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Favaro A, Tenconi E, Degortes D, Manara R, Santonastaso P. Gyrification brain abnormalities as predictors of outcome in anorexia nervosa. Hum Brain Mapp 2015; 36:5113-22. [PMID: 26374960 DOI: 10.1002/hbm.22998] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/03/2015] [Accepted: 09/08/2015] [Indexed: 12/15/2022] Open
Abstract
Gyrification brain abnormalities are considered a marker of early deviations from normal developmental trajectories and a putative predictor of poor outcome in psychiatric disorders. The aim of this study was to explore cortical folding morphology in patients with anorexia nervosa (AN). A MRI brain study was conducted on 38 patients with AN, 20 fully recovered patients, and 38 healthy women. Local gyrification was measured with procedures implemented in FreeSurfer. Vertex-wise comparisons were carried out to compare: (1) AN patients and healthy women; (2) patients with a full remission at a 3-year longitudinal follow-up assessment and patients who did not recover. AN patients exhibited significantly lower gyrification when compared with healthy controls. Patients with a poor 3-year outcome had significantly lower baseline gyrification when compared to both healthy women and patients with full recovery at follow-up, even after controlling for the effects of duration of illness and gray matter volume. No significant correlation has been found between gyrification, body mass index, amount of weight loss, onset age, and duration of illness. Brain gyrification significantly predicted outcome at follow-up even after controlling for the effects of duration of illness and other clinical prognostic factors. Although the role of starvation in determining our findings cannot be excluded, our study showed that brain gyrification might be a predictor of outcome in AN. Further studies are needed to understand if brain gyrification abnormalities are indices of early neurodevelopmental alterations, the consequence of starvation, or the interaction between both factors.
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Affiliation(s)
- Angela Favaro
- Department of Neurosciences, University of Padova, Italy.,Centro Neuroscienze Cognitive, University of Padova, Italy.,Neuroradiology Unit, IRCSS San Camillo, Venice, Italy
| | - Elena Tenconi
- Department of Neurosciences, University of Padova, Italy.,Centro Neuroscienze Cognitive, University of Padova, Italy
| | | | - Renzo Manara
- Department of Medicine, University of Salerno, Italy.,Neuroradiology Unit, IRCSS San Camillo, Venice, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova, Italy.,Centro Neuroscienze Cognitive, University of Padova, Italy
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52
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Riches NG, Loucas T, Baird G, Charman T, Simonoff E. Elephants in Pyjamas: Testing the Weak Central Coherence Account of Autism Spectrum Disorders Using a Syntactic Disambiguation Task. J Autism Dev Disord 2015; 46:155-163. [DOI: 10.1007/s10803-015-2560-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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53
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Heled E, Hoofien D, Bachar E, Ebstein RP. Verbal Versus Figural Fluency Tests in Currently Ill and Weight Restored Anorexia Nervosa Patients. EUROPEAN EATING DISORDERS REVIEW 2015. [PMID: 26206112 DOI: 10.1002/erv.2387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Fluency tests allow domain-specific assessment of verbal and non-verbal executive functions (EF) comparison and also enable utilizing of both quantitative and qualitative scoring methods. Thirty-five currently ill anorexia nervosa patients (PANs), 33 weight-restored patients (WRAN) and 47 healthy controls (HCs) were administered the word fluency test and the five-point test. Results show that WRANs tended to perseverate more than HCs in the verbal-fluency test. In addition, PANs produced significantly less correct figures and perseverated more than HCs and WRANs; HCs used more strategy methods than PANs and WRANs. Additionally, a positive correlation was found in the HC group between the total number of words in the verbal phonemic test and the number of designs produced and the number of correct designs. No such correlations were found in both anorexia groups. In conclusion, there is a differentiation between verbal and non-verbal EF in PANs and WRANs, showing a deficiency in the non-verbal domain. These findings may contribute to our understanding of the cognitive nature of the disorder.
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Affiliation(s)
- Eyal Heled
- Day Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel.,Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Hoofien
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eytan Bachar
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
| | - Richard P Ebstein
- Department of Psychology, National University of Singapore, Singapore
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Weider S, Indredavik MS, Lydersen S, Hestad K. Central Coherence, Visuoconstruction and Visual Memory in Patients with Eating Disorders as Measured by Different Scoring Methods of the Rey Complex Figure Test. EUROPEAN EATING DISORDERS REVIEW 2015; 24:106-13. [PMID: 26136360 DOI: 10.1002/erv.2385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/05/2015] [Accepted: 06/09/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aims of this study were to examine the performance of eating disorder (ED) patients on the Rey Complex Figure Test and to investigate the validity of the Q-score as a new method for measuring central coherence (CC). METHOD Forty-one patients with anorexia nervosa, 40 patients with bulimia nervosa and 40 healthy controls completed the Rey Complex Figure Test, which was scored both quantitatively and qualitatively. RESULTS Both ED groups scored lower than the healthy controls on copy, recall and the Q-score. For the anorexia nervosa group, performance on the Central Coherence Index was associated with the nadir body mass index. Performance on the recall measures was independently associated with the nadir body mass index and depressive symptoms for the bulimia nervosa group. There was a strong correlation between the Q-score and the Central Coherence Index (r = 0.77). DISCUSSION The study reveals different levels of CC and suggests that the Q-score might be an applicable method for measuring CC in ED patients.
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Affiliation(s)
- Siri Weider
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Specialised Unit for Eating Disorder Patients, Department of Psychiatry, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
| | - Marit Saebø Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare, NTNU, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, NTNU, Trondheim, Norway
| | - Knut Hestad
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Division of Mental Health, Innlandet Hospital Trust, Brumunddal, Norway.,Hedmark University College, Elverum, Norway
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55
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Li W, Lai TM, Bohon C, Loo SK, McCurdy D, Strober M, Bookheimer S, Feusner J. Anorexia nervosa and body dysmorphic disorder are associated with abnormalities in processing visual information. Psychol Med 2015; 45:2111-2122. [PMID: 25652023 PMCID: PMC4898970 DOI: 10.1017/s0033291715000045] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted body image and are frequently co-morbid with each other, although their relationship remains little studied. While there is evidence of abnormalities in visual and visuospatial processing in both disorders, no study has directly compared the two. We used two complementary modalities--event-related potentials (ERPs) and functional magnetic resonance imaging (fMRI)--to test for abnormal activity associated with early visual signaling. METHOD We acquired fMRI and ERP data in separate sessions from 15 unmedicated individuals in each of three groups (weight-restored AN, BDD, and healthy controls) while they viewed images of faces and houses of different spatial frequencies. We used joint independent component analyses to compare activity in visual systems. RESULTS AN and BDD groups demonstrated similar hypoactivity in early secondary visual processing regions and the dorsal visual stream when viewing low spatial frequency faces, linked to the N170 component, as well as in early secondary visual processing regions when viewing low spatial frequency houses, linked to the P100 component. Additionally, the BDD group exhibited hyperactivity in fusiform cortex when viewing high spatial frequency houses, linked to the N170 component. Greater activity in this component was associated with lower attractiveness ratings of faces. CONCLUSIONS Results provide preliminary evidence of similar abnormal spatiotemporal activation in AN and BDD for configural/holistic information for appearance- and non-appearance-related stimuli. This suggests a common phenotype of abnormal early visual system functioning, which may contribute to perceptual distortions.
