significant group differences, with higher sleep efficiency in participants with BE-only and longer sleep durations for the NES-NI only group. Subjectively, the BE-only group described a significantly lower sleep quality than either the NES-NI only or the NES+BE groups. ED-related psychopathology was lower in the NES-NI-only group. A stepwise linear regression revealed that general psychopathology (the brief symptom inventory total score) was a significant predictor of subjective sleep quality. Conclusion: NES-NI-only was correlated with less psychopathology, but with more subjective and objective sleep disturbances. These results lend weight to the supposition that NES lies on a continuum of ED psychopathologies, and that NES-NI-only appears to be a separate entity from NES+BE and BE-only in terms of its psychopathology.
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Auger N, Potter BJ, Ukah UV, Low N, Israël M, Steiger H, Healy‐Profitós J, Paradis G. Anorexia nervosa and the long-term risk of mortality in women. World Psychiatry 2021; 20:448-449. [PMID: 34505367 PMCID: PMC8429328 DOI: 10.1002/wps.20904] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Research CentreMontrealQC, Canada,Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada,Department of Social and Preventive MedicineSchool of Public Health, University of MontrealMontrealQC, Canada
| | - Brian J. Potter
- University of Montreal Hospital Research CentreMontrealQC, Canada,Division of Cardiology, Department of MedicineUniversity of Montreal Hospital CenterMontrealQC, Canada
| | - Ugochinyere Vivian Ukah
- Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada
| | - Nancy Low
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Mimi Israël
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island University Integrated Health and Social Service CentreMontrealQC, Canada
| | - Howard Steiger
- Department of PsychiatryMcGill UniversityMontrealQCCanada,Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island University Integrated Health and Social Service CentreMontrealQC, Canada
| | - Jessica Healy‐Profitós
- University of Montreal Hospital Research CentreMontrealQC, Canada,Institut National de Santé Publique du QuébecMontrealQC, Canada
| | - Gilles Paradis
- Institut National de Santé Publique du QuébecMontrealQC, Canada,Department of Epidemiology, Biostatistics, and Occupational HealthMcGill UniversityMontrealQC, Canada
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Psychometric properties of the fear of food measure in Japanese women. Eat Weight Disord 2021; 26:2135-2142. [PMID: 33140377 DOI: 10.1007/s40519-020-01061-9] [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: 11/25/2019] [Accepted: 10/20/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The aim of the present study was to investigate the psychometric properties of the fear of food measure (FOFM) in Japanese women. METHODS This study was a cross-sectional, observational, and multicenter study conducted at the University of Tokyo and Kyushu University. Participants were comprised of 169 healthy women and 149 patients with eating disorders. First, the present study explored the factor structure of FOFM in Japanese women using exploratory factor analyses. Then, the Cronbach's alpha and McDonald's omega were calculated to assess reliability. Concurrent validity was examined by calculating correlation coefficients with the Eating Attitudes Test, negative affect of Positive and Negative Affect Schedule, and Hospital Anxiety and Depression Scale. Additionally, the Wilcoxon rank-sum test was used to compare scores between the healthy control and patient group. RESULTS The final model had four subscales. The subscales, thus, had high reliability and showed significant positive correlations with the questionnaires. The scores of subscales in the patient group were significantly higher than those in the healthy control group. CONCLUSIONS The FOFM had a four-factor structure in Japanese women. Its reliability and validity were verified and it could be used as a tool to assess fear of food. LEVEL OF EVIDENCE III, case-control analytic study.
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Kaß A, Dörsam AF, Weiß M, Zipfel S, Giel KE. The impact of maternal eating disorders on breastfeeding practices: a systematic review. Arch Womens Ment Health 2021; 24:693-708. [PMID: 33830375 PMCID: PMC8492580 DOI: 10.1007/s00737-021-01103-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/11/2021] [Indexed: 01/04/2023]
Abstract
Breastfeeding is an effective way to protect and promote the health of the infant and mother. Cultural, social, economic, medical, or psychological factors might interfere with successful breastfeeding. Therefore, maternal eating disorders (EDs) may have detrimental effects on the decision of breastfeeding initiation and on its continuation. There is limited knowledge about the breastfeeding practices of mothers with EDs. We performed a systematic review to generate more evidence in this area. A search was conducted in PubMed and PsycINFO, and several journals were hand searched for relevant publications. Of N = 3904 hits, 13 full texts were included in the qualitative analysis. The findings on total duration of BF between mothers with and without EDs were mixed, but women with EDs showed more negative experiences and emotional problems during BF. There was not enough evidence to conclude on breastfeeding initiation, or on the duration of exclusive breastfeeding. Maternal EDs might have a negative impact on BF practices with possible negative effects on the maternal-child feeding environment. Further studies with comparable data and information on the women's partners' attitudes about breastfeeding are needed.
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Affiliation(s)
- Anna Kaß
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
- Competence Center for Eating Disorders (KOMET), 72076, Tübingen, Germany
| | - Annica Franziska Dörsam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076, Tübingen, Germany.
- Competence Center for Eating Disorders (KOMET), 72076, Tübingen, Germany.
| | - Magdalene Weiß
- Department of Obstetrics and Gynecology, University Hospital, 72076, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
- Competence Center for Eating Disorders (KOMET), 72076, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, 72076, Tübingen, Germany
- Competence Center for Eating Disorders (KOMET), 72076, Tübingen, Germany
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Liver disease in obesity and underweight: the two sides of the coin. A narrative review. Eat Weight Disord 2021; 26:2097-2107. [PMID: 33150534 DOI: 10.1007/s40519-020-01060-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Malnutrition, whether characterized by not enough or too much nutrient intake, is detrimental to the liver. We herein provide a narrative literature revision relative to hepatic disease occurrence in over or undernourished subjects, to shed light on the paradox where both sides of malnutrition lead to similar liver dysfunction and fat accumulation. METHODS Medline, EMBASE, and Cochrane Library were searched for publications up to July 2020. Articles discussing the association between both chronic and acute liver pathology and malnutrition were evaluated together with studies reporting the dietary intake in subjects affected by malnutrition. RESULTS The association between overnutrition and non-alcoholic fatty liver disease (NAFLD) is well recognized, as the beneficial effects of calorie restriction and very low carbohydrate diets. Conversely, the link between undernutrition and liver injury is more complex and less understood. In developing countries, early exposure to nutrient deficiency leads to marasmus and kwashiorkor, accompanied by fatty liver, whereas in developed countries anorexia nervosa is a more common form of undernutrition, associated with liver injury. Weight gain in undernutrition is associated with liver function improvement, whereas no study on the impact of macronutrient distribution is available. We hypothesized a role for very low carbohydrate diets in the management of undernutrition derived liver pathology, in addition to the established one in overnutrition-related NAFLD. CONCLUSIONS Further studies are warranted to update the knowledge regarding undernutrition-related liver disease, and a specific interest should be paid to macronutrient distribution both in the context of refeeding and relative to its role in the development of hepatic complications of anorexia nervosa. LEVEL OF EVIDENCE Narrative review, Level V.
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Pettersson C, Svedlund A, Wallengren O, Swolin-Eide D, Paulson Karlsson G, Ellegård L. Dietary intake and nutritional status in adolescents and young adults with anorexia nervosa: A 3-year follow-up study. Clin Nutr 2021; 40:5391-5398. [PMID: 34563763 DOI: 10.1016/j.clnu.2021.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND & AIMS Patients with anorexia nervosa (AN) restrict their dietary intake leading to malnutrition. Information is scarce on nutrition status during recovery. The aim of the study was to investigate dietary intake, body composition, biochemistry, and status in young women three years after hospital treatment due to severe restrictive AN. METHODS Dietary intake from four-day food records were compared to a reference group and the Nordic Nutrition Recommendations. Body composition was assessed by dual-energy X-ray absorptiometry (DXA). Serum levels of vitamin A, E, D, folate, and ferritin were assessed. RESULTS Three years after hospital treatment for AN, 12 subjects (60%) were recovered or in partial remission from AN. Subnormal values of body fat and skeletal muscle mass were present in 30% and 25%. Energy intake was 1730 kcal/day (min-max 705-2441) or 33 kcal/kg/day (16-54). Most (80%) had a total energy intake/day below the estimated needs and 6 (32%) had energy intakes below 1550 kcal/day. Micronutrient intakes from food were low; 16 (85%) had intakes below recommendations of iron, folate, and vitamin D. Serum levels of vitamins A, E, D, and folate were on average adequate; but a subnormal value (<50 nmol/L) of vitamin D was found in 20%. Ferritin levels were significantly lower at follow-up, and 25% had values below reference range. Return of menstruation was dependent of energy intake and body fat. CONCLUSIONS A regular and careful assessment of nutritional status along with nutritional counseling during recovery is recommended to reduce malnutrition in patients with AN.
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Affiliation(s)
- Cecilia Pettersson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Eating Disorder Unit - Children & Young Adults, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Svedlund
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Department of Paediatrics, Gothenburg, Sweden
| | - Ola Wallengren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Diana Swolin-Eide
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Department of Paediatrics, Gothenburg, Sweden
| | - Gunilla Paulson Karlsson
- Eating Disorder Unit - Children & Young Adults, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Ellegård
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cingöz G, Özyurt G, Uzun H, Doruk ÖG, Küme T, Dündar BN, Çatlı G. High serum neurotensin level in obese adolescents is not associated with metabolic parameters, hyperphagia or food preference. J Pediatr Endocrinol Metab 2021; 34:971-978. [PMID: 34147046 DOI: 10.1515/jpem-2021-0031] [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: 01/15/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Obesity is often the result of a high-calorie and unbalanced diet for a long time and can sometimes be associated with hyperphagia and eating disorders. Neurotensin (NT) is an anorexigenic peptide, which is secreted from the central nervous system and intestines, and increases intestinal fat absorption. In the literature, conflicting results regarding serum NT level in obesity and the relation of NT with metabolic parameters were reported. Besides, there is no data regarding the relation of NT with eating disorders or food preference in obese individuals. We aimed to evaluate the relation of serum NT level with metabolic parameters, hyperphagia, binge eating disorder (BED) and food preference in obese adolescents. METHODS The study included 65 obese adolescents and 65 healthy controls. Anthropometric measurements, biochemical analyzes and body fat analyzes were performed in all cases. Hyperphagia score, presence of BED and three-day food intake records were also evaluated. RESULTS NT level was significantly higher in obese adolescents than in controls and it was not associated with metabolic parameters, hyperphagia or food preference. In the obese group, NT level was not significantly different according to the presence of BED. CONCLUSIONS Serum NT level is high in obese adolescents; however, it is not associated with metabolic parameters, hyperphagia, BED or food preference.
