Strategies of emotion regulation in adolescents and young adults with substance dependence or eating disorders

Drunkorexia Among a Sample of Lebanese Adults: The Role of Early Maladaptive Schemas

Background: Drunkorexia is a food and alcohol disturbance described as being a range of disordered and compensatory eating behaviors that co-occur with excessive alcohol consumption. The remarkable correlation, highlighted in the literature, between dysfunctional cognitions and both eating disorders and substance use disorders is able to emphasize that cognitive phenomena can be an intrapersonal factor linked to drunkorexia disorder. The aim of this study was to assess the correlation between early maladaptive schemas (EMSs) and drunkorexia among a sample of Lebanese adults.Method: We conducted a cross-sectional study across all the Lebanese governorates (September-December 2020; N = 258). The Drunkorexia Motives and Behaviors Scales, Drunkorexia Fails Scale, Drunkorexia during an Alcohol Consumption Event Scale, and Post-Drinking Compensation Scale were used to assess drunkorexia, whereas the Young Schema Questionnaire-Short Form three was used to measure EMSs.Results: Emotional deprivation and subjugation were significantly associated with more drunkorexia motives, whereas emotional inhibition was significantly associated with less drunkorexia motives. Failure was significantly associated with more drunkorexia behaviors. Abandonment and mistrust were significantly associated with more drunkorexia fails, whereas unrelenting standards was significantly associated with less drunkorexia fails. Subjugation was significantly associated with more drunkorexia during alcohol consumption on events. Social isolation was significantly associated with more post-drinking compensation, whereas unrelenting standards was significantly associated with less post-drinking compensation.Conclusion: Our findings showed that drunkorexia is positively associated with EMSs, delineating as well the specific relationships between dysfunctional cognitive schemas and drunkorexia's maladaptive behavioral aspects. They support the hypothesis that EMSs might play an important role in drunkorexia's development and perpetuation. This study could therefore serve healthcare professionals for the cognitive approach of patients with concomitant alcohol misuse and eating disorders while emphasizing the value of cognitive-behavioral interventions-namely schema therapy.

Insecure Attachment as a Risk Factor for the Development of Anxiety and Depression Symptoms in a Sample of Mexican Adults

PURPOSE

This study evaluated the risk posed by attachment type in the development of anxiety or depression symptomatology in Mexican adults.

DESIGN AND METHODS

This was case-control study in which anxiety and depression symptomatology levels were compared according to the attachment type reported by 3,666 participants.

FINDINGS

It was found that insecure attachment is a risk factor (p≤.001) for the development of severe levels of depression (OR = 2.12, CI 95%: 1.66-2.70) and anxiety symptomatology (OR = 1.52, 95% CI: 1.30-1.77). Findings are discussed based on their implications for psychiatric nursing practice.

PRACTICE IMPLICATIONS

The findings of this study enable nurses to consider the empirical validity of attachment theory for studying psychosocial aspects of mental health and to design intervention strategies that promote secure attachment in populations without psychiatric diagnoses to prevent anxiety and depression symptomatology.

Mapping Phenomena Relevant to Adolescent Emotion Regulation: A Text-Mining Systematic Review

Adolescence is a developmentally sensitive period for emotion regulation with potentially lifelong implications for mental health and well-being. Although substantial empirical research has addressed this topic, the literature is fragmented across subdisciplines, and an overarching theoretical framework is lacking. The first step toward constructing a unifying framework is identifying relevant phenomena. This systematic review of 6305 articles used text mining to identify phenomena relevant to adolescents' emotion regulation. First, a baseline was established of relevant phenomena discussed in theory and recent narrative reviews. Then, article keywords and abstracts were analyzed using text mining, examining term frequency as an indicator of relevance and term co-occurrence as an indicator of association. The results reflected themes commonly featured in theory and narrative reviews, such as socialization and neurocognitive development, but also identified undertheorized themes, such as developmental disorders, physical health, external stressors, structural disadvantage, substance use, identity and moral development, and sexual development. The findings illustrate how text mining systematic reviews, a novel approach, may complement narrative reviews. Future theoretical work might integrate these undertheorized themes into an overarching framework, and empirical research might consider them as promising areas for future research, or as potential confounders in research on adolescents' emotion regulation.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-021-00160-7.