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Affiliation(s)
- W Li
- Interdepartmental Neuroscience Program,University of California,Los Angeles,CA,USA
| | - T M Lai
- Department of Psychology,University of California,Los Angeles, CA,USA
| | - C Bohon
- Department of Psychiatry and Behavioral Sciences,Stanford University,Palo Alto,CA,USA
| | - S K Loo
- Department of Psychiatry and Biobehavioral Sciences,University of California,Los Angeles, CA,USA
| | - D McCurdy
- University of California,Los Angeles, CA,USA
| | - M Strober
- Department of Psychiatry and Biobehavioral Sciences,University of California,Los Angeles, CA,USA
| | - S Bookheimer
- Department of Psychiatry and Biobehavioral Sciences,University of California,Los Angeles, CA,USA
| | - J Feusner
- Department of Psychiatry and Biobehavioral Sciences,University of California,Los Angeles, CA,USA
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56
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Juarascio AS, Manasse SM, Espel HM, Kerrigan SG, Forman EM. Could training executive function improve treatment outcomes for eating disorders? Appetite 2015; 90:187-93. [PMID: 25777264 PMCID: PMC4844012 DOI: 10.1016/j.appet.2015.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/22/2022]
Abstract
Current gold standard treatments for eating disorders (EDs) lack satisfactory efficacy, and traditional psychological treatments do not directly address executive functioning deficits underpinning ED pathology. The goal of this paper is to explore the potential for enhancing ED treatment outcomes by improving executive functioning deficits that have been demonstrated to underlie eating pathology. To achieve our objective, we (1) review existing evidence for executive functioning deficits that underpin EDs and consider the extent to which these deficits could be targeted in neurocognitive training programs, (2) present the evidence for the one ED neurocognitive training program well-studied to date (Cognitive Remediation Therapy), (3) discuss the utility of neurocognitive training programs that have been developed for other psychiatric disorders with similar deficits, and (4) provide suggestions for the future development and research of neurocognitive training programs for EDs. Despite the fact that the body of empirical work on neurocognitive training programs for eating disorders is very small, we conclude that their potential is high given the combined evidence for the role of deficits in executive functioning in EDs, the initial promise of Cognitive Remediation Training, and the success in treating related conditions with neurocognitive training. Based on the evidence to date, it appears that the development and empirical evaluation of neurocognitive training programs for EDs is warranted.
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Affiliation(s)
| | | | - Hallie M Espel
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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57
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Li W, Lai TM, Loo SK, Strober M, Mohammad-Rezazadeh I, Khalsa S, Feusner J. Aberrant early visual neural activity and brain-behavior relationships in anorexia nervosa and body dysmorphic disorder. Front Hum Neurosci 2015; 9:301. [PMID: 26082703 PMCID: PMC4451358 DOI: 10.3389/fnhum.2015.00301] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) and anorexia nervosa (AN) share the clinical symptom of disturbed body image, which may be a function of perceptual distortions. Previous studies suggest visual or visuospatial processing abnormalities may be contributory, but have been unable to discern whether these occur early or late in the visual processing stream. We used electroencephalography (EEG) and visual event related potentials (ERP) to investigate early perceptual neural activity associated with processing visual stimuli. METHODS We performed EEG on 20 AN, 20 BDD, 20 healthy controls, all unmedicated. In order to probe configural/holistic and detailed processing, participants viewed photographs of faces and houses that were unaltered or filtered to low or high spatial frequencies, respectively. We calculated the early ERP components P100 and N170, and compared amplitudes and latencies among groups. RESULTS P100 amplitudes were smaller in AN than BDD and healthy controls, regardless of spatial frequency or stimulus type (faces or houses). Similarly, N170 latencies were longer in AN than healthy controls, regardless of spatial frequency or stimulus type, with a similar pattern in BDD at trend level significance. N170 amplitudes were smaller in AN than controls for high and normal spatial frequency images, and smaller in BDD than controls for normal spatial frequency images, regardless of stimulus type. Poor insight correlated with lower N170 amplitudes for normal and low spatial frequency faces in the BDD group. CONCLUSIONS Individuals with AN exhibit abnormal early visual system activity, consistent with reduced configural processing and enhanced detailed processing. This is evident regardless of whether the stimuli are appearance-or non-appearance-related, and thus may be a reflection of general, early perceptual abnormalities. As N170 amplitude could be a marker of structural encoding of faces, lower values may be associated with perceptual distortions and could contribute to poor insight in BDD. Future studies may explore visual ERP measures as potential biomarkers of illness phenotype.
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Affiliation(s)
- Wei Li
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Tsz M Lai
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Sandra K Loo
- Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
| | | | - Sahib Khalsa
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA
| | - Jamie Feusner
- Department of Neuroscience, University of California, Los Angeles Los Angeles, CA, USA ; Department of Psychiatry, University of California, Los Angeles Los Angeles, CA, USA
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58
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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59
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Weider S, Indredavik MS, Lydersen S, Hestad K. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa. Int J Eat Disord 2015; 48:397-405. [PMID: 24719259 DOI: 10.1002/eat.22283] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study explored the neuropsychological performance of patients diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) compared with healthy controls (HCs). An additional aim was to investigate the effect of several possible mediators on the association between eating disorders (EDs) and cognitive function. METHOD Forty patients with AN, 39 patients with BN, and 40 HCs who were comparable in age and education were consecutively recruited to complete a standardized neuropsychological test battery covering the following cognitive domains: verbal learning and memory, visual learning and memory, speed of information processing, visuospatial ability, working memory, executive function, verbal fluency, attention/vigilance, and motor function. RESULTS The AN group scored significantly below the HCs on eight of the nine measured cognitive domains. The BN group also showed inferior performance on six cognitive domains. After adjusting for possible mediators, the nadir body mass index (lowest lifetime BMI) and depressive symptoms explained all findings in the BN group. Although this adjustment reduced the difference between the AN and HC groups, the AN group still performed worse than the HCs regarding verbal learning and memory, visual learning and memory, visuospatial ability, working memory, and executive functioning. DISCUSSION Patients with EDs scored below the HCs on several cognitive function measures, this difference being most pronounced for the AN group. The nadir BMI and depressive symptoms had strong mediating effects. Longitudinal studies are needed to identify the importance of weight restoration and treatment of depressive symptoms in the prevention of a possible cognitive decline.
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Affiliation(s)
- Siri Weider
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Specialised Unit for Eating Disorder Patients, Department of Psychiatry, Levanger Hospital, Health Trust Nord-Trøndelag, Levanger, Norway
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60
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Lock J, La Via MC. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry 2015; 54:412-25. [PMID: 25901778 DOI: 10.1016/j.jaac.2015.01.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 10/23/2022]
Abstract
This Practice Parameter reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents. Where empirical support is limited, clinical consensus opinion is used to supplement systematic data review. The Parameter focuses on the phenomenology of eating disorders, comorbidity of eating disorders with other psychiatric and medical disorders, and treatment in children and adolescents. Because the database related to eating disorders in younger patients is limited, relevant literature drawn from adult studies is included in the discussion.
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61
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Pugh M. A narrative review of schemas and schema therapy outcomes in the eating disorders. Clin Psychol Rev 2015; 39:30-41. [PMID: 25932958 DOI: 10.1016/j.cpr.2015.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/02/2015] [Accepted: 04/15/2015] [Indexed: 12/25/2022]
Abstract
Whilst cognitive-behavioural therapy has demonstrated efficacy in the treatment of eating disorders, therapy outcomes and current conceptualizations still remain inadequate. In light of these shortcomings there has been growing interest in the utility of schema therapy applied to eating pathology. The present article first provides a narrative review of empirical literature exploring schemas and schema processes in eating disorders. Secondly, it critically evaluates outcome studies assessing schema therapy applied to eating disorders. Current evidence lends support to schema-focused conceptualizations of eating pathology and confirms that eating disorders are characterised by pronounced maladaptive schemas. Treatment outcomes also indicate that schema therapy, the schema-mode approach, and associated techniques are promising interventions for complex eating disorders. Implications for clinical practice and future directions for research are discussed.
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Affiliation(s)
- Matthew Pugh
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, Royal Holloway, University of London, London, England, United Kingdom.
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62
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Micali N, Kothari R, Nam KW, Gioroukou E, Walshe M, Allin M, Rifkin L, Murray RM, Nosarti C. Eating disorder psychopathology, brain structure, neuropsychological correlates and risk mechanisms in very preterm young adults. EUROPEAN EATING DISORDERS REVIEW 2015; 23:147-55. [PMID: 25645448 DOI: 10.1002/erv.2346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 12/19/2014] [Accepted: 12/27/2014] [Indexed: 12/11/2022]
Abstract
This study investigates the prevalence of eating disorder (ED) psychopathology, neuropsychological function, structural brain correlates and risk mechanisms in a prospective cohort of very preterm (VPT) young adults. We assessed ED psychopathology and neuropsychological correlates in 143 cohort individuals born at <33 weeks of gestation. Structural brain correlates and risk factors at birth, in childhood and adolescence, were investigated using prospectively collected data throughout childhood/adolescence. VPT-born individuals had high levels of ED psychopathology at age 21 years. Executive function did not correlate with ED symptomatology. VPT adults presenting with ED psychopathology had smaller grey matter volume at age 14/15 years in the left posterior cerebellum and smaller white matter volume in the fusiform gyrus bilaterally, compared with VPT adults with no ED psychopathology. Caesarean delivery predicted engaging in compensatory behaviours, and severe eating difficulty at age 14 years predicted ED symptomatology in young adulthood. VPT individuals are at risk for ED symptomatology, with evidence of associated structural alterations in posterior brain regions. Further prospective studies are needed to clarify the pathways that lead from perinatal/obstetric complications to ED and relevant neurobiological mechanisms. © 2015 The Authors. European Eating Disorders Review published by John Wiley &Sons, Ltd.