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Affiliation(s)
- Gülten Cingöz
- Department of Pediatrics, Tepecik Training and Research Hospital, Sağlık Bilimleri Üniversitesi, İzmir, Turkey
| | - Gonca Özyurt
- Department of Pediatric and Adolescent Psychiatry, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Hamide Uzun
- Department of Nutrition and Dietetics, Tepecik Training and Research Hospital, Sağlık Bilimleri University, İzmir, Turkey
| | - Özlem Gürsoy Doruk
- Department of Biochemistry, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Tuncay Küme
- Department of Biochemistry, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Bumin Nuri Dündar
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Gönül Çatlı
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
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Towards a Comprehensive Understanding of Body Image: Integrating Positive Body Image, Embodiment and Self-Compassion. Psychol Belg 2021; 61:248-261. [PMID: 34394951 PMCID: PMC8323527 DOI: 10.5334/pb.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Body image (BI) disturbance is a relevant factor in the etiology and treatment of eating disorders (ED). Although progress has been made in recent decades in understanding BI and its relationship with ED, the efficacy of BI disturbance prevention and intervention programs is still limited. In order to reach deeper understanding of BI disturbance and clarify the interactions between some protective and risk factors related to this construct, we carried out a literature review on some specific BI-related factors that so far have been analyzed independently. We specifically examined positive and negative BI; embodiment and its role in the development of positive and negative BI; and self-compassion as a protective factor that promotes positive embodiment (vs. disembodiment) and protection against body shame. We conclude that integrating the available evidence on these factors into BI models may be used to enhance our understanding of BI and improve the efficacy of prevention and intervention programs to help fight negative BI (by reducing body shame and disembodiment) and promote positive BI (by increasing self-compassion and positive embodiment).
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Thiebaut S, Millaud F, Lemaire P, Ryst A, Girod C, Seneque M, Dupuis-Maurin K, Sahuc N, Courtet P, Guillaume S. [Feasibility of a psychoeducation group for patients with anorexia nervosa: An open study]. Encephale 2021; 48:430-435. [PMID: 34238567 DOI: 10.1016/j.encep.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Management of anorexia nervosa is difficult and few treatments have shown their effectiveness, justifying the exploration of new therapeutic approaches. Available evidence suggests an interest of psychoeducational groups in a significant number of psychiatric disorders. In patients suffering from anorexia, to date there are few groups or interventions available. We aimed to assess the feasibility and acceptability of a psycho-educational program promoting information about the disease and presenting techniques that can help to cope with anorexia and the functional impact it causes. The exploratory secondary objectives were to evaluate if such a group is associated with clinical improvement. METHOD Twenty-seven patients suffering from anorexia nervosa, in three groups, received eight weekly interventions in addition to their usual care. The study was open-label and non-randomized. Patients were assessed three times (baseline, at the end of the group and three months later). The assessments were both qualitative (Eating Disorder Examination questionnaire, The Anorexia Nervosa Stage of Change Questionnaire, the Eating Disorders Quality of Life questionnaire, Work and Social Adjustment Scale) and qualitative. RESULTS Seventy-eight percent of participants attended more than 75 % of the sessions. Seventy percent of participants found the group useful, and 95 % said it helped them improve their knowledge of the disease and its consequences. The average BMI of participants changed significantly with an average increase of 2.5kg between baseline and the three month assessment. There was an improvement of the eating disorders features in EDE-Q for the total score and for all subscores. The improvement in the total score was significant at the end of the group sessions, while the improvement in the sub scores became significant at three months. There was also a significant mood improvement at the end of the group. Finally, there was a significant improvement in daily functioning with a decrease in Work and Social Adjustment Scale scores and an improvement in quality of life. On qualitative assessment, patients were satisfied with the care proposal. They were able to appreciate the support and sharing of experience provided by the group formula. Most of them reported changes in their daily lives, either in their relationship to care and illness, or in their relationships with their loved ones, their leisure/work, their mood or their eating behavior. CONCLUSION Both qualitative and quantitative results suggest that this group psychoeducation program is feasible and well accepted by patients in addition to usual management. Although the methodology does not allow any conclusions, the clinical improvements observed during the group are encouraging with regard to the safety of this type of intervention and its possible effectiveness and argue for a controlled study.
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Affiliation(s)
- S Thiebaut
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - F Millaud
- Unité d'hospitalisation Farandole sur le pôle 30I03 au CH du Mas Careiron, chemin du paradis, 30700 UZES, France
| | - P Lemaire
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Clinique de l'anxiété, IACCA (Institut d'accompagnement cognitivo-comportemental de l'anxiété), Centre Hospitalier "Le Mas Careiron", chemin du Paradis, 30700 Uzès, France
| | - A Ryst
- Centre de psychiatrie ambulatoire de cenon, 50, bis avenue Jean Jaurès, 33150 Cenon, France
| | - C Girod
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - M Seneque
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France
| | - K Dupuis-Maurin
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France
| | - N Sahuc
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Clinique du Chateau, 11, bis rue de la porte jaune, 92380 Garches, France
| | - P Courtet
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France
| | - S Guillaume
- Service d'Urgences et post urgences psychiatriques, Hôpital Lapeyronie, avenue Gaston Giraud, 34295 Montpellier cedex 5, France; Inserm, U1061, Université de Montpellier, Montpellier, France.
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Rousselet M, Reinhardt H, Forestier B, Eyzop E, Lambert S, Rocher B, Gailledrat L, Hardouin JB, Grall-Bronnec M. Are marked body shape concerns associated with poorer outcomes at the one-year follow-up in anorexia nervosa? Brain Behav 2021; 11:e02199. [PMID: 34037330 PMCID: PMC8323028 DOI: 10.1002/brb3.2199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Anorexia nervosa (AN) is a complex disease in which obsessive thoughts about body image, shape, or weight are expressed. The intensity of these concerns varies among individuals, and only a few studies have focused on their impact on patients' clinical course when patients are treated on an outpatient basis. Our study aimed to determine whether marked body concerns at inclusion were predictive of the one-year follow-up. METHOD Participants (N = 72) were women seeking treatment for AN in a specialized unit for eating disorder management. All participants were assessed at inclusion and at the 1-year follow-up. Clinical outcome was assessed using the Morgan & Russel Outcome Average Score (MROAS), and body concerns were assessed using the Body Shape Questionnaires (BSQ). RESULTS Marked body concerns (BSQ score >140) at inclusion were associated with a poorer outcome at the 12-month follow-up (lower MROAS "total score"). Other characteristics at inclusion that were predictive of a poorer outcome at 12 months were as follows: higher severity of ED at inclusion, longer hospitalization during follow-up, and experiencing a lower impact of the illness on school/work life. DISCUSSION The results confirmed the importance of a multifocal treatment that should address body concerns and motivation to change. Our results also highlighted the necessity of promoting the maintenance of school/work during the treatment course.
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Affiliation(s)
- Morgane Rousselet
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
| | - Hélène Reinhardt
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Emeline Eyzop
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Sylvain Lambert
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Bruno Rocher
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | - Lucie Gailledrat
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France
| | | | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, Nantes University Hospital, Nantes, France.,UMR 1246, Nantes University and Tours University, Nantes, France
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Hypokalemic metabolic alkalosis in an adolescent female: Answers. Pediatr Nephrol 2021; 36:2119-2121. [PMID: 33620570 DOI: 10.1007/s00467-021-04989-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
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Anderson LM, Smith KE, Nuñez MC, Farrell NR. Family accommodation in eating disorders: a preliminary examination of correlates with familial burden and cognitive-behavioral treatment outcome. Eat Disord 2021; 29:327-343. [PMID: 31414973 PMCID: PMC7021579 DOI: 10.1080/10640266.2019.1652473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Previous research suggests caregivers of individuals with eating disorders (EDs) may attempt to reduce family strain by engaging in accommodation and enabling behaviors to avoid conflict or alleviate stress of the affected individual. Moreover, families often reorganize life around the ED, reinforcing ED behaviors and exacerbating family dysfunction and caregiver distress. However, limited research has examined how accommodation relates to caregivers' distress, family functioning, and treatment outcomes. The current study provides an initial evaluation of these associations among treatment-seeking individuals with EDs and their family members. Forty family members of individuals receiving cognitive behavioral therapy for EDs in a residential treatment setting completed the Accommodation and Enabling Scale for Eating Disorders (AESED) and measures of anxiety (Patient-Reported Outcomes Measurement Information System anxiety scale) and family functioning (Family Assessment Device; FAD) at the time of their family member's treatment admission. Eighteen patients completed the Eating Disorder Examination-Questionnaire (EDE-Q) at admission and discharge. AESED scores were positively associated with family member anxiety, FAD roles, FAD behavioral control, and higher patient EDE-Q global scores at discharge. Findings provide preliminary evidence that greater family accommodation not only relates to poorer family functioning, but uniquely relates to worse ED treatment outcome.