The Factor Structure of the CA-MIR as Evaluated Using Confirmatory Factor Analysis

Introduction: The aim of the current study was to evaluate the factor structure of the CArtes- Modèles Individuels de Relations (CA-MIR), a self-report questionnaire designed to tap into the relational strategies of adults that was developed by a French-speaking research group coordinated by Blaise Pierrehumbert. The CA-MIR's particular merit lies in the richness and complexity of the theoretical model underpinning it. However, to date, this model has only been partially reproduced in studies using exploratory analysis and has never been tested via confirmatory factor analysis (CFA). Objective and Method: We thus conducted CFA on data collected from a sample of 979 subjects, recruited using a snowball sampling method during the spring and fall of 2005. To assess if some item multidimensionality was present, we estimated both the independent clusters model (ICM-CFA) and a model in which some zero loading restrictions were removed. Results: The results supported the originally proposed structure of the CA-MIR; the large majority of items were good indicators of the expected latent dimensions and only few items showed relevant secondary loadings or loaded in an unexpected factor. The instrument adequately differentiates the three attachment styles, taking into account both past and present experiences of attachment relationships, and providing a rich and complex assessment of multiple features of attachment. In terms of internal consistency, alpha values were satisfactory and comparable to those found in the original Swiss validation study. Conclusions: Our results are of key importance for both research and clinical work, given the lack of valid and easy-to-administer tools for evaluating adult attachment.

Addiction Vulnerability and Binge Eating in Women: Exploring Reward Sensitivity, Affect Regulation, Impulsivity & Weight/Shape Concerns

Almost 40% of individuals with eating disorders have a comorbid addiction. The current study examined weight/shape concerns as a potential moderator of the relation between the hypothesized latent factor "addiction vulnerability" (i.e., impairments in reward sensitivity, affect regulation and impulsivity) and binge eating. Undergraduate women (n=272) with either high or low weight/shape concerns completed self-report measures examining reward sensitivity, emotion regulation, impulsivity and disordered (binge) eating. Results showed that (1) reward sensitivity, affect regulation and impulsivity all loaded onto a latent "addiction vulnerability" factor for both women with high and with low weight/shape concerns, (2) women with higher weight/shape concerns reported more impairment in these areas, and (3) weight/shape concerns moderated the relation between addiction vulnerability and binge eating. These findings suggest that underlying processes identified in addiction are present in individuals who binge eat, though weight/shape concerns may be a unique characteristic of disordered eating.

The effects of parental mental health and social-emotional coping on adolescent eating disorder attitudes and behaviors

This study examined whether social-emotional coping skills moderate the association between parental mental health symptoms and adolescent disordered eating attitudes and behaviors in a clinical sample of adolescents with internalizing and/or externalizing symptoms. Fifty-nine adolescent-parent dyads (N = 118 total participants) recruited from a metropolitan area in the Northeastern United States completed assessments at baseline and 12-month follow-up. Generally, higher parental depression and anxiety were only found to be associated with greater disordered eating attitudes and behaviors among adolescents who reported poorer (versus stronger) emotional awareness/expression skills and less (versus greater) ability to regulate emotions. Results may suggest that adolescents who lack the ability to effectively recognize, express, and manage negative emotions that arise in the context of a challenging home environment may be at greater risk for engaging in maladaptive coping behaviors, such as disordered eating. Thus, bolstering adolescent social-emotional coping skills may help protect against adolescent disordered eating.

