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Stern CM, Graver H, McPherson I, Gydus J, Kambanis PE, Breithaupt L, Burton-Murray H, Zayas L, Eddy KT, Thomas JJ, Becker KR. Difficulties in Emotion Regulation in Avoidant/Restrictive Food Intake Disorder. Int J Eat Disord 2024. [PMID: 39219064 DOI: 10.1002/eat.24281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/31/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Despite substantial research indicating difficulties with emotion regulation across eating disorder presentations, emotion regulation has yet to be studied in adults with avoidant/restrictive food intake disorder (ARFID). We hypothesized that (1) those with ARFID would report greater overall emotion regulation difficulties than nonclinical participants, and (2) those with ARFID would not differ from those with other eating disorders on the level of emotion regulation difficulty. METHODS One hundred and thirty-seven adults (age 18-30) from an outpatient clinic with ARFID (n = 27), with other primarily restrictive eating disorders (e.g., anorexia nervosa; n = 34), and with binge/purge eating disorders (e.g., bulimia nervosa; n = 51), as well as nonclinical participants (n = 25) recruited via Amazon Mechanical Turk (MTurk) completed the Difficulties in Emotion Regulation Scale (DERS). We compared DERS scores across groups. RESULTS In line with expectations, patients with ARFID scored significantly higher than nonclinical participants on the DERS Total (p = 0.01) with a large effect size (d = 0.87). Also as hypothesized, those with ARFID did not differ from those with other primarily restrictive (p = 0.99) or binge/purge disorders (p = 0.29) on DERS Total. DISCUSSION Adults with ARFID appear to exhibit emotion regulation difficulties which are greater than nonclinical participants, and commensurate with other eating disorders. These findings highlight the possibility of emotion regulation difficulties as a maintenance mechanism for ARFID.
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Affiliation(s)
- Casey M Stern
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Haley Graver
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Iman McPherson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia Gydus
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Evelyna Kambanis
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Helen Burton-Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lázaro Zayas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Huntjens A, van den Bosch LMCW, Sizoo B, Kerkhof A, Smit F, van der Gaag M. The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial. Psychol Med 2024:1-12. [PMID: 38606582 DOI: 10.1017/s0033291724000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUNDS Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts. METHODS At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes. RESULTS At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition. CONCLUSIONS DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | - Ad Kerkhof
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
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Liakopoulou E, Vassalou G, Tzavara C, Gonidakis F. A 12-month study of dialectical behavioral therapy for bοrderline patients suffering from eating disorders. Eat Weight Disord 2023; 28:81. [PMID: 37798605 PMCID: PMC10556119 DOI: 10.1007/s40519-023-01612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Individuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD. METHODS Seventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment. RESULTS The major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology. CONCLUSIONS These results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
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Affiliation(s)
- Efi Liakopoulou
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vassalou
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Tzavara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiskos Gonidakis
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Denning DM, Perry TR, Reilly EE, Berner LA, Velkoff EA, Kaye WH, Wierenga CE, Brown TA. Associations of suicide risk with emotional reactivity, dysregulation, and eating disorder treatment outcomes. Suicide Life Threat Behav 2022; 52:1126-1139. [PMID: 36082588 PMCID: PMC10394756 DOI: 10.1111/sltb.12907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/27/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Emotional processes play a role in both suicide risk and eating disorders (EDs), which are often comorbid. However, limited research has explored how emotional processes relate to suicide risk in EDs and the prognostic value of suicide risk for ED treatment. Thus, the current study examined associations between emotion dysregulation and reactivity with suicide risk in patients with EDs, and determined if suicide risk predicts ED treatment outcomes. METHODS Participants (n = 201) were adults in an ED partial hospitalization program who completed measures at admission, 1-month post-admission, and discharge. RESULTS When controlling for depressive symptoms, limited access to adaptive emotion regulation strategies, difficulties engaging in goal-oriented behaviors, and engaging in impulsive behavior when experiencing negative emotions (i.e., emotion dysregulation) were associated with suicide attempt frequency. Depressive symptoms were associated with suicide risk severity, while emotion dysregulation and reactivity were not. Importantly, patients with elevated suicide risk at admission improved comparably to other risk categories across treatment, despite presenting with greater ED symptoms at admission. CONCLUSION Emotion dysregulation and depression are salient factors when examining suicide risk in patients with EDs. Suicide risk and attempt history may not negatively impact ED treatment outcomes when using emotion-focused treatment.