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Affiliation(s)
- Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, USA
| | - Kathryn E Smith
- Sanford Center for Bio-behavioral Research, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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Exploring alternatives for adolescent anorexia nervosa: adolescent and parent treatment (APT) as a novel intervention prospect. J Eat Disord 2021; 9:67. [PMID: 34108051 PMCID: PMC8191096 DOI: 10.1186/s40337-021-00423-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Recovery and remission rates of adolescent anorexia nervosa (AN) following Family Based Treatment (FBT) have seen a relative decline over recent years. While reasonably successful in achieving physical recovery (i.e. weight restoration), both empirical and anecdotal accounts highlight a lack of attention to the psychological recovery of the adolescent within manualised FBT. As such, there is a need for innovation to explore treatment variations and alternatives for the proportion of adolescents with AN who do not respond favourably to this first-line treatment. This paper introduces a new treatment framework to the field for clinical consideration and empirical assessment. Adolescent and Parent Treatment (APT) for adolescent AN draws from both family-based and individual treatment models, applying a developmental lens. APT attends to physical and psychological recovery simultaneously and from the start of treatment, with capacity to tailor individual psychological modules to the adolescent formulation. While clearly in its infancy, APT provides an exciting new avenue for exploration within the field, as we seek new avenues to support young people and their families to effectively combat this deadly illness.
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65
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Khanna S, Talwar D, Kumar S, Madaan S, Goyal A. Bulimia Nervosa Leading to Squamous Cell Carcinoma of the Esophagus in a Young Adult. Cureus 2021; 13:e15536. [PMID: 34268054 PMCID: PMC8266603 DOI: 10.7759/cureus.15536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
Bulimia nervosa is an eating disorder which is defined as binge eating which is followed by purging and inappropriately increased concern about one’s weight and body shape. We report a case of a 20 year old female who presented with a history of a dysphagia since 2 months. She had a history of binge eating disorder followed by a ritual of purging activity since six years. She also gave a history of increased concern about her weight and body shape. On endoscopy, a growth was seen on the esophagus, which upon biopsy showed features of squamous cell carcinoma.Thus, even in a young female, a simple psychological eating disorder might manifest as a malignancy. This emphasizes the need of early diagnosis and treatment of such innocent looking eating disorders to prevent serious complications in the future.
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Affiliation(s)
- Shivam Khanna
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Dhruv Talwar
- General Medicine, Acharya Vinobha Bhave Rural Hospital, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sparsh Madaan
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Wardha, IND
| | - Aditi Goyal
- Department of Pathology, Jawaharlal Nehru Medical College, Wardha, IND
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66
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Yeh HW, Chien WC, Chung CH, Chang HA, Kao YC, Tzeng NS. Eating disorders and the risk of esophageal and stomach cancers-A nationwide, population-based cohort study in Taiwan. Int J Eat Disord 2021; 54:959-968. [PMID: 32914482 DOI: 10.1002/eat.23367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous studies have shown elevated cancer risk in anorexia nervosa but the literature on other eating disorders (EDs) is scarce. This study aimed to investigate the association between all EDs and esophageal, stomach, and other cancers. METHODS We used a retrospective cohort design, based on a two-million randomized longitudinal health insurance dataset, a sub-dataset of Taiwan's National Health Insurance Research Database. From all the potential participants aged 20 years or more, a total of 6,628 participants were enrolled, including 1,657 patients with EDs, with sex-, age-, and indexed date-matched (1:3) 4,971 controls. Each participant was individually tracked from 2000 to 2015 to identify incident cases of cancers, including esophageal cancer (EC), stomach cancer (SC), and all other cancers (AOC). The multivariate Cox proportional hazards model was employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDs and cancer. RESULTS Of the total 6,628 enrollees, 222 in 1,657 individuals with EDs and 810 in the 4,971 non-ED control individuals developed cancer (1,262.40 vs. 1,472.15 per 100,000 person-years), and the Kaplan-Meier survival analysis was not statistically significant (log-rank, p = .324). However, after adjusting for covariates, the risk of EC and SC among the individuals with an ED was significantly higher, with adjusted HRs of 5.32 (95% CI: 1.07-26.49, p < .001) and 4.61 (95% CI: 1.91-11.14, p < .001), respectively. EDs were not associated with other cancers. CONCLUSIONS This study provides evidence for the association between EDs and the risk for EC and SC. Further research on mechanisms and prevention is therefore needed.
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Affiliation(s)
- Hui-Wen Yeh
- Institute of Bioinformatics and System Biology, National Chiao-Tung University, Hsin-Chu, Taiwan, Republic of China.,Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of Nursing, Tri-Service General Hospital, and School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.,School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
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67
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Michels N, De Backer F, Dimakopoulou M, Mane K, Indave I, Huybrechts I. Eating disorders and the risk of developing cancer: a systematic review. Eat Weight Disord 2021; 26:1021-1035. [PMID: 33025526 DOI: 10.1007/s40519-020-01020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. METHODS A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. RESULTS From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). CONCLUSIONS The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex). LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Fien De Backer
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | | | - Katerina Mane
- International Agency for Research on Cancer, Lyon, France
| | - Iciar Indave
- International Agency for Research on Cancer, Lyon, France
| | - Inge Huybrechts
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
- International Agency for Research on Cancer, Lyon, France
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68
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Chang PGRY, Delgadillo J, Waller G. Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 86:102032. [PMID: 33915335 DOI: 10.1016/j.cpr.2021.102032] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers have been published since, which might influence the size of the effect of early response or the potential role of moderating factors. This pre-registered systematic review presents a comprehensive examination of this literature. Three databases were searched (Scopus, PsycInfo, PubMed). In total, 33 eligible studies were included in a narrative synthesis, and 25 studies were included in random-effects meta-analysis. The majority (91%) of studies were rated as having low or moderate risk of bias. Approximately half of patients across clinical samples showed early response to psychological therapy, which was most often defined as reliable symptomatic improvement during the first four sessions. A significant and moderate association was found between early response and post-treatment outcomes (r = 0.41 [95% CI: 0.32-0.481], p < .0001). Significant evidence of heterogeneity (Q[28] = 136.42, p < .0001; I2 = 80.2%) was evident. The review was limited by the exclusion of grey literature and only 76% of studies provided sufficient statistical information for meta-analytic synthesis, although we found no significant evidence of publication bias, χ2(1) = 0.001, p = .97. Overall, evidence accumulated over twenty years establishes early response as the most robust predictor of treatment outcomes in the field of eating disorders. However, only half of patients show early change in this way. Further research is needed to determine whether there are patient or clinician characteristics that predict early response to psychological treatment for eating disorders.
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Affiliation(s)
- Peter G R Y Chang
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
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69
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D’Agata F, Caroppo P, Spalatro A, Lavagnino L, Abbate Daga G, Boghi A, Bergui M, Cicerale A, Vitiello B, Fassino S, Derntl B, Amianto F. Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia. PLoS One 2021; 16:e0231684. [PMID: 33836002 PMCID: PMC8034744 DOI: 10.1371/journal.pone.0231684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 03/09/2021] [Indexed: 11/18/2022] Open
Abstract
Aim The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms. Methods The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy. Results AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations. Conclusions Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.
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Affiliation(s)
- Federico D’Agata
- Department of Neurosciences, University of Torino, Turin, Italy
- Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Paola Caroppo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Angela Spalatro
- Department of Neurosciences, University of Torino, Turin, Italy
| | - Luca Lavagnino
- UT Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, UT Houston Medical School, Houston, Texas, United States of America
| | | | - Andrea Boghi
- ASL TO2 San Giovanni Bosco Hospital, Turin, Italy
| | - Mauro Bergui
- Department of Neurosciences, University of Torino, Turin, Italy
| | | | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Torino, Turin, Italy
| | - Secondo Fassino
- Department of Neurosciences, University of Torino, Turin, Italy
| | - Birgit Derntl
- Department for Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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70
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Nivière P, Da Fonseca D, Deruelle C, Bat-Pitault F. [Use of virtual reality in eating disorders]. Encephale 2021; 47:263-269. [PMID: 33814164 DOI: 10.1016/j.encep.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 10/21/2022]
Abstract
Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population.
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Affiliation(s)
- P Nivière
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France.
| | - D Da Fonseca
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France; Service de Pédopsychiatrie, Hôpital Salvator, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - C Deruelle
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France
| | - F Bat-Pitault
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France; Service de Pédopsychiatrie, Hôpital Salvator, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
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71
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Lewis YD, Elran-Barak R, Grundman-Shem Tov R, Zubery E. The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients' perspectives during the COVID-19 lockdown. J Eat Disord 2021; 9:31. [PMID: 33673876 PMCID: PMC7934980 DOI: 10.1186/s40337-021-00383-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Studies investigating patients' perspectives towards an abrupt transition from face-to-face to online treatment in eating disorders (EDs) are scarce. The current study aimed to (1) conduct a preliminary assessment of patients' perspectives regarding this transition, and (2) explore potential demographic, clinical, and treatment-related factors associated with these perspectives. METHODS Sixty-three patients with EDs whose treatment was moved to an online format, were surveyed during the COVID-19 lockdown (April-May 2020). A 6-item measure was developed to examine their perspectives toward this transition. Exploratory factor analyses (EFAs) were conducted to confirm the rational-theoretical structure of the measure (Eigenvalue = 3.745, explaining 62.4% of variance). The Cronbach's alpha value was excellent (α = 0.878). Validated questionnaires were used to measure ED symptoms, general psychopathology, therapeutic alliance, and pandemic anxiety, and their associations with our transition-focused scale and telemedicine satisfaction were examined. RESULTS Mixed views were found regarding the transition, with the majority (68%) stating that they would not choose to continue online therapy given the option. Longer duration of treatment (r = 0.291, p = 0.022), stronger therapeutic alliance (r = 0.293, p = 0.028), and higher COVID-19 anxiety (r = 0.276, p = 0.029) were linked with more positive views towards the transition. CONCLUSIONS Analyses suggest that patients' perspectives towards the transition can be measured using a Likert-type 6-item scale. Findings highlight the various responses to online treatment and indicate a need to identify patients who may face difficulties in the transition to this newly ubiquitous treatment mode. Clinicians should be cognizant of these potential difficulties and consider appropriate modes of treatment in the ongoing pandemic situation.