Anorexia and attachment: dysregulated defense and pathological mourning

The role of defensive exclusion (Deactivation and Segregated Systems) in the development of early relationships and related to subsequent manifestations of symptoms of eating disorders was assessed using the Adult Attachment Projective Picture System (AAP). Fifty-one DSM-IV diagnosed women with anorexia participated in the study. Anorexic patients were primarily classified as dismissing or unresolved. Quantitative and qualitative analyses of defensive exclusion were carried out. Results showed potential benefits of using the AAP defense exclusion coding system, in addition to the main attachment classifications, in order to better understand the developmental issues involved in anorexia. Discussion concerned the processes, such as pathological mourning, that may underlie the associations between dismissing and unresolved attachment and anorexia. Implications for developmental research and clinical nosology are discussed.

Attachment and socio-emotional skills: a comparison of depressed inpatients, institutionalized delinquents and control adolescents

This study compared 50 depressed inpatients, 51 institutionalized delinquents and 51 control adolescents (total n = 152) regarding attachment and associated socio-emotional skills. All of the participants took an individual interview (i.e., anamnesis, diagnostic interview and intelligence test) and completed the attachment measure and self-report measures of socio-emotional skills (i.e., emotional intelligence, empathy and resilience). Results showed that controls scored higher on secure attachment, whereas both of the other groups scored higher on preoccupied attachment. Depressed adolescents had lower scores on emotional intelligence than did controls. Finally, depressed adolescents had lower scores than the other two groups on resilience. The anxious or preoccupied attachment in both clinical groups, the overall frailty of depressive adolescents and the apparent resilience of delinquent adolescents despite their cognitive limitations should inform the respective treatment plans for these groups of adolescents. Suggestions for future research into differences between depressed and delinquent adolescents are outlined.

KEY PRACTITIONER MESSAGE

Both depressed and delinquent adolescents show more anxious attachment. Depressed adolescents are less resilient than delinquent adolescents. Delinquent adolescents are less intelligent than the other two groups but well-adjusted overall. These differences should inform treatment plans for these two clinical groups.

Cognitive and physiological dissociations in response to emotional pictures in patients with anorexia

Recent studies suggest that patients with anorexia may express dissociated cognitive and physiological reactivities to emotional stimuli. The present research aimed to compare subjective and autonomic responses to pleasant, unpleasant and neutral scenes during a categorization task and an activation rating task in anorexic (AN), alexithymic (AL), depressed (DEP) and control participants (CONT). The participants first categorized pictures according to their emotional valence, followed by a rating of their activation level, concomitant with the recording of skin conductance responses (SCRs). Main findings showed that the AN patients presented major difficulty in categorizing pictures, particularly neutral ones. Contrary to the AL participants, this difficulty did not induce significant increases of SCR amplitude in the AN patients. In the second task, the AN patients rated the intensity of activation of unpleasant pictures higher than the AL participants and that of pleasant ones higher than the AL and CONT participants. In addition, no significant linear correlation was observed between the intensity of activation ratings and SCR amplitude in the AN, AL or DEP participants contrarily to what was observed for control participants. This lack of relation suggests a non-specific disconnection between physiological and cognitive self-reported responses to emotional stimuli. Our results highlight a specific form of emotional processing in the AN patients distinct from that observed in alexithymia or depression and characterized by a dissociation between cognitive and physiological responses. This kind of disconnection could be associated with emotional regulation processes and may benefit the AN patients by lowering the psychological stress response.

Outcome of dialectical behaviour therapy for concurrent eating and substance use disorders

AIM

The current study examined the preliminary efficacy of dialectical behaviour therapy (DBT) adapted for concurrent eating disorders (EDs) and substance use disorders (SUDs).

METHOD

A matched randomized controlled trial was carried out with 25 female outpatients diagnosed with concurrent ED and SUD. Participants randomized to the intervention condition received DBT, whereas those randomized to the control condition received treatment as usual (TAU), both for a period of 1 year. A series of measures related to disordered eating, substance use and depression were administered to the participants at the beginning of treatment and at 3, 6, 9 and 12 months into treatment, followed by 3-month and 6-month follow-up assessments.