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Affiliation(s)
- Dominic M. Denning
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Taylor R. Perry
- Department of Psychology, State University of New York at Albany, Albany, New York, USA
| | - Erin E. Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Laura A. Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth A. Velkoff
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Walter H. Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Christina E. Wierenga
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Tiffany A. Brown
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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5
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Yin Q, Stern M, Kleiman EM, Rizvi SL. Investigating predictors of treatment response in Dialectical Behavior Therapy for borderline personality disorder using LASSO regression. Psychother Res 2022; 33:455-467. [PMID: 36305345 DOI: 10.1080/10503307.2022.2138790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Prior studies of Dialectical Behavior Therapy (DBT) for borderline personality disorder (BPD) have yielded heterogeneous findings on what factors differentiate individuals with or without sufficient treatment response, highlighting the need for further research. METHOD We investigated a sample of 105 individuals with BPD receiving a 6-month course of DBT. Participants were categorized as sufficient or insufficient responders using clinical and statistical change indices (based on emotion dysregulation, BPD symptom severity, utilization of DBT skills, and functional impairment). Sociodemographic, clinical severity, and treatment process factors were tested as potential predictors of treatment response using a machine learning approach (LASSO regression). RESULTS Two cross-validated LASSO regression models predicted treatment response (AUCs > .75). They suggested that higher homework completion rate, retention in treatment, and greater baseline severity were the most important predictors of DBT treatment response indicated by BPD symptom severity and utilization of DBT skills. Favorable effects of some aspects of therapeutic alliance during initial sessions were also found. CONCLUSIONS Future research may benefit from consolidating the criteria of treatment response, identifying clinically relevant variables, and testing the generalizability of findings to enhance knowledge of insufficient treatment response in DBT for BPD.
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Affiliation(s)
- Qingqing Yin
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Molly Stern
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Evan M. Kleiman
- Department of Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Shireen L. Rizvi
- Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
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Bemmouna D, Coutelle R, Weibel S, Weiner L. Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study. J Autism Dev Disord 2022; 52:4337-4354. [PMID: 34626285 PMCID: PMC8501315 DOI: 10.1007/s10803-021-05317-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/14/2022]
Abstract
Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID). Emotion dysregulation (ED), the difficulty in modulating emotions, has been identified as an important risk factor. Dialectical behavior therapy (DBT) has been proved effective to treat ED in disorders other than autism spectrum disorder. Our study aimed at assessing the feasibility, acceptability and preliminary efficacy of DBT in seven autistic adults without ID exhibiting self-harm and/or suicidal behaviors linked to severe ED. Our results suggest that DBT is feasible and highly acceptable to autistic adults without ID. Additionally, mean scores on the Difficulties in Emotion Regulation Scale decreased significantly post-treatment and at 4-month follow-up, suggesting that DBT might be efficacious in reducing ED in this population.
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Affiliation(s)
- Doha Bemmouna
- Inserm U1114, 1 Place de l'Hôpital, 67000, Strasbourg, France.
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France.
| | - Romain Coutelle
- Inserm U1114, 1 Place de l'Hôpital, 67000, Strasbourg, France
- Expert Center of Autism Spectrum Disorder Without Intellectual Disability, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Sébastien Weibel
- Inserm U1114, 1 Place de l'Hôpital, 67000, Strasbourg, France
- Psychiatry Department, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Luisa Weiner
- Psychiatry Department, University Hospital of Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
- Department of Psychology, University of Strasbourg, 12 Rue Goethe, 67000, Strasbourg, France
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7
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Ciesinski NK, Sorgi-Wilson KM, Cheung JC, Chen EY, McCloskey MS. The effect of dialectical behavior therapy on anger and aggressive behavior: A systematic review with meta-analysis. Behav Res Ther 2022; 154:104122. [DOI: 10.1016/j.brat.2022.104122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
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Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up. Int J Eat Disord 2022; 55:902-913. [PMID: 35665526 PMCID: PMC9328197 DOI: 10.1002/eat.23750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. METHOD Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation. RESULTS Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). DISCUSSION Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. PUBLIC SIGNIFICANCE In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.