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Affiliation(s)
- Yael Doreen Lewis
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | - Rinat Grundman-Shem Tov
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eynat Zubery
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Denman E, Parker EK, Ashley MA, Harris DM, Halaki M, Flood V, Stefoska-Needham A. Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: an online survey. J Eat Disord 2021; 9:27. [PMID: 33602327 PMCID: PMC7891015 DOI: 10.1186/s40337-021-00380-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs. METHODS An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios. RESULTS In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%). CONCLUSIONS This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.
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Affiliation(s)
- Elyse Denman
- SMART Foods Centre, Illawarra Health and Medical Research Institute, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Elizabeth Kumiko Parker
- Department of Dietetics & Nutrition, Westmead Hospital, Westmead, NSW, 2145, Australia. .,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Mellisa Anne Ashley
- Department of Dietetics & Nutrition, Westmead Hospital, Westmead, NSW, 2145, Australia.,Adult Eating Disorder Service, Western Sydney Local Health District, Sydney, NSW, 2145, Australia
| | - Deanne Maree Harris
- Department of Dietetics & Nutrition, Tamworth Rural Referral Hospital, Tamworth, NSW, 2340, Australia
| | - Mark Halaki
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Western Sydney Local Health District, Sydney, NSW, 2145, Australia
| | - Anita Stefoska-Needham
- SMART Foods Centre, Illawarra Health and Medical Research Institute, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
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Gutiérrez E, Carrera O. Severe and Enduring Anorexia Nervosa: Enduring Wrong Assumptions? Front Psychiatry 2021; 11:538997. [PMID: 33658948 PMCID: PMC7917110 DOI: 10.3389/fpsyt.2020.538997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
To the extent that severe and lasting anorexia nervosa (SE-AN) is defined in terms of refractoriness to the best treatments available, it is mandatory to scrutinize the proven effectiveness of the treatments offered to patients. The array of so-called current evidence-based treatments for anorexia nervosa (AN) encompasses the entire spectrum of treatments ranging from specialized brand-type treatments to new treatments adapted to the specific characteristics of people suffering from AN. However, after several randomized control trials, parity in efficacy is the characteristic among these treatments. To further complicate the landscape of effective treatments, this "tie score" extends to the treatment originally conceived as control conditions, or treatment as usual conditions. In retrospection, one can understand that treatments considered to be the best treatments available in the past were unaware of their possible iatrogenic effects. Obviously, the same can be said of the theoretical assumptions underpinning such treatments. In either case, if the definition of chronicity mentioned above is applied, it is clear that the responsibility for the chronicity of the disorder says more about the flagrant inefficacy of the treatments and the defective assumptions underpinning them, than the nature of the disorder itself. A historical analysis traces the emergence of the current concept of "typical" AN and Hilde Bruch's contribution to it. It is concluded that today's diagnostic criteria resulting from a long process of acculturation distort rather than capture the essence of the disorder, as well as marginalizing and invalidating patients' perspectives.
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Affiliation(s)
- Emilio Gutiérrez
- Department of Clinical Psychology and Psychobiology, College of Psychology, University of Santiago, Santiago de Compostela, Spain
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
| | - Olaia Carrera
- Venres Clínicos Unit, College of Psychology, University of Santiago, Santiago de Compostela, Spain
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Differential longitudinal changes of neuronal and glial damage markers in anorexia nervosa after partial weight restoration. Transl Psychiatry 2021; 11:86. [PMID: 33558486 PMCID: PMC7870648 DOI: 10.1038/s41398-021-01209-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
Atrophic brain changes in acute anorexia nervosa (AN) are often visible to the naked eye on computed tomography or magnetic resonance imaging scans, but it remains unclear what is driving these effects. In neurological diseases, neurofilament light (NF-L) and tau protein have been linked to axonal damage. Glial fibrillary acidic protein (GFAP) has been associated with astroglial injury. In an attempt to shed new light on factors potentially underlying past findings of structural brain alterations in AN, the current study investigated serum NF-L, tau protein, and GFAP levels longitudinally in AN patients undergoing weight restoration. Blood samples were obtained from 54 acutely underweight, predominantly adolescent female AN patients and 54 age-matched healthy control participants. AN patients were studied in the severely underweight state and again after short-term partial weight restoration. Group comparisons revealed higher levels of NF-L, tau protein, and GFAP in acutely underweight patients with AN compared to healthy control participants. Longitudinally, a decrease in NF-L and GFAP but not in tau protein levels was observed in AN patients upon short-term partial weight restoration. These results may be indicative of ongoing neuronal and astroglial injury during the underweight phase of AN. Normalization of NF-L and GFAP but not tau protein levels may indicate an only partial restoration of neuronal and astroglial integrity upon weight gain after initial AN-associated cell damage processes.
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75
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Thompson A, Petrie T, Tackett B, Balcom K, Watkins CE. Eating disorder diagnosis and the female athlete: A longitudinal analysis from college sport to retirement. J Sci Med Sport 2021; 24:531-535. [PMID: 33423947 DOI: 10.1016/j.jsams.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Female athletes experience eating disorders (EDs) at clinical, and subclinical, levels; most studies have determined point-prevalence rates through cross-sectional methodologies. To date, few studies have examined the long-term stability of EDs in female athletes; none extend into retirement. DESIGN A longitudinal investigation of ED classification (i.e., Clinical ED, Subclinical ED, Healthy) and weight control behaviors (e.g., vomiting, laxative use) from when athletes actively competed (T1) into their retirement (T2). METHODS Participants included U.S. female athletes (N=193) who were collegiate competitors (T1) and eventually were retired from their collegiate sports six years later (T2). RESULTS At T2, athletes were classified as Healthy (69.9%), Subclinical ED (26.9%), and Clinical ED (3.1%). Overall percentage of Subclinical EDs increased from 18.7% (T1) to 26.9% (T2); 52.8% of T1 Subclinical ED athletes continued to meet criteria for either Subclinical or Clinical ED at T2. Of the 13 Clinical ED athletes at T1, six (46.2%) continued to meet criteria for either a subclinical or clinical ED at T2. Though exercising (2+ hours/day; n=8, 4.1%) and dieting/fasting (4+ times/year; n=14, 7.3%) were the most frequently used weight control behaviors at T2, rates were substantially lower than at T1. CONCLUSIONS Retirement does not result in immediate remittance of eating concerns among female athletes; many continue or develop Subclinical and Clinical ED symptoms. Thus, addressing healthy body image and nutrition when athletes are competing is imperative to assist prevention and intervention efforts that may alleviate ED symptoms as athletes transition from sport.
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76
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Miyata N, Hata T, Takakura S, Yoshihara K, Morita C, Mikami K, Nomoto K, Miyazaki K, Tsuji H, Sudo N. Metabolomics profile of Japanese female patients with restricting-type anorexia nervosa. Physiol Behav 2021; 228:113204. [PMID: 33053407 DOI: 10.1016/j.physbeh.2020.113204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 01/21/2023]
Abstract
In this study, the serum metabolic profiles of 10 female patients with restricting type anorexia nervosa (ANR) were compared to those of 10 age-matched healthy female controls. While the levels of amino acids were lower among the patients than among the controls, the levels of uremic toxins, including p-cresyl sulfate (PCS), indole-3-acetic acid, and phenyl sulfate, were higher in ANR patients. The serum PCS levels correlated positively with the abundance of the Clostridium coccoides group or the C. leptum subgroup in the feces of patients, but not in those of controls. Collectively, these results indicate that the serum metabolic profiles of patients with ANR differ from those of healthy women in terms of both decreased amino acid levels and increased uremic toxins. Gut microbes including C. coccoides or C. leptum may be involved in such an increase in uremic toxins.
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Affiliation(s)
- Noriyuki Miyata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomokazu Hata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Chihiro Morita
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Japan
| | - Koji Nomoto
- Tokyo University of Agriculture, Faculty of Life Sciences, Department of Molecular Microbiology, Japan
| | | | | | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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77
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Baumann S, Mareš T, Albrecht J, Anders M, Vochosková K, Hill M, Bulant J, Yamamotová A, Štastný O, Novák T, Holanová P, Lambertová A, Papežová H. Effects of Transcranial Direct Current Stimulation Treatment for Anorexia Nervosa. Front Psychiatry 2021; 12:717255. [PMID: 34690831 PMCID: PMC8526853 DOI: 10.3389/fpsyt.2021.717255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/27/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Although transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear. Objective: This study investigated changes in maladaptive eating behavior, body mass index (BMI), and depression after 10 sessions of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC). Methods: In this double-blind, randomized controlled trial, 43 inpatients with AN were divided to receive either active (n = 22) or sham (n = 21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2 mA for 30 min). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung Self-Rating Depression Scale (ZUNG), and their BMI was measured. These values were obtained repeatedly in four stages: (1) before tDCS treatment, (2) after tDCS treatment, (3) in the follow-up after 2 weeks, and (4) in the follow-up after 4 weeks. Results: Primary outcomes (EDE-Q) based on the ANOVA results do not show any between-group differences either after the active part of the study or in the follow-up. Secondary analysis reveals a reduction in some items of EDE-Q. Compared with sham tDCS, active tDCS significantly improved self-evaluation based on body shape (p < 0.05) and significantly decreased the need of excessive control over calorie intake (p < 0.05) in the 4-week follow-up. However, the results do not survive multiple comparison correction. In both sham and active groups, the BMI values improved, albeit not significantly. Conclusion: We did not observe a significant effect of tDCS over the left DLPFC on complex psychopathology and weight recovery in patients with AN. tDCS reduced the need to follow specific dietary rules and improved body image evaluation in patients with AN. Tests with a larger sample and different positions of electrodes are needed. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03273205.