FINDINGS

Participants randomized to the DBT condition evidenced a superior retention rate relative to their counterparts in the TAU condition at various study time points, including post-treatment (80% versus 20%) and follow-up (60% versus 20%). Due to the unexpected elevated dropout rates and the worsening of ED-SUD symptomatology in the TAU condition, recruitment efforts were terminated early. Results from the DBT condition revealed that the intervention had a significant positive effect on behavioural and attitudinal features of disordered eating, substance use severity and use, negative mood regulation and depressive symptoms. Finally, increases in participants' perceived ability to regulate and cope with negative emotional states were significantly associated with decreases in emotional eating and increases in levels of confidence in ability to resist urges for substance use.

CONCLUSION

Results suggest that the adapted DBT might hold promise for treating individuals with concurrent ED and SUD.

KEY PRACTITIONER MESSAGE

The current study is the first study to report positive effects of DBT on individuals with concurrent eating and substance use disorders. Although the results require replication and extension, they suggest that the DBT may be promising for this population. The results suggest that clinicians treating individuals with concurrent eating and substance use problems should be particularly cautious of poor treatment retention and treatment complications. The results bear upon the highly salient and important issue of whether individuals with concurrent substance use need to be excluded from research studies and treatment programmes.

Eating disorder behavior and early maladaptive schemas in subgroups of eating disorders

To examine relationship between Eating Disorder Behaviors (EDB) and Early Maladaptive Schemas (EMS) across eating disorder (ED) subgroups. EMS and ED behaviors were measured by Young Schema Questionnaire and Eating Behavior Severity Scale, respectively, among patients diagnosed with Restrictive or Binge/purging Anorexia, or bulimia nervosa. Canonical component analysis showed significant association between ED behaviors and EMSs. Canonical factor-pairs (EDB and EMS) revealed specific associations between certain patterns of EDBs, including binge-purging and physical exercise, and certain patterns of maladaptive cognitive schema, including Emotional deprivation, Abandonment, Enmeshments, Subjugation, and Emotional inhibition. ED subgroups significantly differred between the EMS and EDB canonical factors, respectively. Our findings indicate that EMS and EDB are associated, and that the factors that potentially mediate the association differ significantly among ED subgroups. These results are consistent with the notion that EMSs play a specific role in the development and maintenance of ED behaviors.

Dynamics of emotional expression in autobiographic speech of patients with anorexia nervosa

Emotional disturbances in persons with anorexia nervosa have mainly been documented using static descriptions. This study presents the temporal organisation of emotional expression in autobiographical speech of anorexic patients and thereby provides a first attempt to quantify the dynamics of emotions in patients' speech. The temporal pattern of emotional expression for persons with anorexia nervosa was studied after transforming the autobiographical narratives of 14 patients and 13 matched controls into symbolic sequences of positive, negative, and neutral emotional expressions. These symbolic sequences of emotional states and silences were analyzed using static and dynamic indices. Static indices showed that patients with anorexia nervosa expressed more negative emotions and fewer neutral states than control participants. Dynamic indices showed in patients' speech a cycle of negative emotions and silence. These results showed specific dynamics of emotional expression in persons with anorexia nervosa characterised by the presence of negative emotional perseveration. The possible clinical implications of these findings are discussed.

Autobiographical memory deficit in anorexia nervosa: emotion regulation and effect of duration of illness

Emotional deficits in anorexia nervosa can be expressed in autobiographical memory recall. The aim of this study is to test whether deficits in autobiographical memory exist in anorexic patients and concern specifically negative or positive emotional valence. Moreover, it is unclear whether these deficits are dependent upon comorbid aspects (depression, alexithymia, and anxiety) or upon illness duration. Anorexic patients (n=25) were compared to healthy volunteers based on their clinical assessment, explicit memory test score, and autobiographical memory test score. The study makes use of the autobiographical test of Williams and Scott, which involves specific emotional cues to elicit memory. Anorexic patients recalled more general memories than controls in autobiographical memory test, but had no deficit in explicit memory test. This pattern, observed both for negative and positive cues, was neither related to depression or alexithymia, nor to anxiety severity, but increased significantly with illness duration. These results show that anorexic patients are characterized by relative difficulty in the integration of both negative and positive emotional experiences, and that this impairment is reinforced by illness duration.