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Affiliation(s)
- Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, UK
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63
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Calderoni S, Fantozzi P, Balboni G, Pagni V, Franzoni E, Apicella F, Narzisi A, Maestro S, Muratori F. The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa. Neuropsychiatr Dis Treat 2015; 11:75-85. [PMID: 25609969 PMCID: PMC4294691 DOI: 10.2147/ndt.s73235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although previous studies indicated a positive association between restrictive anorexia-nervosa (AN-R) and autistic traits, the potential interference of psychiatric internalizing comorbidity on this association is not yet fully investigated. MATERIALS AND METHODS The aim of this study was to explore autistic traits and internalizing psychopathology in adolescents (age range: 11.7-17.2 years) with AN-R. Twenty-five patients referred to two tertiary-care hospitals were compared to a large control group (N=170) with no differences in age and sex. AN-R patients and controls filled out instruments assessing autistic traits (autism spectrum quotient [AQ]), psychopathology (youth self-report [YSR] 11-18), and eating patterns (eating attitude test [EAT]). In order to disentangle the possible mediating role of internalizing symptoms on autistic traits, two separate control groups (called True and False healthy control, both composed of 25 eating-problem-free participants) were derived from the whole control group on the basis of the presence or absence of internalizing problems in the YSR. RESULTS AN-R patients scored significantly higher on AQ compared to the whole control group and to controls without internalizing problems (True HC), but these differences disappeared when only controls with internalizing problems (False HC) were considered. CONCLUSION Autistic traits in AN-R individuals may have been overestimated and may partly be due to comorbid internalizing symptoms in investigated patients.
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Affiliation(s)
- Sara Calderoni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Pamela Fantozzi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Giulia Balboni
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Veronica Pagni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Emilio Franzoni
- Child Neuropsychiatric Unit, Women, Children and Adolescents Health Department, University Hospital S Orsola-Malpighi, Bologna, Italy
| | - Fabio Apicella
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Sandra Maestro
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy ; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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64
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Oltra-Cucarella J, Rojo Moreno L, Arribas Sáiz P, Sanguesa García C, Latorre Paniagua P, Hidalgo Muñoz E, Rojo Bofill L. Impaired executive functioning influences verbal memory in anorexia nervosa. Eat Behav 2015; 16:47-53. [PMID: 25464067 DOI: 10.1016/j.eatbeh.2014.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND How executive functioning affects delayed verbal recall in AN has never been tested. We investigated the influence of speed of information processing (SIP) and inhibition on delayed verbal recall in females with AN. METHODS Measures of SIP and inhibition from 35 females with AN were analyzed using hierarchical multiple regression after controlling for age, depressive symptomatology and body mass index. Each predictor was evaluated using structure coefficients, common variance and dominance weights. RESULTS The combination of measures of SIP and inhibition accounted for almost 80% of the variance on the delayed recall of the story recall task. When the rest of the variables were partialled out, SIP and inhibition accounted for more than 50% of the variance. CONCLUSIONS As it occurs with visuospatial abilities in AN, basic cognitive abilities such as speed of information processing and cognitive inhibition may affect other cognitive functions such as delayed verbal memory regardless of immediate recall. These findings may help interpret performance on cognitive tests in future research.
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Affiliation(s)
| | - L Rojo Moreno
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain, CIBERESP
| | - P Arribas Sáiz
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - C Sanguesa García
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - P Latorre Paniagua
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - E Hidalgo Muñoz
- Unit of Infant/Juvenile Psychiatry and Eating Disorders, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - L Rojo Bofill
- Psychiatry Service, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
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65
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Using the theory of planned behaviour to measure motivation for recovery in anorexia nervosa. Appetite 2015; 84:309-15. [DOI: 10.1016/j.appet.2014.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/26/2014] [Accepted: 10/30/2014] [Indexed: 11/21/2022]
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66
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Steinglass J, Foerde K, Kostro K, Shohamy D, Timothy Walsh B. Restrictive food intake as a choice--a paradigm for study. Int J Eat Disord 2015; 48:59-66. [PMID: 25130380 PMCID: PMC4276488 DOI: 10.1002/eat.22345] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/06/2014] [Accepted: 07/18/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Inadequate intake and preference for low-calorie foods are salient behavioral features of Anorexia Nervosa (AN). The neurocognitive mechanisms underlying pathological food choice have not been characterized. This study aimed to develop a new paradigm for experimentally modeling maladaptive food choice in AN. METHOD Individuals with AN (n = 22) and healthy controls (HC, n = 20) participated in a computer-based Food Choice Task, adapted for individuals with eating disorders. Participants first rated 43 food images (including high-fat and low-fat items) for Healthiness and Tastiness; an item rated neutral on both blocks was then selected as the Reference item. On each of 42 subsequent trials participants were asked to choose between the food item presented and the Reference item. RESULTS The AN group was less likely to choose high-fat foods relative to HC, as evidenced both in multilevel logistic regression (z = 2.59, p = .009) and ANOVA (F(1,39) = 7.80, p = .008) analyses. Health ratings influenced choice significantly more in AN relative to HC (z = 2.7, p = .006), and were more related to Taste among AN (χ(2) = 4.10, p = .04). Additionally, taste ratings declined with duration of illness (r = -.50, p = .02). DISCUSSION The Food Choice Task captures the preference for low-fat foods among individuals with AN. The findings suggest that the experience of tastiness changes over time and may contribute to perpetuation of illness. By providing an experimental quantitative measure of food restriction, this task opens the door to new experimental investigations into the cognitive, affective, and neural factors contributing to maladaptive food choices characteristic of AN.
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Affiliation(s)
- Joanna Steinglass
- Columbia University Medical Center, 622 West 168Street New York, NY 10032,New York State Psychiatric Institute, 1051 Riverside Drive New York, NY 10032,Corresponding Author: Joanna Steinglass, MD, 1051 Riverside Drive, Unit 98, New York, NY 10032 phone: 646-774-6345,
| | - Karin Foerde
- New York State Psychiatric Institute, 1051 Riverside Drive New York, NY 10032,New York University, 6 Washington Place, New York, NY 10003,Corresponding Author: Joanna Steinglass, MD, 1051 Riverside Drive, Unit 98, New York, NY 10032 phone: 646-774-6345,
| | - Katrina Kostro
- Columbia University Medical Center, 622 West 168Street New York, NY 10032
| | - Daphna Shohamy
- Columbia University, 1190 Amsterdam Avenue, New York, NY 10027
| | - B. Timothy Walsh
- Columbia University Medical Center, 622 West 168Street New York, NY 10032
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Talbot A, Hay P, Buckett G, Touyz S. Cognitive deficits as an endophenotype for anorexia nervosa: an accepted fact or a need for re-examination? Int J Eat Disord 2015; 48:15-25. [PMID: 25046823 DOI: 10.1002/eat.22332] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether impaired set shifting and weak central coherence represent state or trait characteristics and, therefore, candidate endophenotypes of anorexia nervosa (AN). METHOD Forty-nine individuals with lifetime AN (24 acutely unwell, 10 weight recovered, and 15 fully recovered) and 43 healthy controls completed the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test, and the Rey Complex Figure Task measuring cognitive flexibility, local processing, and global processing, respectively. Participants also completed questionnaires assessing eating disorder, anxiety and depressive symptoms, obsessional traits, interpersonal functioning, and quality of life. Body mass index was calculated from height and weight measurements. RESULTS Participants with lifetime AN demonstrated poorer set shifting ability than healthy controls as evidenced by a greater number of perseverative errors on the WCST. When participants were grouped according to illness status, only those in the two recovered groups demonstrated poorer set shifting ability than healthy controls while patients with acute AN performed comparably to all other groups. There were no significant differences between groups on measures of local and global processing. No relationship was found between specific clinical features of AN and cognitive performance. DISCUSSION The results of this study are consistent with a global trend toward set shifting difficulties in patients with AN but do not support weak central coherence as a candidate endophenotype for AN. These findings have clinical implications in terms of treatment selection and planning, particularly in relation to the use of cognitive remediation therapy with patients with AN.