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Affiliation(s)
- Silvie Baumann
- Department of Psychotherapy, National Institute of Mental Health, Klecany, Czechia.,First Faculty of Medicine, Charles University, Prague, Czechia
| | - Tadeáš Mareš
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
| | - Jakub Albrecht
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
| | - Martin Anders
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
| | - Kristýna Vochosková
- Department of Psychotherapy, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Martin Hill
- Department of Steroid Hormones and Proteohormones, Institute of Endocrinology, Prague, Czechia
| | - Josef Bulant
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia.,Department of Steroid Hormones and Proteohormones, Institute of Endocrinology, Prague, Czechia.,Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Anna Yamamotová
- Department of Physiology, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Ota Štastný
- Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Tomáš Novák
- Department of Psychotherapy, National Institute of Mental Health, Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Petra Holanová
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
| | - Alena Lambertová
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
| | - Hana Papežová
- First Faculty of Medicine, Charles University, Prague, Czechia.,Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czechia
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78
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Kaufmann LK, Moergeli H, Milos GF. Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome. Front Psychiatry 2021; 12:682952. [PMID: 34335330 PMCID: PMC8319499 DOI: 10.3389/fpsyt.2021.682952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favorable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome. Methods: We included 107 patients aged 17-56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1-6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients' age, sex, and duration of illness. Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI. Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.
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Affiliation(s)
- Lisa-Katrin Kaufmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Gabriella Franca Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
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79
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Agüera Z, Jiménez-Murcia S. Advances in Eating Disorders. J Clin Med 2020; 9:E4047. [PMID: 33333763 PMCID: PMC7765238 DOI: 10.3390/jcm9124047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022] Open
Abstract
Eating disorders (EDs) are a group of mental disorders characterized by an altered food intake and the presence of inappropriate behaviors for the control of body weight, framed as an excessive concern regarding one's weight and figure [...].
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Affiliation(s)
- Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 08907 Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain
- Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, 08907 Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 08907 Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
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80
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Imperatori C, Massullo C, Carbone GA, Farina B, Colmegna F, Riboldi I, Giacomo ED, Clerici M, Dakanalis A. Electroencephalographic (EEG) alterations in young women with high subclinical eating pathology levels: a quantitative EEG study. Eat Weight Disord 2020; 25:1631-1642. [PMID: 31667777 DOI: 10.1007/s40519-019-00801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To explore electroencephalographic (EEG) alterations in young women with different eating disorder (ED) psychopathology levels. METHODS Thirty-seven young women completed general and ED psychopathology (i.e., the ED Examination Questionnaire; EDE-Q) measures. EEG power spectra data were investigated in two conditions: (a) 5 min of resting state (RS) and (b) 5 min of RS after a single taste of a milkshake (ML-RS). EEG analyses were performed using exact Low-Resolution Electromagnetic Tomography software (eLORETA). RESULTS Cluster analysis performed on the EDE-Q responses revealed a group of 17 women with high levels of ED pathology falling into the subclinical (i.e., sub-threshold) EDs category and a group of 20 women with low levels of ED pathology (controls). In the RS conditions, no significant modifications were observed between groups. Compared to controls, women with subclinical EDs showed an increase in theta activity in the parieto-occipital areas in the ML-RS condition. After controlling for body mass index and general psychopathology, theta activity in these brain structures was positively associated with EDE-Q global and subscale (restraint, shape and weight concern) scores. CONCLUSIONS Our results may reflect the neurophysiological substrate of ED psychopathology core features like shape/weight concerns. Previous brain imaging and qEEG studies with full-syndrome ED patients also underscored the involvement of parieto-occipital areas in ED pathophysiology. These studies also found brain alterations in the RS condition, not observed here. This is notable given that full-syndrome and subclinical EDs are considered as different manifestations of the same disease along a severity spectrum. LEVEL OF EVIDENCE Level V, cross-sectional, electroencephalographic, descriptive study.
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Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Chiara Massullo
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Giuseppe Alessio Carbone
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Fabrizia Colmegna
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Ester Di Giacomo
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Massimo Clerici
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
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81
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Hughes EK. Comorbid depression and anxiety in childhood and adolescent anorexia nervosa: Prevalence and implications for outcome. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00034.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elizabeth K. Hughes
- Department of Paediatrics, University of Melbourne
- Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, Victoria, Australia
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82
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Bou Khalil R, Sleilaty G, Richa S, Seneque M, Iceta S, Rodgers R, Alacreu-Crespo A, Maimoun L, Lefebvre P, Renard E, Courtet P, Guillaume S. The Impact of Retrospective Childhood Maltreatment on Eating Disorders as Mediated by Food Addiction: A Cross-Sectional Study. Nutrients 2020; 12:nu12102969. [PMID: 32998411 PMCID: PMC7601309 DOI: 10.3390/nu12102969] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022] Open
Abstract
Background: The current study aimed to test whether food addiction (FA) might mediate the relationship between the presence of a history of childhood maltreatment and eating disorder (ED) symptom severity. Methods: Participants were 231 patients with ED presenting between May 2017 and January 2020 to a daycare treatment facility for assessment and management with mainly the Eating Disorder Inventory-2 (EDI-2), the Child Trauma Questionnaire (CTQ), and the Yale Food Addiction Scale (YFAS 2.0). Results: Participants had a median age of 24 (interquartile range (IQR) 20–33) years and manifested anorexia nervosa (61.47%), bulimia nervosa (16.88%), binge-eating disorders (9.09%), and other types of ED (12.55%). They were grouped into those likely presenting FA (N = 154) and those without FA (N = 77). The group with FA reported higher scores on all five CTQ subscales, as well as the total score of the EDI-2 (p < 0.001). Using mediation analysis; significant indirect pathways between all CTQ subscales and the EDI-2 total score emerged via FA, with the largest indirect effect emerging for physical neglect (standardized effect = 0.208; 95% confidence interval (CI) 0.127–0.29) followed by emotional abuse (standardized effect = 0.183; 95% CI 0.109–0.262). Conclusion: These results are compatible with a model in which certain types of childhood maltreatment, especially physical neglect, may induce, maintain, and/or exacerbate ED symptoms via FA which may guide future treatments.
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Affiliation(s)
- Rami Bou Khalil
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut BP 166830, Lebanon;
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (A.A.-C.); (P.C.); (S.G.)
- Correspondence: ; Tel.: +96-1142-1000
| | - Ghassan Sleilaty
- Clincal Research Center and Department of Cardiac and Thoracic Surgery, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut BP 166830, Lebanon;
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut BP 166830, Lebanon;
| | - Maude Seneque
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (A.A.-C.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France;
| | - Sylvain Iceta
- Quebec Heart and Lung Institute (IUCPQ), Québec, QC G1V 4G5, Canada;
- School of Nutrition, Laval University, Québec, QC G1V 0A6, Canada
- Referral Center for Eating Disorder, Hospices Civils de Lyon, F-69677 Bron, France
| | - Rachel Rodgers
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France;
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA 02115, USA
| | - Adrian Alacreu-Crespo
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (A.A.-C.); (P.C.); (S.G.)
| | - Laurent Maimoun
- PhyMedExp, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France;
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295 Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.)
| | - Eric Renard
- Department of Endocrinology, Diabetes, and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.)
- UMR CNRS 5203, INSERM U1191, Institute of Functional Genomics, University of Montpellier, 34295 Montpellier, France
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (A.A.-C.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France;
| | - Sebastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (A.A.-C.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France;
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83
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Peyser D, Scolnick B, Hildebrandt T, Taylor JA. Heart rate variability as a biomarker for anorexia nervosa: A review. EUROPEAN EATING DISORDERS REVIEW 2020; 29:20-31. [PMID: 32975349 DOI: 10.1002/erv.2791] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) typically begins in early adolescence and other than weight status has few reliable biomarkers. Early diagnosis is a critical prognostic factor, but this can be clinically challenging. Heart rate variability (HRV), the beat-by-beat variance in heart rate (HR), may provide a unique assessment for the presence of AN because it has clinical utility as a biomarker of cardiac autonomic control in various populations (e.g., athletes, the aged, those with cardiovascular diseases, etc.). We present a review of the literature examining HRV in those with AN. METHOD Relevant publications were selected from PubMed using the search terms 'anorexia nervosa AND (HR OR HRV)'. Twenty papers were selected and reviewed. RESULTS The majority of studies suggest that those with AN have markedly and consistently elevated HRV compared to controls, even greater than among young athletes. However, no studies have explored HRV as a biomarker for AN. DISCUSSION Future studies on HRV should elucidate its role as a diagnostic biomarker for AN as well as its responsiveness with serial measurement to track response rates and predict relapse.
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Affiliation(s)
- Deena Peyser
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Barbara Scolnick
- Department of Psychology, Boston University, Boston, Massachusetts, USA
| | - Tom Hildebrandt
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J Andrew Taylor
- Spaulding Research Institute and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
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84
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Bang EB, Ko JK, Kwag KH, Lee GY, Kim YR. A comparison of patients with anorexia nervosa and women who are constitutionally thin. EUROPEAN EATING DISORDERS REVIEW 2020; 28:633-642. [PMID: 32842173 DOI: 10.1002/erv.2777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many of the clinical features of anorexia nervosa (AN) can be secondary problems associated with malnutrition, which mask the primary features of AN. This study aimed to investigate the intrinsic features of AN by comparing AN patients to women who are constitutionally thin (CT). METHOD Twenty-six patients with AN and 53 CT women of similar body mass index (AN: 17.13 ± 1.73 kg/m2 , CT: 16.62 ± 0.61 kg/m2 ) participated in the study. We examined medical findings, psychiatric features, and disturbed body image between the two groups. RESULTS Patients with AN had earlier menarche but less frequent menstrual periods compared to CT women. They had lower blood pressure, lower triiodothyronine, and fasting glucose levels than CT women. Patients with AN had more disturbed body images and restricted diet patterns and also had higher neuroticism compared to CT women. CONCLUSIONS The patients with AN viewed their current body shape as fatter and had more restrained eating than the CT women. The results suggest that the disturbed body image may be a salient feature of AN differentiating from CT women, the underlying neural mechanism of which requires further study.