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Affiliation(s)
- Mirjam W. Lammers
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Maartje S. Vroling
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA,School of Medicine and Health SciencesUniversity of North DakotaFargoNorth DakotaUSA
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9
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Berner LA, Reilly EE, Yu X, Krueger A, Trunko ME, Anderson LK, Chen J, Simmons AN, Kaye WH. Changes in cognitive and behavioral control after lamotrigine and intensive dialectical behavioral therapy for severe, multi-impulsive bulimia nervosa: an fMRI case study. Eat Weight Disord 2022; 27:1919-1928. [PMID: 34661882 PMCID: PMC9122851 DOI: 10.1007/s40519-021-01308-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/18/2021] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Adults with bulimia nervosa (BN) and co-occurring emotional dysregulation and multiple impulsive behaviors are less responsive to existing interventions. Initial data suggest that the combination of Dialectical Behavior Therapy (DBT) and a mood stabilizer, lamotrigine, significantly reduces symptoms of affective and behavioral dysregulation in these patients. Identifying candidate neurobiological mechanisms of change for this novel treatment combination may help guide future randomized controlled trials and inform new and targeted treatment development. Here, we examined neurocognitive and symptom changes in a female patient with BN and severe affective and behavioral dysregulation who received DBT and lamotrigine. METHODS Go/no-go task performance data and resting-state functional MRI scans were acquired before the initiation of lamotrigine (after 6 weeks in an intensive DBT program), and again after reaching and maintaining a stable dose of lamotrigine. The patient completed a battery of symptom measures biweekly for 18 weeks over the course of treatment. RESULTS After lamotrigine initiation, the patient made fewer errors on a response inhibition task and showed increased and new connectivity within frontoparietal and frontolimbic networks involved in behavioral and affective control. Accompanying this symptom improvement, the patient reported marked reductions in bulimic symptoms, behavioral dysregulation, and reactivity to negative affect, along with increases in DBT skills use. CONCLUSION Improved response inhibition and cognitive control network connectivity should be further investigated as neurocognitive mechanisms of change with combined DBT and lamotrigine for eating disorders. Longitudinal, controlled trials integrating neuroimaging and symptom measures are needed to fully evaluate the effects of this treatment. LEVEL OF EVIDENCE IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
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Affiliation(s)
- Laura A Berner
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin E Reilly
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Xinze Yu
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Angeline Krueger
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Mary Ellen Trunko
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Joanna Chen
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Alan N Simmons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.,VA San Diego Healthcare System, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA.
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Grohmann D, Laws KR. Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis. J Psychosom Res 2021; 149:110592. [PMID: 34399197 DOI: 10.1016/j.jpsychores.2021.110592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity. METHODS We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395). RESULTS Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = -0.39, 95% CI -0.68, -0.11) at end of trial, but was not maintained at follow-up (g = -0.06, 95% CI, -0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability. CONCLUSION MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.
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Affiliation(s)
- Dominique Grohmann
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
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11
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Chugani CD, Murphy CE, Talis J, Miller E, McAneny C, Condosta D, Kamnikar J, Wehrer E, Mazza JJ. Implementing Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) in a Low-Income School. SCHOOL MENTAL HEALTH 2021; 14:391-401. [PMID: 34377215 PMCID: PMC8339697 DOI: 10.1007/s12310-021-09472-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
Adolescents living in low-income areas often have high need for mental health supports due to experiences of poverty and trauma, coupled with limited access and availability of such supports. This study investigated the implementation of a socio-emotional learning curriculum titled, “Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A),” which was integrated into health classes in a low-income high school. While preliminary evidence suggests that DBT STEPS-A can be effective in reducing mental health symptoms in high school students, this study is the first to explore the program’s acceptability, appropriateness, and feasibility when implemented in a low-income school. The implementation presented here also diverged from recommended training protocols due to time and cost limitations. Quantitative and qualitative data were collected from 29 school stakeholders prior to implementation and from 23 school stakeholders post-implementation. Our results indicate that DBT STEPS-A is acceptable and feasible for teachers involved in offering the program and that more work is needed to address appropriateness of the content for racially and socio-economically diverse students, ease of implementing lessons, and support for teachers using DBT STEPS-A skills outside of class. We conclude with a discussion of key implementation challenges and solutions generated.