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Affiliation(s)
- Amy Talbot
- The Redleaf Practice, Wahroonga, New South Wales, Australia; Department of Psychology, University of Sydney, New South Wales, Australia
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68
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Heled E, Hoofien D, Bachar E, Cooper-Kazaz R, Gur E, Ebstein RP. Employing executive functions of perceptual and memory abilities in underweight and weight-restored anorexia nervosa patients. Eat Weight Disord 2014; 19:479-87. [PMID: 24859670 DOI: 10.1007/s40519-014-0119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 03/21/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Executive functions (EF) have been widely investigated in anorexia nervosa (AN) revealing difficulties in various aspects. We aimed at testing the effects of EF on stimuli perception and its representations in memory. METHODS Thirty AN underweight patients, 30 weight-restored AN patients, and 44 control participants, were recruited. Various EF were assessed using the Rey-Osterrieth Complex Figure Test, analyzed with the Boston Qualitative Scoring System. RESULTS No differences were found in visuo-constructional measures in either AN groups compared to controls on the copy and memory stages. However, both groups performed significantly worse than controls on most EF variables in the copy stage, while in the immediate and delayed memory stages the difference was less substantial. CONCLUSIONS Difficulties in EF among AN patients, current and weight restored, are more pronounced in the perceptual module and less so when employed through memory retrieval. The pattern, which is apparent after weight gain, suggests that there is no ameliorative effect on these difficulties.
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Affiliation(s)
- Eyal Heled
- Day Treatment Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel,
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Lang K, Lopez C, Stahl D, Tchanturia K, Treasure J. Central coherence in eating disorders: an updated systematic review and meta-analysis. World J Biol Psychiatry 2014; 15:586-98. [PMID: 24882144 DOI: 10.3109/15622975.2014.909606] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES A bias towards local information over the global "gist" (weak central coherence, WCC), has been identified as a possible contributing and maintaining factor in eating disorders (ED). The present study aimed to provide an updated review of the WCC literature and examine the hypothesis that individuals with ED have WCC. METHODS The new search found 12 eligible studies. Meta-analyses were performed on nine of these 12 studies, the remaining three were commented on individually. Data were combined with data from the previous 2008 review, and meta- analyses were performed on 16 studies (nine studies from the new search and seven studies from 2008 review). RESULTS Meta-analysis of the Group Embedded Figures Task provided evidence of superior local processing across all ED subtypes (pooled effect size of d = -0.62 (95% CI = -0.94, -0.31), P < 0.001). Evidence of poorer global processing in ED groups was found from meta-analyses of the Rey-Osterrieth Complex Figures task (d = -0.63 (95% CI = -0.77, -0.49, P < 0.001), and the Object Assembly Task (d = -0.65 (95% CI = -0.94, -0.37), P < 0.0001). CONCLUSIONS As well as supporting the results of previous studies by providing evidence of inefficient global processing, this review has provided evidence of superior local processing, which supports the WCC hypothesis in ED.
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Affiliation(s)
- Katie Lang
- King's College London (KCL), Psychological Medicine, Section of Eating Disorders Institute of Psychiatry , UK
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70
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Mountford VA, Brown A, Bamford B, Saeidi S, Morgan JF, Lacey H. BodyWise: evaluating a pilot body image group for patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:62-7. [PMID: 25382845 DOI: 10.1002/erv.2332] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 10/08/2014] [Accepted: 10/17/2014] [Indexed: 01/17/2023]
Abstract
Body image disturbance can be enduring and distressing to individuals with eating disorders and effective treatments remain limited. This pilot study evaluated a group-based treatment-BodyWise-developed for use in full and partial hospitalization with patients with anorexia nervosa at low weight. A partial crossover waitlist design was used. BodyWise (N = 50) versus treatment as usual (N = 40) were compared on standardized measures of body image disturbance. Results demonstrated significant improvement in the group compared to treatment as usual for the primary outcome measure (Eating Disorder Examination-Questionnaire Shape Concern subscale) and other manifestations of body image disturbance including body checking and body image quality of life. BodyWise appeared acceptable to participants, and was easy to deliver within the pragmatics of a busy eating disorder service. There is potential for its wider dissemination as a precursor to more active body image interventions.
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Affiliation(s)
- Victoria A Mountford
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London
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71
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Pender S, Gilbert SJ, Serpell L. The neuropsychology of starvation: set-shifting and central coherence in a fasted nonclinical sample. PLoS One 2014; 9:e110743. [PMID: 25338075 PMCID: PMC4206438 DOI: 10.1371/journal.pone.0110743] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Recent research suggests certain neuropsychological deficits occur in anorexia nervosa (AN). The role of starvation in these deficits remains unclear. Studies of individuals without AN can elucidate our understanding of the effect of short-term starvation on neuropsychological performance. METHODS Using a within-subjects repeated measures design, 60 healthy female participants were tested once after fasting for 18 hours, and once when satiated. Measures included two tasks to measure central coherence and a set-shifting task. RESULTS Fasting exacerbated set-shifting difficulties on a rule-change task. Fasting was associated with stronger local and impaired global processing, indicating weaker central coherence. CONCLUSIONS Models of AN that propose a central role for set-shifting difficulties or weak central coherence should also consider the impact of short-term fasting on these processes.
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Affiliation(s)
- Sarah Pender
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Sam J. Gilbert
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Lucy Serpell
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
- Eating Disorders Service, North East London Foundation Trust, Essex, United Kingdom
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Tchanturia K, Lounes N, Holttum S. Cognitive remediation in anorexia nervosa and related conditions: a systematic review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:454-62. [PMID: 25277720 DOI: 10.1002/erv.2326] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/07/2022]
Abstract
Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Trust Eating Disorders National Service, UK; Illia University Tbilisi, Georgia
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73
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Morris R, Bramham J, Smith E, Tchanturia K. Empathy and social functioning in anorexia nervosa before and after recovery. Cogn Neuropsychiatry 2014; 19:47-57. [PMID: 23697879 DOI: 10.1080/13546805.2013.794723] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION People with anorexia nervosa (AN) are known to have difficulties with social and emotional functioning, as indicated by their symptom presentation and also performance on tests of emotion perception. This study explores the level of empathy in AN, in terms of resonant experience of emotion in other people using a self-report measure. METHODS Twenty-eight women with acute AN were compared to 25 women who have recovered from AN, and a further 54 healthy control (HC) participants. They were assessed using a questionnaire to measure reported levels of empathy, emotional recognition, social conformity, and antisocial behaviour. RESULTS The acute AN group reported lower levels of empathy than the recovered AN group and HC, but they also reported less antisocial behaviour. No differences were found in emotional recognition or social conformity. CONCLUSIONS These results suggest that emotional empathy is reduced during acute AN. Lower levels of antisocial behaviour may reflect a contrasting desire of people with AN to minimise presentation of antisocial behaviour in the acute state.