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Affiliation(s)
- Eun Byul Bang
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Jeong Kyung Ko
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Kyung Hwa Kwag
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea
| | - Gi Young Lee
- Master of Public Health Program, University of Southern California, Los Angeles, California, USA
| | - Youl-Ri Kim
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Republic of Korea.,Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, Republic of Korea
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85
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Bala R, Singh V, Rajender S, Singh K. Environment, Lifestyle, and Female Infertility. Reprod Sci 2020; 28:617-638. [DOI: 10.1007/s43032-020-00279-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/24/2020] [Indexed: 01/01/2023]
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86
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Masaki S, Watanabe T, Minaga K, Kamata K, Komeda Y, Kimura M, Kudo M. Possible involvement of autophagy in esophageal ulcers in anorexia nervosa. Clin J Gastroenterol 2020; 13:473-476. [PMID: 31900839 DOI: 10.1007/s12328-019-01089-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/21/2019] [Indexed: 12/18/2022]
Abstract
Although patients with anorexia nervosa (AN) present with various gastrointestinal disorders, little has been understood regarding the incidence and pathophysiology of gastrointestinal ulcers related to AN. A 20-year-old woman with a past history of AN was hospitalized for further examination of dysphagia and chest pain. Her nutritional status was very poor as evidenced by very low body mass index. Esophagogastroduodenoscopy detected longitudinal and geographical ulcers in the entire circumference of the cervical and upper esophagus. Enhanced expression of autophagy-related proteins, LC3B and p62, was seen in the esophageal epithelium surrounding the active ulcers. Expression of these autophagy markers disappeared from the esophageal epithelium soon after the nutritional rehabilitation. Given the fact that starvation and malnutrition are potent inducers for autophagy, these findings suggest that autophagy might be involved in the development of gastrointestinal ulcers in patients with AN.
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Affiliation(s)
- Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masatomo Kimura
- Department of Diagnostic Pathology, Kindai University Hospital, Osaka-Sayama, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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87
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Duriez P, Bou Khalil R, Chamoun Y, Maatoug R, Strumila R, Seneque M, Gorwood P, Courtet P, Guillaume S. Brain Stimulation in Eating Disorders: State of the Art and Future Perspectives. J Clin Med 2020; 9:E2358. [PMID: 32717984 PMCID: PMC7465000 DOI: 10.3390/jcm9082358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 12/13/2022] Open
Abstract
The management of eating disorders (EDs) is still difficult and few treatments are effective. Recently, several studies have described the important contribution of non-invasive brain stimulation (repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and electroconvulsive therapy) and invasive brain stimulation (deep brain stimulation and vagal nerve stimulation) for ED management. This review summarizes the available evidence supporting the use of brain stimulation in ED. All published studies on brain stimulation in ED as well as ongoing trials registered at clinicaltrials.gov were examined. Articles on neuromodulation research and perspective articles were also included. This analysis indicates that brain stimulation in EDs is still in its infancy. Literature data consist mainly of case reports, cases series, open studies, and only a few randomized controlled trials. Consequently, the evidence supporting the use of brain stimulation in EDs remains weak. Finally, this review discusses future directions in this research domain (e.g., sites of modulation, how to enhance neuromodulation efficacy, personalized protocols).
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Rami Bou Khalil
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
| | - Yara Chamoun
- Department of Psychiatry, Hotel Dieu de France- Saint Joseph University, 166830 Beirut, Lebanon; (R.B.K.); (Y.C.)
| | - Redwan Maatoug
- Sorbonne Université, AP-HP, Service de Psychiatrie Adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, 75013 Paris, France;
| | - Robertas Strumila
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, 03101 Vilnius, Lithuania;
| | - Maude Seneque
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Philip Gorwood
- GHU Paris Psychiatry and Neuroscience, Clinique des Maladies Mentales et de l’Encéphale (CMME), Sainte-Anne Hospital, 75014 Paris, France; (P.D.); (P.G.)
- Institute of Psychiatry and Neurosciences of Paris (IPNP), UMR_S1266, INSERM, Université de Paris, 102-108 rue de la Santé, 75014 Paris, France
| | - Philippe Courtet
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
| | - Sébastien Guillaume
- Neuropsychiatry: Epidemiological and Clinical Research, Université Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.)
- Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 34295 Montpellier, France
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88
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Sawhill C, Fipps DC, Palomo JV, Miller M. End-Stage Anorexia Nervosa: When to Say "When"-A Literature Review of an Ethically Complicated Case. PSYCHOSOMATICS 2020; 61:779-786. [PMID: 32674855 DOI: 10.1016/j.psym.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Christine Sawhill
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC.
| | - David C Fipps
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC
| | - Jennifer V Palomo
- University of South Carolina, Greenville, Prisma Health, Upstate, Greenville, SC
| | - Melanie Miller
- Consult Liaison Division, Department of Psychiatry, Prisma Health, Upstate, Greenville, SC
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89
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Shimizu M, Kawai K, Yamashita M, Shoji M, Takakura S, Hata T, Nakashima M, Tatsushima K, Tanaka K, Sudo N. Very long chain fatty acids are an important marker of nutritional status in patients with anorexia nervosa: a case control study. Biopsychosoc Med 2020; 14:14. [PMID: 32695219 PMCID: PMC7368782 DOI: 10.1186/s13030-020-00186-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background Anorexia nervosa (AN) is a disease resulting in extreme weight loss. It is caused by multiple factors, including psychosocial, environmental, and genetic factors. A genetic abnormality affecting lipid metabolism has been recently reported in patients with AN. However, it is unknown whether lipid metabolism abnormalities in AN are caused by eating behavior, undernutrition, and/or genetic factors. The meaning of lipid metabolism in AN remains unclear. In particular, differences in the profiles of very long-chain fatty acids (VLCFAs) in patients with various types of AN have not been studied. This study aimed to determine changes to the fatty acid profile over a 3-month period, specifically that of long-chain fatty acids (LCFAs) and VLCFAs in patients with various types of AN. Methods We evaluated 69 female patients with AN, subclassified as AN-restricting type (AN-R) and AN-Binge-Eating/Purging type (AN-BP). On admission and after 3 months of treatment, height, weight, body mass index, plasma and serum parameters, and plasma fatty acid concentrations were measured in all patients. The control group included 25 healthy, age-matched women. Comparisons between the groups were made using one-way ANOVA, while those between the various parameters at admission and after 3 months within each group were made using the Wilcoxon signed rank test. Results On admission, the AN-R and the AN-BP groups had significantly higher levels of 18-24C and > 14C fatty acids (LCFAs and VLCFAs, respectively) than the control group. After 3 months of treatment, both groups showed high levels of 14-24C fatty acids. The levels of VLCFAs (C22:0 and C24:0) and LCFA (C18:3) after 3 months of treatment remained high in both AN groups relative to the control group. Conclusions Eating behaviors appear to be associated with levels of LCFAs. Lipid metabolism abnormalities under conditions of starvation in AN might have a genetic basis and appear to be associated with VLCFA (C22:0 and C24:0) and LCFA (C18:3) levels.
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90
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Viguria I, Alvarez-Mon MA, Llavero-Valero M, Asunsolo Del Barco A, Ortuño F, Alvarez-Mon M. Eating Disorder Awareness Campaigns: Thematic and Quantitative Analysis Using Twitter. J Med Internet Res 2020; 22:e17626. [PMID: 32673225 PMCID: PMC7388051 DOI: 10.2196/17626] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/06/2020] [Accepted: 06/13/2020] [Indexed: 01/09/2023] Open
Abstract
Background Health awareness initiatives are frequent but their efficacy is a matter of controversy. We have investigated the effect of the Eating Disorder Awareness Week and Wake Up Weight Watchers campaigns on Twitter. Objective We aimed to examine whether the Eating Disorder Awareness Week and Wake Up Weight Watchers initiatives increased the volume and dissemination of Twitter conversations related to eating disorders and investigate what content generates the most interest on Twitter. Methods Over a period of 12 consecutive days in 2018, we collected tweets containing the hashtag #wakeupweightwatchers and hashtags related to Eating Disorder Awareness Week (#eatingdisorderawarenessweek, #eatingdisorderawareness, or #EDAW), with the hashtag #eatingdisorder as a control. The content of each tweet was rated as medical, testimony, help offer, awareness, pro-ana, or anti-ana. We analyzed the number of retweets and favorites generated, as well as the potential reach and impact of the hashtags and the characteristics of contributors. Results The number of #wakeupweightwatchers tweets was higher than that of Eating Disorder Awareness Week and #eatingdisorder tweets (3900, 2056, and 1057, respectively). The content of tweets was significantly different between the hashtags analyzed (P<.001). Medical content was lower in the awareness campaigns. Awareness and help offer content were lower in #wakeupweightwatchers tweets. Retweet and favorite ratios were highest in #wakeupweightwatchers tweets. Eating Disorder Awareness Week achieved the highest impact, and very influential contributors participated. Conclusions Both awareness campaigns effectively promoted tweeting about eating disorders. The majority of tweets did not promote any specific preventive or help-seeking behaviors.