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Affiliation(s)
- Robin Morris
- a Department of Psychology , Institute of Psychiatry, King's College London , London , UK
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74
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Dingemans AE, Danner UN, Donker JM, Aardoom JJ, van Meer F, Tobias K, van Elburg AA, van Furth EF. The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:29-36. [PMID: 24281361 DOI: 10.1159/000355240] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 08/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse. Deficits in cognitive flexibility, i.e., set-shifting and central coherence, might perpetuate the symptoms. Cognitive remediation therapy (CRT) was developed to improve cognitive flexibility, thereby increasing the likelihood of improved outcome. The focus of CRT is on how patients think, rather than on what patients think. The present study investigated the effectiveness of CRT for patients with a severe or enduring eating disorder by means of a randomized controlled trial comparing intensive treatment as usual (TAU) to CRT plus TAU. METHODS Eighty-two patients were randomly assigned to CRT plus TAU (n = 41) or TAU alone (n = 41). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology, motivation, quality of life and self-esteem. Assessments were performed at baseline (n = 82) and after 6 weeks (T1; n = 75) and 6 months (T2; n = 67). Data were analyzed by means of linear mixed model analyses. RESULTS Patients who received CRT in addition to TAU improved significantly more with regard to eating disorder-related quality of life at the end of treatment (T1) and eating disorder psychopathology at follow-up (T2), compared to those who received TAU only. Moreover, moderator analyses revealed that patients with poor baseline set-shifting abilities benefited more from CRT than patients with no deficits in set-shifting abilities at baseline; the quality of life of the former group was higher than that of the latter at follow-up. CONCLUSIONS CRT seems to be promising in enhancing the effectiveness of concurrent treatment.
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75
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Vancleef K, Acke E, Torfs K, Demeyere N, Lafosse C, Humphreys G, Wagemans J, de-Wit L. Reliability and validity of the Leuven Perceptual Organization Screening Test (L-POST). J Neuropsychol 2014; 9:271-98. [PMID: 25042381 DOI: 10.1111/jnp.12050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/22/2014] [Indexed: 11/28/2022]
Abstract
Neuropsychological tests of visual perception mostly assess high-level processes like object recognition. Object recognition, however, relies on distinct mid-level processes of perceptual organization that are only implicitly tested in classical tests. Furthermore, the psychometric properties of the existing instruments are limited. To fill this gap, the Leuven perceptual organization screening test (L-POST) was developed, in which a wide range of mid-level phenomena are measured in 15 subtests. In this study, we evaluated reliability and validity of the L-POST. Performance on the test is evaluated relative to a norm sample of more than 1,500 healthy control participants. Cronbach's alpha of the norm sample and test-retest correlations for 20 patients provide evidence for adequate reliability of L-POST performance. The convergent and discriminant validity of the test was assessed in 40 brain-damaged patients, whose performance on the L-POST was compared with standard clinical tests of visual perception and other measures of cognitive function. The L-POST showed high sensitivity to visual dysfunction and decreased performance was specific to visual problems. In conclusion, the L-POST is a reliable and valid screening test for perceptual organization. It offers a useful online tool for researchers and clinicians to get a broader overview of the mid-level processes that are preserved or disrupted in a given patient.
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Affiliation(s)
- Kathleen Vancleef
- Department of Experimental Psychology, University of Leuven, Belgium
| | - Elia Acke
- Department of Experimental Psychology, University of Leuven, Belgium
| | - Katrien Torfs
- Institute of Neuroscience, University of Louvain, Louvain-la-neuve, Belgium
| | - Nele Demeyere
- Department of Experimental Psychology, University of Oxford, UK
| | | | - Glyn Humphreys
- Department of Experimental Psychology, University of Oxford, UK
| | - Johan Wagemans
- Department of Experimental Psychology, University of Leuven, Belgium
| | - Lee de-Wit
- Department of Experimental Psychology, University of Leuven, Belgium
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76
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: a feasibility study. Clin Child Psychol Psychiatry 2014; 19:476-87. [PMID: 23761592 DOI: 10.1177/1359104513489980] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN. METHODS A sample of 20 in- and outpatients (13-18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a "CRT Resource Pack." Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences. RESULTS Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment. CONCLUSIONS The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children, London, UK Care UK, London, UK
| | - Nils-Inge Landrø
- Center for the Study of Human Cognition, Department of Psychology, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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77
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Fairweather-Schmidt AK, Wade TD. DSM-5 eating disorders and other specified eating and feeding disorders: is there a meaningful differentiation? Int J Eat Disord 2014; 47:524-33. [PMID: 24616045 DOI: 10.1002/eat.22257] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In the DSM-5 diagnostic criteria for eating disorders, two main groups appear, threshold eating disorders (TED; anorexia nervosa, bulimia nervosa, and binge eating disorder), and other specified feeding and eating disorders (OSFED). In addition to calculating prevalence of these two groups, we examined the degree to which they could be differentiated in terms of impairment and risk factors. METHOD Adolescent female twins (N = 699) were interviewed with the Eating Disorder Examination on three occasions spanning 12.70-19.84 years of age. Assessments also included self-report measures related to impairment and risk. RESULTS Prevalence of DSM-5 ED in this adolescent population was 10.4%; 5.4% for TED and 5% for OSFED. Impairment levels did not distinguish TED and OSFED groups at any wave. Examination of latent risk factors showed TED and OSFED groups to share a common genetic basis; however, largely nonoverlapping unique environmental influences contributed to the two groups. Specific risk factors commonly differentiated the no ED and TED groups, but not OSFED. DISCUSSION The findings suggest that TED and OSFED groups cannot be discriminated by prevalence or impairment or genetic risk factors. It is anticipated that OSFED will possess limited clinical utility for adolescents. Future research should examine clinical cases of these two groups in terms of meaningful differences, and a research focus should be maintained on both groups. Further examination of specific environmental risk factors that may attenuate the level of symptoms between the two groups may provide useful information for prevention efforts.
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Manasse SM, Juarascio AS, Forman EM, Berner LA, Butryn ML, Ruocco AC. Executive functioning in overweight individuals with and without loss-of-control eating. EUROPEAN EATING DISORDERS REVIEW 2014; 22:373-7. [PMID: 24962637 DOI: 10.1002/erv.2304] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/11/2014] [Accepted: 05/30/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The current study sought to examine executive function (EF) in overweight individuals with and without loss-of-control (LOC) eating. METHOD Eighty overweight and obese individuals entering a behavioural weight loss trial with (n=18) and without (n=62) LOC eating were administered a clinical interview and neuropsychological battery designed to assess self-regulatory control, planning, delayed discounting and working memory. RESULTS After controlling for age, IQ and depression, individuals with LOC eating performed worse on tasks of planning and self-regulatory control and did not differ in performance on other tasks. DISCUSSION Results indicate that overweight individuals with LOC eating display relative deficits in EF compared with overweight individuals without LOC eating. Planning and self-regulatory control deficits in particular may contribute to dysregulated eating patterns, increasing susceptibility to LOC episodes. Future research should examine how EF deficits relate to treatment outcome.
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Allen KL, Byrne SM, Hii H, van Eekelen A, Mattes E, Foster JK. Neurocognitive functioning in adolescents with eating disorders: a population-based study. Cogn Neuropsychiatry 2014; 18:355-75. [PMID: 22803827 DOI: 10.1080/13546805.2012.698592] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Neurocognitive deficits have been identified in eating disorders, including anorexia nervosa and bulimia nervosa. However, current data do not allow for firm conclusions regarding the nature or extent of these deficits. The current study aimed to evaluate neurocognitive functioning in a population-based sample of adolescents with and without eating disorders. METHODS Participants (N=669) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Cognitive testing was conducted using the computerised CogState assessment battery. Eating disorder symptoms were assessed using questions adapted from the Child Eating Disorder Examination and Eating Disorder Examination-Questionnaire. Adolescents who met full or partial criteria for a DSM-IV eating disorder (n=58) were compared to adolescents with no significant eating pathology (n=592). RESULTS The eating disorder sample showed impaired performance on measures of executive functioning, including global processing and set shifting, but performed better than control participants on measures of visual attention and vigilance. CONCLUSIONS This is the first study to evaluate neurocognitive functioning in a population-based sample of adolescents with eating disorders. Support is provided for weak central coherence and set-shifting difficulties early in the course of eating disorders. Research is needed to determine if these deficits precede and predict eating disorder onset.