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Affiliation(s)
- Iranzu Viguria
- Department of Psychiatry and Medical Psychology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Psychiatry and Medical Psychology, Clinica Universidad de Navarra, Pamplona, Spain.,Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain.,Department of Psychiatry and Medical Psychology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Maria Llavero-Valero
- Department of Endocrinology and Nutrition, Clinica Universidad de Navarra, Pamplona, Spain
| | | | - Felipe Ortuño
- Department of Psychiatry and Medical Psychology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcala, Alcalá de Henares, Spain.,Internal Medicine and Immune System Diseases-Rheumatology Service, University Hospital Príncipe de Asturias, Alcala de Henares, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto Ramón y Cajal de Investigaciones Sanitarias, Madrid, Spain
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91
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Zelkowitz RL, Cole DA. Longitudinal relations of self-criticism with disordered eating behaviors and nonsuicidal self-injury. Int J Eat Disord 2020; 53:1097-1107. [PMID: 32406548 PMCID: PMC7641508 DOI: 10.1002/eat.23284] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Self-criticism has been proposed as a transdiagnostic predictor of disordered eating and nonsuicidal self-injury (NSSI). First, this study explored cross-sectional associations of multiple disordered eating behaviors, NSSI, and self-criticism. Second, it tested longitudinal relations of self-criticism with disordered eating and NSSI, adjusting for baseline levels of both behaviors. METHODS In Sub-study 1, undergraduates (N = 251, 79.5% female, Mage = 19.1 years) completed self-report measures of disordered eating, NSSI, and self-criticism at baseline and after 8 weeks. In Sub-study 2, community-based young adults with histories of disordered eating, NSSI, or both (N = 517, 88.8% female, Mage = 24.7 years) completed measures of disordered eating, NSSI, and self-criticism at baseline and after 4 weeks. All measures were completed online. RESULTS In Sub-study 1, both disordered eating and NSSI showed significant cross-sectional associations with self-criticism, and self-criticism was significantly related to binge eating, fasting, and NSSI at follow-up. In Sub-study 2, both behaviors again showed significant cross-sectional associations with self-criticism. Self-criticism showed significant longitudinal relations with fasting, purging, and excessive exercise. Longitudinal relations of self-criticism with NSSI varied across disordered eating behaviors. DISCUSSION NSSI showed cross-sectional associations with a range of disordered eating behaviors. Self-criticism reflects a common correlate of both disordered eating and NSSI. Evidence supported transdiagnostic longitudinal impact of self-criticism across multiple forms of disordered eating but provided more limited support for impacts on NSSI.
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Affiliation(s)
- Rachel L. Zelkowitz
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA.,Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System,Correspondence should be directed to Rachel Zelkowitz, 150 S. Huntington Ave., Boston, MA 02130; Tel: (857) 364-6232;
| | - David A. Cole
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
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92
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Herpertz-Dahlmann B, Borzikowsky C, Altdorf S, Heider K, Dempfle A, Dahmen B. 'Therapists in action'-Home treatment in adolescent anorexia nervosa: A stepped care approach to shorten inpatient treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 29:427-442. [PMID: 32558214 DOI: 10.1002/erv.2755] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It was the aim of this pilot study to apply a novel eating disorder (ED)-specific home treatment (HoT) to adolescents with anorexia nervosa (AN) and to investigate its feasibility, effects and safety. METHOD Twenty-two patients consecutively admitted to the hospital and fulfilling DSM-5 criteria for typical or atypical AN received HoT after 4-8 weeks of inpatient treatment. During the first two months of HoT, the patient and her family were visited on average three to four times per week, during the third and fourth months of HoT once or twice a week by a multi-professional team. Body mass index, ED and general psychopathology, quality of life and treatment satisfaction were assessed in the patients at admission, start and end of HoT and the 1-year follow-up as well as carers' skills and burden. RESULTS The majority of patients successfully achieved target weight within HoT and maintained it successfully at the 1-year follow-up. ED and general psychopathology in the patients and carers' skills improved significantly associated with a high treatment satisfaction. CONCLUSIONS HoT seems to be a promising new tool to improve outcome in adolescent AN and to reduce time of hospitalisation. Larger randomised controlled trials are needed to generalise these results.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie Altdorf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Kathrin Heider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
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93
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Mensi MM, Balottin L, Rogantini C, Orlandi M, Galvani M, Figini S, Chiappedi M, Balottin U. Focus on family functioning in anorexia nervosa: new perspectives using the Lausanne Trilogue Play. Psychiatry Res 2020; 288:112968. [PMID: 32320861 DOI: 10.1016/j.psychres.2020.112968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/14/2022]
Abstract
31 families of female adolescents affected by anorexia nervosa (AN) and 20 of girls with emotional and behavioral disorders participated in a semi-standardized videotaped game: the Lausanne Trilogue Play (LTPc). We aimed to clarify if there is a typical AN family profile and if the LTPc procedure could predict the risk of developing AN. We confirmed that AN families exhibit dysfunctional alliances. Particularly because of the difficulty of the three members to be available to the interaction at least with their body (participation) and to comply with the role expected at each stage of the game (organization). Moreover, these families show a significant worse functioning, especially regards to the mother-daughter phase of the game, in focal attention and affective contact functional levels, while in triadic and couple phases they present lower scores than comparison group in all functional levels. Furthermore, we found that LTPc may predict the possibility of belonging to a family with a daughter with AN rather than one whose daughter has a different disorder. Therefore, LTPc would allow clinicians foresee the risk of developing AN and tailoring the most suitable therapeutic intervention and finally see its effectiveness using LTPc for later follow-up video feedback sessions.
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Affiliation(s)
- Martina Maria Mensi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy; Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Laura Balottin
- Childhood, Adolescence and Family Unit, ULSS 16, University of Padua, Italy
| | - Chiara Rogantini
- Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marika Orlandi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Galvani
- Department of Mathematics, University of Pavia, Pavia, Italy; BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Figini
- Department of Political and Social Sciences, University of Pavia, Pavia, Italy; BioData Science Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Chiappedi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Umberto Balottin
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy; Child Neuropsychiatry Unit, Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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94
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Risk of eating disorders in international adoptees: a cohort study using Swedish national population registers. Epidemiol Psychiatr Sci 2020; 29:e131. [PMID: 32452335 PMCID: PMC7264708 DOI: 10.1017/s2045796020000451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Compared to the general population, adoptees are more often referred to specialist psychiatric treatment, exhibit increased risk of suicide and display more symptoms of attention-deficit/hyperactivity-disorder. However, little is known about the impact of being an adoptee on the risk of developing an eating disorder. The aim of the present study was to assess whether international adoptees have a higher risk for eating disorders than native Swedes. METHODS In the present retrospective cohort study, data from the Swedish total population registers on individuals born between 1979 and 2005 were used to assess whether international adoptees residing in Sweden (n = 25 287) have a higher risk for anorexia nervosa (AN) and other eating disorders (OED) than non-adoptees with Swedish-born parents from the general population (n = 2 046 835). The patterns of these results were compared to those for major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and anxiety disorders to determine whether any observed effects were unique to eating disorders or reflected a more general impact on mental health outcomes. RESULTS A survival analysis adjusting for relevant demographic covariates revealed an elevated risk of all examined psychiatric disorders in international adoptees: hazard ratios (95% confidence intervals) are 1.21 (1.04-1.41) for AN, 1.60 (1.44-1.79) for OED, 1.90 (1.81-2.00) for MDD, 1.25 (1.09-1.44) for OCD, and 1.69 (1.60-1.78) for anxiety disorders. CONCLUSIONS Elevated risk of eating disorders as well as of MDD, OCD, and anxiety disorders was found in international adoptees. A parallel pattern between AN and OCD was observed, which both display less elevated rates than the other diagnoses. A considerable number of biological, environmental, and societal factors have been suggested to explain the observed differences in mental health between adoptees and non-adoptees, but they remain primarily theoretical.
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95
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Lao-Kaim NP, Giampietro VP, Williams SCR, Simmons A, Tchanturia K. Functional MRI investigation of verbal working memory in adults with anorexia nervosa. Eur Psychiatry 2020; 29:211-8. [PMID: 23849992 DOI: 10.1016/j.eurpsy.2013.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 05/10/2013] [Accepted: 05/22/2013] [Indexed: 11/28/2022] Open
Abstract
AbstractLiterature regarding verbal working memory (vWM) in anorexia nervosa (AN) has been inconsistent due to a misunderstanding of the key components of vWM and introduction of confounding stimuli. Furthermore, there are no studies looking at how brain function in people with AN relates to vWM performance. The present study used functional magnetic resonance imaging (fMRI) with a letter n-back paradigm to study the effect of increasing vWM task difficulty on cortical functioning in the largest AN sample to date (n = 31). Although the AN group had low BMI and higher anxious and depressive symptomology compared to age-matched controls (HC), there were no between-group differences in accuracy and speed at any task difficulty. fMRI data revealed no regions exhibiting significant differences in activation when groups were compared at each difficulty separately and no regions showing group x condition interaction. Although there was a trend towards lower accuracy as duration of illness increased, this was not correlated with activity in regions associated with vWM. These findings indicate that vWM in AN is as efficient and performed using the same cognitive strategy as HC, and that there may not be a need for therapies to pursue remediation of this particular neurocognitive faculty.
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Affiliation(s)
- N P Lao-Kaim
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - V P Giampietro
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom
| | - S C R Williams
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom; NIHR Biomedical Research Centre for Mental Health at South London, Maudsley NHS Foundation Trust, Institute of Psychiatry, King's College London, London, United Kingdom
| | - A Simmons
- King's College London, Institute of Psychiatry, Department of Neuroimaging, SE5 8AF London, United Kingdom; NIHR Biomedical Research Centre for Mental Health at South London, Maudsley NHS Foundation Trust, Institute of Psychiatry, King's College London, London, United Kingdom
| | - K Tchanturia
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom.