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Affiliation(s)
- Karina L Allen
- a Telethon Institute for Child Health Research, Centre for Child Health Research , University of Western Australia , Subiaco , Western Australia
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Validity and reliability of the behavior rating inventory of executive function - adult version in a clinical sample with eating disorders. Eat Behav 2014; 15:175-81. [PMID: 24854800 DOI: 10.1016/j.eatbeh.2014.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/29/2013] [Accepted: 01/22/2014] [Indexed: 11/20/2022]
Abstract
This study is a preliminary investigation of the reliability and validity of the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in a clinical sample of patients with eating disorders (ED). Participants were 252 adult females who were referred to a centre for the treatment of EDs, as well as 31 individuals who completed the informant version of the BRIEF-A. Patients completed the BRIEF-A and other psychological measures on one occasion during their initial clinic visit, and informants nominated by patients completed the informant version at home. Reliability analyses revealed high internal consistency (Cronbach's alpha) of the two indices (Metacognition Index and Behavioral Regulation Index), and for the Global Executive Composite (GEC) of the BRIEF-A (α = .96). Convergent validity was shown by a high positive relationship between the self-report and informant-report versions of the BRIEF-A, and between the GEC and the Anxiety and Depression scales. Construct validity was assessed by an exploratory and confirmatory factor analysis. The BRIEF-A may be a reliable and valid tool for measuring executive functioning (EF) in an ED population, and may serve as an initial screening tool of EF for clinicians and researchers.
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81
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Tchanturia K, Doris E, Fleming C. Effectiveness of Cognitive Remediation and Emotion Skills Training (CREST) for Anorexia Nervosa in Group Format: A Naturalistic Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2014; 22:200-5. [DOI: 10.1002/erv.2287] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/24/2014] [Accepted: 02/11/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Kate Tchanturia
- King's College London; Division of Psychological Medicine, Institute of Psychiatry; London UK
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
- Illia State University Tbilisi; Georgia
| | - Eli Doris
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
| | - Caroline Fleming
- Eating Disorders Unit; South London and Maudsley NHS Foundation Trust; London UK
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van Noort BM, Pfeiffer E, Lehmkuhl U, Kappel V. [An international neuropsychological assessment tool for children, adolescents, and adults with anorexia nervosa – the German adaptation of the Ravello Profile]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 41:371-81. [PMID: 24240493 DOI: 10.1024/1422-4917/a000253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions. METHODS The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN. RESULTS AND CONCLUSIONS The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.
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Affiliation(s)
- Betteke Maria van Noort
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin
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83
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Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria. REVISTA LATINOAMERICANA DE PSICOLOGIA 2014. [DOI: 10.1016/s0120-0534(14)70022-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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84
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Carton AM, Smith AD. Assessing the relationship between eating disorder psychopathology and autistic traits in a non-clinical adult population. Eat Weight Disord 2014; 19:285-93. [PMID: 24272141 DOI: 10.1007/s40519-013-0086-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Previous research demonstrates a genetic and behavioural link between eating disorders and autism spectrum disorders, and a recent study (Coombs et al. in Br J Clin Psychol 50:326-338, 2011) extends this link to typical populations, showing a positive correlation between behaviours in typically developing children. The purpose of the present study was to examine whether this relationship continues beyond development, by studying the link between behaviours in a non-clinical adult population. METHODS We examined associations between performance on measures relating to autistic traits and disordered eating. Undergraduate students, equally balanced by gender and by subject studied (i.e. humanity or science), completed three tasks: to measure autistic traits, participants were administered the Embedded Figures Test (EFT) and the Autism-Spectrum Quotient (AQ). Eating disorder symptomatology was measured by the Eating Attitudes Test (Eat-26). RESULTS Our data revealed a significant positive correlation between scores on the AQ and Eat-26. Multiple linear regressions showed that higher scores on the AQ were particularly associated with higher scores on the Bulimia & Food Preoccupation subscale of the Eat-26. EFT performance was positively related to behaviours associated with autism and eating disorders, although not reliably so. CONCLUSIONS These data support the broader link between autistic traits and disordered eating in the non-clinical population, and demonstrate that it extends into adulthood (a time at which autistic behaviours can decrease). This work carries implications for the development of cognitive therapies for people with eating disorders.
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Affiliation(s)
- Amelia Myri Carton
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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85
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Heled E, Hoofien D, Bachner-Melman R, Bachar E, Ebstein RP. The sorting test of the D-KEFS in current and weight restored anorexia nervosa patients. Int J Eat Disord 2014; 47:92-8. [PMID: 24166931 DOI: 10.1002/eat.22203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Efforts have been made to characterize executive functions (EF) in anorexia nervosa (AN) both in the acute stage of the illness and after weight gain, yet many questions remain. The question of verbal versus visuo-perceptual stimuli in this regard has not been adequately addressed. The aim of this study is to further examine EF in women with past and present AN and to compare their performances in verbal and visual modalities with women who have never suffered from an eating disorder. METHOD Thirty-five underweight AN patients, 33 weight-restored patients symptom-free for at least 2 years, and 48 healthy female controls completed the Delis-Kaplan Executive Function System Sorting Test, so as to evaluate their EF. RESULTS No differences were observed between the scores of women with current and past AN. Both groups scored lower than controls on most test variables. However, while in the visuo-perceptual domain the performance of the AN groups was worse than that of controls, in the verbal domain they performed similarly to them. DISCUSSION Women with a past or present diagnosis of AN show difficulties in visuo-perceptual EF, whereas verbal EF seem to be preserved. There may be a dissociation between verbal and visuo-perceptual EF that persists after weight restoration.
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Affiliation(s)
- Eyal Heled
- Day Treatment Rehabilitation Unit, Sheba Medical Center, Ramat Gan, Israel; Department of Psychology, Hebrew University, Jerusalem, Israel
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86
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Schmidt U, Wade TD, Treasure J. The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence. J Cogn Psychother 2014; 28:48-71. [PMID: 32759130 DOI: 10.1891/0889-8391.28.1.48] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anorexia nervosa (AN) is a severe mental disorder that affects mainly young females. In adults with a well-established form of the illness, it is hard to treat. In 2006, we proposed a maintenance model of AN, combining intra- and interpersonal factors and we have recently refined this model. The model encompasses four main maintaining factors (a thinking style characterized by rigidity, detail focus, and a fear of making mistakes; an avoidant emotion processing and relational style; positive beliefs about the use of anorexia for the person [pro-anorexia beliefs]; and a response of close others to the illness characterized by high expressed emotion and enabling of and accommodation to the illness). In this article, we describe how the model has been translated into a novel treatment for AN and the preliminary evidence supporting this. Implications for clinical practice and research are discussed.
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Affiliation(s)
- Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London
| | - Tracey D Wade
- School of Psychology, Flinders University, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London
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87
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Fonville L, Giampietro V, Surguladze S, Williams S, Tchanturia K. Increased BOLD signal in the fusiform gyrus during implicit emotion processing in anorexia nervosa. NEUROIMAGE-CLINICAL 2013; 4:266-73. [PMID: 24501698 PMCID: PMC3913832 DOI: 10.1016/j.nicl.2013.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/30/2013] [Accepted: 12/02/2013] [Indexed: 12/02/2022]
Abstract
Background The behavioural literature in anorexia nervosa (AN) has suggested impairments in psychosocial functioning and studies using facial expression processing tasks (FEPT) have reported poorer recognition and slower identification of emotions. Methods Functional magnetic resonance imaging (fMRI) was used alongside a FEPT, depicting neutral, mildly happy and happy faces, to examine the neural correlates of implicit emotion processing in AN. Participants were instructed to specify the gender of the faces. Levels of depression, anxiety, obsessive–compulsive symptoms and eating disorder behaviour were obtained and principal component analysis (PCA) was performed to acquire uncorrelated variables. Results fMRI analysis revealed a greater blood-oxygenation level dependent (BOLD) response in AN in the right fusiform gyrus to all facial expressions. This response showed a linear increase with the happiness of the facial expression and was found to be stronger in those not taking medication. PCA analysis revealed a single component indicating a greater level of general clinical symptoms. Conclusion Neuroimaging findings would suggest that alterations in implicit emotion processing in AN occur during early perceptual processing of social signals and illustrate greater engagement on the FEPT. The lack of separate components using PCA suggests that the questionnaires used might not be suited as predictive measures. Greater BOLD response in AN in the right fusiform gyrus to all facial expressions. The BOLD response showed a linear increase with the happiness of the expression The BOLD response was stronger in those not taking psychotropic medication These alterations occur during early perceptual processing of social signals
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Affiliation(s)
- Leon Fonville
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Simon Surguladze
- King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom ; Cognitive & Affective Neuroscience Lab, Ilia University, Tblisi, Georgia
| | - Steven Williams
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom ; NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, United Kingdom
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
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88
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Neuropsychological variables and clinical status in anorexia nervosa: relationship between visuospatial memory and central coherence and eating disorder symptom severity. Eat Weight Disord 2013; 18:421-8. [PMID: 24014260 DOI: 10.1007/s40519-013-0062-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022] Open
Abstract
AIM To explore the relationship between visuospatial memory, weak central coherence, and eating disorder (ED) symptoms in anorexia nervosa (AN) inpatients. SAMPLE 31 female AN inpatients. METHODS Rey complex figure test (RCFT) was used to assess both visuospatial memory and central coherence. RCFT consisted of copy and recall trials. ED symptoms were assessed by The Eating Disorder Examination-Questionnaire (EDE-Q) and The Clinical and Research Inventory for Eating Disorders (CR-EAT). RESULTS We found a statistically significant negative correlation between recall accuracy and the total EDE-Q score. Furthermore, recall accuracy and recall central coherence significantly negatively correlate with several EDE-Q and CR-EAT scales. CONCLUSIONS These findings may contribute to a better understanding of cognitive impairments specifically in ED, and to refining interventions aiming at their improvement.