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96
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Wang L, Bi K, Song Z, Zhang Z, Li K, Kong QM, Li XN, Lu Q, Si TM. Disturbed Resting-State Whole-Brain Functional Connectivity of Striatal Subregions in Bulimia Nervosa. Int J Neuropsychopharmacol 2020; 23:356-365. [PMID: 32215560 PMCID: PMC7311647 DOI: 10.1093/ijnp/pyaa023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disturbed self-regulation, taste reward, as well as somatosensory and visuospatial processes were thought to drive binge eating and purging behaviors that characterize bulimia nervosa. Although studies have implicated a central role of the striatum in these dysfunctions, there have been no direct investigations on striatal functional connectivity in bulimia nervosa from a network perspective. METHODS We calculated the functional connectivity of striatal subregions based on the resting-state functional Magnetic Resonance Imaging data of 51 bulimia nervosa patients and 53 healthy women. RESULTS Compared with the healthy women, bulimia nervosa patients showed increased positive functional connectivity in bilateral striatal nuclei and thalamus for nearly all of the striatal subregions, and increased negative functional connectivity in bilateral primary sensorimotor cortex and occipital areas for both ventral striatum and putamen subregions. Only for the putamen subregions, we observed reduced negative functional connectivity in the prefrontal (bilateral superior and middle frontal gyri) and parietal (right inferior parietal lobe and precuneus) areas. Several striatal connectivities with occipital and primary sensorimotor cortex significantly correlated with the severity of bulimia. CONCLUSIONS The findings indicate bulimia nervosa-related alterations in striatal functional connectivity with the dorsolateral prefrontal cortex supporting self-regulation, the subcortical striatum and thalamus involved in taste reward, as well as the visual occipital and sensorimotor regions mediating body image, which contribute to our understanding of neural circuitry of bulimia nervosa and encourage future therapeutic developments for bulimia nervosa by modulating striatal pathway.
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Affiliation(s)
- Li Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Peking University the Sixth Hospital (Institute of Mental Health); National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Kun Bi
- Key Laboratory of Child Development and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China
| | - Zhou Song
- Taiyuan Psychiatric Hospital, Taiyuan, Shanxi, China
| | - Zhe Zhang
- Taiyuan Psychiatric Hospital, Taiyuan, Shanxi, China
| | - Ke Li
- Peking University the Sixth Hospital (Institute of Mental Health); National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Qing-Mei Kong
- Peking University the Sixth Hospital (Institute of Mental Health); National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Xue-Ni Li
- Department of Radiology, 306 Hospital of People’s Liberation Army, Beijing, China
| | - Qing Lu
- Key Laboratory of Child Development and Learning Science, School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, China
| | - Tian-Mei Si
- Peking University the Sixth Hospital (Institute of Mental Health); National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
- Correspondence: Tian-Mei Si, PhD, Clinical Psychopharmacology Division, Institute of Mental Health, Peking University, No. 51 Hua Yuan Bei Road, Hai Dian District 100191, Beijing, China ()
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97
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Srismith D, Wider LM, Wong HY, Zipfel S, Thiel A, Giel KE, Behrens SC. Influence of Physical Activity Interventions on Body Representation: A Systematic Review. Front Psychiatry 2020; 11:99. [PMID: 32265747 PMCID: PMC7096574 DOI: 10.3389/fpsyt.2020.00099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
Distorted representation of one's own body is a diagnostic criterion and corepsychopathology of disorders such as anorexia nervosa and body dysmorphic disorder. Previousliterature has raised the possibility of utilising physical activity intervention (PI) as atreatment option for individuals suffering from poor body satisfaction, which is traditionallyregarded as a systematic distortion in "body image." In this systematic review,conducted according to the PRISMA statement, the evidence on effectiveness of PI on body representation outcomes is synthesised. We provide an update of 34 longitudinal studies evaluating the effectiveness of different types of PIs on body representation. No systematic risk of bias within or across studies were identified. The reviewed studies show that the implementation of structured PIs may be efficacious in increasing individuals' satisfaction of their own body, and thus improving their subjective body image related assessments. However, there is no clear evidence regarding an additional or interactive effect of PI when implemented in conjunction with established treatments for clinical populations. We argue for theoretically sound, mechanism-oriented, multimethod approaches to future investigations on body image disturbance. Specifically, we highlight the need to consider expanding the theoretical framework for the investigation of body representation disturbances to include further body representations besides body image.
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Affiliation(s)
- Duangkamol Srismith
- Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Max Planck Institute for Intelligent Systems, Department of Perceiving Systems, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tübingen, Tübingen, Germany
| | - Leona-Magdelena Wider
- Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Hong Yu Wong
- Werner Reichardt Centre for Integrative Neurosciences, University of Tübingen, Tübingen, Germany
- Department of Philosophy, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Ansgar Thiel
- Institute of Sports Science, Faculty of Economic and Social Sciences, University of Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
| | - Simone Claire Behrens
- Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, Tübingen, Germany
- Max Planck Institute for Intelligent Systems, Department of Perceiving Systems, Tübingen, Germany
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98
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Bou Khalil R, Guillaume S. Is post-traumatic embitterment disorder a yet unknown comorbidity of anorexia nervosa? Med Hypotheses 2020; 140:109670. [PMID: 32182559 DOI: 10.1016/j.mehy.2020.109670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
Abstract
Patients with anorexia nervosa (AN) present more frequently a personal history of traumatizing life events than they manifest a comorbid, clinically characterized, post-traumatic stress disorder (PTSD). The psychological impact of traumatic events on patients with AN may also manifest through a post-traumatic embitterment disorder (PTED). In PTED, the traumatic event is perceived as unjust and the patient's response involves feelings of embitterment, rage, and helplessness along with repeated intrusive memories and a persistent negative change in mental well-being. Patients with AN share several psychopathological features with the clinical disturbed dimensions described in PTED. Accordingly, the comorbidity between PTED and AN needs further characterization. Moreover, specific therapeutic intervention known to improve symptoms of PTED such as cognitive-behavioral therapy based on wisdom psychology should be tested in selected patients with AN.
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Affiliation(s)
- Rami Bou Khalil
- Hotel Dieu de France, Beirut, Lebanon; Saint Joseph University, Beirut, Lebanon.
| | - Sebastien Guillaume
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier & Inserm U1061, Université de Montpellier, Montpellier, France
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99
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Liu W, Zhan S, Li D, Lin Z, Zhang C, Wang T, Pan S, Zhang J, Cao C, Jin H, Li Y, Sun B. Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study. Brain Stimul 2020; 13:643-649. [PMID: 32289691 DOI: 10.1016/j.brs.2020.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Given that anorexia nervosa (AN) is a life-threatening mental disorder and has poor clinical outcomes, novel effective treatments are warranted, especially for severe and persistent cases. OBJECTIVE To investigate the safety, feasibility, and clinical outcomes of using deep brain stimulation (DBS) of the nucleus accumbens (NAcc) in treatment-refractory AN patients. METHODS A total of 28 women with refractory AN underwent NAcc-DBS and completed this 2-year follow-up study. The clinical outcomes, including body mass index (BMI) and mood, anxiety, and obsessive symptoms, were assessed using a series of psychiatric scales at 6 and 24 months post operation. RESULTS While no fatalities were reported during this study, 1 patient showed device rejection. The most common short-term side effect observed was varying degrees of pain at the incision sites (n = 22), which usually disappeared 3-4 days following the operation. No severe surgical adverse events were observed. Compared to presurgical levels, significant increases in BMI and improvement in psychiatric scale scores were noted during the 6-month follow-up and were maintained at the 2-year review. Finally, a post-hoc analysis revealed that the NAcc-DBS was less effective for weight restoration in patients with the binge-eating/purge subtype of AN than in those with the restricting subtype (R-AN). CONCLUSION Our long-term follow-up study suggests that NAcc-DBS is safe and effective for improving the BMI and psychiatric symptoms of patients with refractory AN. Although NAcc-DBS appears to be more suitable for patients with R-AN, strict inclusion criteria must be applied considering surgery-related complications.
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Affiliation(s)
- Wei Liu
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shikun Zhan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sijian Pan
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Zhang
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Cao
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Shanghai YangPu District Mental Health Center, Shanghai, China
| | - Bomin Sun
- Department of Stereotactic and Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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100
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Lai J, Xu T, Zhang H, Xi C, Zhou H, Du Y, Jiang J, Wu L, Zhang P, Xu Y, Hu S, Xu D. Fractional amplitude of low frequency fluctuation in drug-naïve first-episode patients with anorexia nervosa: A resting-state fMRI study. Medicine (Baltimore) 2020; 99:e19300. [PMID: 32118747 PMCID: PMC7478752 DOI: 10.1097/md.0000000000019300] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To characterize the fractional amplitude of low-frequency fluctuation (fALFF) in drug-naïve first-episode female patients with anorexia nervosa (AN) using resting-state functional magnetic resonance imaging (rs-fMRI).Whole brain rs-fMRI data were collected from 7 drug-naïve first-episode female patients with DSM-5 AN and 14 age-matched healthy female controls. fALFF values were calculated and compared between the two groups using a two-sample t test. Correlation analysis between the fALFF values in the entire brain and body mass index (BMI) was performed.Compared with the healthy controls, increased fALFF values were observed in the AN patients in their right hippocampus and left superior frontal gyrus, while decreased fALFF values were observed in their left rectus and left middle occipital gyrus. Moreover, low BMI was significantly associated with decreased fALFF in the left inferior frontal gyrus but increased fALFF in the left calcarine. In particular, the z-standardized fALFF (zfALFF) value of the left rectus was positive associated with BMI.Our findings suggest that spontaneous brain activity in the frontal region, hippocampus and rectus, characterized by fALFF values, was altered in drug-naïve, first-episode female patients with AN.
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Affiliation(s)
- Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Tingting Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
- Mental Health Centre, Xiaoshan Hospital of Zhejiang Province, Hangzhou
| | - Haorong Zhang
- Shanghai Key Laboratory of Magnetic Resonance Imaging & Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
| | - Caixi Xi
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Hetong Zhou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Yanli Du
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Jiajun Jiang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Lingling Wu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Peifen Zhang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- Zhejiang University School of Medicine
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province
- Brain Research Institute of Zhejiang University
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY 10032
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