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89
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Huke V, Turk J, Saeidi S, Kent A, Morgan JF. The Clinical Implications of High Levels of Autism Spectrum Disorder Features in Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2013; 22:116-21. [DOI: 10.1002/erv.2269] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Vanessa Huke
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
| | - Jeremy Turk
- St George's, University of London; London UK
- Southwark Child & Adolescent Mental Health Neurodevelopmental Service; South London and Maudsley NHS Foundation Trust; UK
- Institute of Psychiatry; King's College; London UK
| | | | - Andrew Kent
- St George's, University of London; London UK
| | - John. F. Morgan
- St George's, University of London; London UK
- Yorkshire Centre for Eating Disorders; Leeds UK
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90
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Tchanturia K, Smith E, Weineck F, Fidanboylu E, Kern N, Treasure J, Baron Cohen S. Exploring autistic traits in anorexia: a clinical study. Mol Autism 2013; 4:44. [PMID: 24220604 PMCID: PMC4176300 DOI: 10.1186/2040-2392-4-44] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/05/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The objectives of this study were to explore associations between autistic traits and self-reported clinical symptoms in a population with anorexia nervosa (AN). Experimental and self-report evidence reveals similarities between AN and autism spectrum condition (ASC) populations in socio-emotional and cognitive domains; this includes difficulties with empathy, set-shifting and global processing. Focusing on these similarities may lead to better tailored interventions for both conditions. METHODS A cross-sectional independent-groups design was employed. Participants with AN (n = 66) and typical controls (n = 66) completed self-report questionnaires including the Short (10-Item) Version Autism Spectrum Quotient (AQ-10) questionnaire (the first time this has been implemented in this population), the Eating Disorder Examination Questionnaire, the Hospital Anxiety and Depression Scale and the Work and Social Adjustment Scale. Group differences and the relationship between autistic traits and other questionnaire measures were investigated. RESULTS The AN group had a significantly higher AQ-10 total score and a greater proportion scored above the clinical cut-off than the control group. Seven out of ten AQ-10 items significantly discriminated between groups. In the AN group, levels of autistic traits correlated with a greater self-reported anxiety and depression and a lower ability to maintain close relationships; however, eating disorder symptoms were not associated with autistic traits. CONCLUSIONS Women with anorexia possess a greater number of autistic traits than typical women. AQ-10 items that discriminated between groups related to 'bigger picture' (global) thinking, inflexibility of thinking and problems with social interactions, suggesting that autistic traits may exacerbate factors that maintain the eating disorder rather than cause the eating disorder directly. Using screening instruments may improve understanding of patients' problems, leading to better tailoring of intervention. We conclude that further investigation of autistic traits in AN could inform new intervention approaches based on joint working between ASC and eating disorder services.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Emma Smith
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Felicitas Weineck
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Eliz Fidanboylu
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Nikola Kern
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Janet Treasure
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Simon Baron Cohen
- Autism Research Centre, Psychiatry Department, Cambridge University, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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91
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Urgesi C, Fornasari L, Canalaz F, Perini L, Cremaschi S, Faleschini L, Thyrion EZ, Zuliani M, Balestrieri M, Fabbro F, Brambilla P. Impaired configural body processing in anorexia nervosa: evidence from the body inversion effect. Br J Psychol 2013; 105:486-508. [PMID: 24206365 DOI: 10.1111/bjop.12057] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/13/2013] [Indexed: 11/29/2022]
Abstract
Patients with anorexia nervosa (AN) suffer from severe disturbances of body perception. It is unclear, however, whether such disturbances are linked to specific alterations in the processing of body configurations with respect to the local processing of body part details. Here, we compared a consecutive sample of 12 AN patients with a group of 12 age-, gender- and education-matched controls using an inversion effect paradigm requiring the visual discrimination of upright and inverted pictures of whole bodies, faces and objects. The AN patients presented selective deficits in the discrimination of upright body stimuli, which requires configural processing. Conversely, patients and controls showed comparable abilities in the discrimination of inverted bodies, which involves only detail-based processing, and in the discrimination of both upright and inverted faces and objects. Importantly, the body inversion effect negatively correlated with the persistence scores at the Temperament and Character Inventory, which evaluates increased tendency to convert a signal of punishment into a signal of reinforcement. These results suggest that the deficits of configural processing in AN patients may be associated with their obsessive worries about body appearance and to the excessive attention to details that characterizes their general perceptual style.
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Affiliation(s)
- Cosimo Urgesi
- Department of Human Sciences, University of Udine, Italy; IRCCS Scientific Institute "E. Medea", Pordenone, Italy
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92
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Rose M, Frampton IJ, Lask B. Central coherence, organizational strategy, and visuospatial memory in children and adolescents with anorexia nervosa. APPLIED NEUROPSYCHOLOGY-CHILD 2013; 3:284-96. [PMID: 24147879 DOI: 10.1080/21622965.2013.775064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The vast majority of studies in anorexia nervosa that have investigated the domains of central coherence, organizational strategy, and visuospatial memory have focused on adult samples. In addition, studies investigating visuospatial memory have focused on free recall. No study to date has reported the association between recognition memory and central coherence or organizational strategy in younger people with this disorder, yet the capacity to recognize previously seen visual stimuli may contribute to overall visuospatial ability. Therefore, we investigate these domains in children and adolescents with anorexia nervosa compared to age- and gender-matched healthy controls. There were no significant group differences in immediate, delayed, or recognition memory, central coherence, or organization strategy. When compared with controls, patients with anorexia nervosa scored significantly higher on accuracy and took significantly longer when copying the Rey Complex Figure Task. Caution must be taken when interpreting these findings due to lower-than-expected scores in memory performance in the control group and because of a potential lack of sensitivity in the measures used when assessing this younger population. For neuropsychological functions where no normative data exist, we need a deeper, more thorough knowledge of the developmental trajectory and its assessment in young people in the general population before drawing conclusions in anorexia nervosa.
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Affiliation(s)
- Mark Rose
- a Eating Disorders Service , The Huntercombe Group , Maidenhead , United Kingdom
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93
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Visual processing in anorexia nervosa and body dysmorphic disorder: similarities, differences, and future research directions. J Psychiatr Res 2013; 47:1483-91. [PMID: 23810196 PMCID: PMC3786585 DOI: 10.1016/j.jpsychires.2013.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are psychiatric disorders that involve distortion of the experience of one's physical appearance. In AN, individuals believe that they are overweight, perceive their body as "fat," and are preoccupied with maintaining a low body weight. In BDD, individuals are preoccupied with misperceived defects in physical appearance, most often of the face. Distorted visual perception may contribute to these cardinal symptoms, and may be a common underlying phenotype. This review surveys the current literature on visual processing in AN and BDD, addressing lower- to higher-order stages of visual information processing and perception. We focus on peer-reviewed studies of AN and BDD that address ophthalmologic abnormalities, basic neural processing of visual input, integration of visual input with other systems, neuropsychological tests of visual processing, and representations of whole percepts (such as images of faces, bodies, and other objects). The literature suggests a pattern in both groups of over-attention to detail, reduced processing of global features, and a tendency to focus on symptom-specific details in their own images (body parts in AN, facial features in BDD), with cognitive strategy at least partially mediating the abnormalities. Visuospatial abnormalities were also evident when viewing images of others and for non-appearance related stimuli. Unfortunately no study has directly compared AN and BDD, and most studies were not designed to disentangle disease-related emotional responses from lower-order visual processing. We make recommendations for future studies to improve the understanding of visual processing abnormalities in AN and BDD.
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94
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Juarascio A, Shaw J, Forman EM, Timko CA, Herbert JD, Butryn ML, Lowe M. Acceptance and Commitment Therapy for eating disorders: Clinical applications of a group treatment. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2013. [DOI: 10.1016/j.jcbs.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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95
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Kanakam N, Treasure J. A review of cognitive neuropsychiatry in the taxonomy of eating disorders: state, trait, or genetic? Cogn Neuropsychiatry 2013; 18:83-114. [PMID: 22994309 DOI: 10.1080/13546805.2012.682362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A greater understanding of neuropsychological traits in eating disorders may help to construct a more biologically based taxonomy. The aim of this paper is to review the current evidence base of neuropsychological traits in people with eating disorders. Evidence of difficulties in set shifting, weak central coherence, emotional processing difficulties, and altered reward sensitivity is presented for people both in the acute and recovered phase of the illness. These traits are also seen in first degree relatives. At present there is limited research linking these neuropsychological traits with genetic and neuroanatomical measures. In addition to improving the taxonomy of eating disorders, neuropsychological traits may be of value in producing targeted treatments.
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Affiliation(s)
- Natalie Kanakam
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
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96
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Courty A, Maria AS, Lalanne C, Ringuenet D, Vindreau C, Chevallier C, Pouga L, Pinabel F, Philippe A, Adrien JL, Barry C, Berthoz S. Levels of autistic traits in anorexia nervosa: a comparative psychometric study. BMC Psychiatry 2013; 13:222. [PMID: 24015680 PMCID: PMC3848448 DOI: 10.1186/1471-244x-13-222] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD. METHODS We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ-B and IRI subscales. RESULTS These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing). CONCLUSION The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders.
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Affiliation(s)
- Annaig Courty
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Anne Solène Maria
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Christophe Lalanne
- AP-HP, Department of Clinical Research, Saint-Louis Hospital, Paris, France
- Inserm Unit UMR-SO 669, University Paris Sud, Paris Descartes, Paris, France
| | - Damien Ringuenet
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Christine Vindreau
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Coralie Chevallier
- Inserm U960 – LNC, Paris, France
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - François Pinabel
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpétrière, Paris Descartes University, Paris, France
- Private Practice, 6 avenue de Tourville, Paris 75007, France
| | - Anne Philippe
- Inserm U781 & Department of Genetic, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Jean-Louis Adrien
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Caroline Barry
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Sylvie Berthoz
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
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97
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Drive for muscularity and muscularity-oriented disordered eating in men: the role of set shifting difficulties and weak central coherence. Body Image 2013; 10:636-9. [PMID: 23680082 DOI: 10.1016/j.bodyim.2013.04.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/02/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022]
Abstract
Set shifting difficulties and weak central coherence are information-processing biases associated with thinness-oriented eating and body image pathology in women. However, little is known about the relationship between these processing biases and muscularity-oriented eating and body image pathology. We investigated whether set shifting and central coherence were uniquely related to the drive for muscularity and muscularity-oriented disordered eating in a sample of 91 male undergraduates. Participants completed the Wisconsin Card Sort Test, the Matching Familiar Figures Task, the Drive for Muscularity scale, and a modified Eating Disorders Examination-Questionnaire. Results indicated that set shifting difficulties and weak central coherence were both uniquely positively associated with the drive for muscularity, and that set shifting difficulties were uniquely positively associated with muscularity-oriented disordered eating. Results are discussed with regard to the male experience of body image and eating pathology, and in regard to muscle dysmorphia.
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98
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Dahlgren CL, Lask B, Landrø NI, Rø Ø. Neuropsychological functioning in adolescents with anorexia nervosa before and after cognitive remediation therapy: a feasibility trial. Int J Eat Disord 2013; 46:576-81. [PMID: 23828636 DOI: 10.1002/eat.22155] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate neuropsychological functioning in adolescents with anorexia nervosa (AN) before and after receiving cognitive remediation therapy (CRT). METHOD Twenty young females with AN participated in an individually-delivered CRT treatment program. Neuropsychological and psychiatric assessments were administered before and after treatment. Weight, depression, anxiety, duration of illness, and level of eating disorder psychopathology were considered as covariates in statistical analyses. RESULTS Significant changes in weight, depression, visio-spatial memory, perceptual disembedding abilities, and verbal fluency were observed. Changes in weight had a significant effect on improvements in visuo-spatial memory and verbal fluency. Results also revealed a significant effect of depressive symptoms on perceptual disembedding abilities. DISCUSSION The results suggest improvements on a number of neuropsychological functions during the course of CRT. Future studies should explore the use of additional assessment instruments, and include control groups to assess the effectiveness of the intervention.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital Ullevål HF, Norway
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Lock J, Agras WS, Fitzpatrick KK, Bryson SW, Jo B, Tchanturia K. Is outpatient cognitive remediation therapy feasible to use in randomized clinical trials for anorexia nervosa? Int J Eat Disord 2013; 46:567-75. [PMID: 23625628 PMCID: PMC3757112 DOI: 10.1002/eat.22134] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE There are limited data supporting specific treatments for adults with anorexia nervosa (AN). Randomized clinical trials (RCTs) for adults with AN are characterized by high attrition limiting the feasibility of conducting and interpreting existing studies. High dropout rates may be related to the inflexible and obsessional cognitive style of patients with AN. This study evaluated the feasibility of using cognitive remediation therapy (CRT) to reduce attrition in RCTs for AN. METHOD Forty-six participants (mean age of 22.7 years and mean duration of AN of 6.4 years) were randomized to receive eight sessions of either CRT or cognitive behavioral therapy (CBT) over 2 months followed by 16 sessions of CBT for 4 months. RESULTS During the 2-month CRT vs. CBT treatment, rates of attrition were lower in CRT (13%) compared with that of CBT (33%). There were greater improvements in cognitive inefficiencies in the CRT compared with that of the CBT group at the end of 2 months. There were no differences in other outcomes. DISCUSSION These results suggest that CRT is acceptable and feasible for use in RCTs for outpatient treatment of AN. CRT may reduce attrition in the short term. Adequately powered future studies are needed to examine CRT as an outpatient treatment for AN.
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Affiliation(s)
- James Lock
- Stanford Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305
| | - W. Stewart Agras
- Stanford Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305
| | | | - Susan W. Bryson
- Stanford Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305
| | - Booil Jo
- Stanford Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA 94305
| | - Kate Tchanturia
- Department of Psychological, Institute of Psychiatry, Denmark Hill 103, De Crespigny Park, London SE58AF
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Zuchova S, Erler T, Papezova H. Group cognitive remediation therapy for adult anorexia nervosa inpatients: first experiences. Eat Weight Disord 2013; 18:269-73. [PMID: 23765593 DOI: 10.1007/s40519-013-0041-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022] Open
Abstract
AIM In this study, we aim to explore the feasibility and acceptability of group cognitive remediation therapy (CRT) for anorexia nervosa (AN) inpatients, and to suggest modifications for future use. METHODS We performed ten 45-min CRT sessions, once a week, in two consecutive groups of adult AN inpatients. The groups consisted of 14 and 20 participants, respectively. At the end of each session, participants filled in a questionnaire asking them to evaluate whether and how they benefited from the exercise RESULTS Group-based CRT could be well incorporated into the therapeutic program of the Eating Disorders Unit, and was well received by the participants. Based on patients' feedback and our observations, we discuss several options for future modifications.
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Affiliation(s)
- Svetlana Zuchova
- Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Ke Karlovu 11, 120 00, Prague 2, Czech Republic,
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