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Affiliation(s)
- Carla D Chugani
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Courtney E Murphy
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Janine Talis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | | | | | - James J Mazza
- University of Washington College of Education, Seattle, WA USA
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12
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Converging vulnerability factors for compulsive food and drug use. Neuropharmacology 2021; 196:108556. [PMID: 33862029 DOI: 10.1016/j.neuropharm.2021.108556] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/29/2021] [Accepted: 04/03/2021] [Indexed: 12/12/2022]
Abstract
Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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MacDonald DE, McFarlane T, Dionne MM, Trottier K, Olmsted MP. Development, Feasibility, and Acceptability of a Brief, Adjunctive Cognitive-Behavioral Intervention Aimed at Encouraging Rapid Response to Intensive Eating Disorder Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Peterson CM, Mara CA, Conard LAE, Grossoehme D. The relationship of the UPPS model of impulsivity on bulimic symptoms and non-suicidal self-injury in transgender youth. Eat Behav 2020; 39:101416. [PMID: 32861052 DOI: 10.1016/j.eatbeh.2020.101416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This brief report examined the relationship of negative urgency (the tendency to act rashly in response to negative emotional states), (lack of) perseverance, (lack of) premeditation, and sensation seeking in association with non-suicidal self-injury (NSSI) and symptoms of bulimia nervosa (BN) in a sample of treatment-seeking transgender (TG) youth. METHOD Eighty-six TG youth with a mean age of 17 (sd = 3.2) agreed to participate in the study. The majority of our sample identified as TG male (n = 60) with 20 participants identifying as TG female and 6 identifying as non-binary. The racial ethnic breakdown of our sample was 8.2% Black, 8.2% Multi-racial, 1.2% Native American, and 82.4% White. Over ¼ of our sample endorsed at least one episode of objective binge eating in the last 28 days and 62% endorsed a history of NSSI. RESULTS Negative urgency was significantly associated with the odds of NSSI, objective binge eating, and general eating disorder symptoms. Lack of premeditation was significantly related to the odds of NSSI only. No other factors were significantly associated with NSSI or symptoms of BN. CONCLUSIONS Negative urgency appears to be an important personality construct in understanding increased risk for NSSI and BN symptoms in transgender youth.
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Affiliation(s)
- Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lee Ann E Conard
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent & Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Grossoehme
- Haslinger Family Palliative Care Center, Akron Children's Hospital, Akron, OH, USA; Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
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Bulimic symptoms in a sample of college women: disentangling the roles of body size, body shame and negative urgency. Eat Weight Disord 2020; 25:1357-1364. [PMID: 31555972 PMCID: PMC7508931 DOI: 10.1007/s40519-019-00771-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/26/2019] [Indexed: 11/05/2022] Open
Abstract
UNLABELLED Purpose This study set out to disentangle the roles of body size, body shame and negative urgency on bulimic symptomatology in a sample of college women. We predicted that body shame would mediate the relationship between body size and bulimic symptomatology: with increasing body size, the greater would be the experience of body shame and, in turn, the greater the bulimic symptomatology. We also predicted that negative urgency would exacerbate this mediation pathway, and that the moderated mediation model would occur over and above current levels of depression. METHOD A convenience sample of 237 college women indicated their age, height and weight and then completed measures of body shame, negative urgency, depression and bulimic symptomatology. Bootstrap analysis was used to test the predicted moderation mediation model. RESULTS The bootstrap analysis supported all predictions. Thus, with greater the increase in body size, the greater was the body shame and the more frequent bulimic symptomatology. Furthermore, negative urgency moderated the relationship between body shame and bulimic symptomatology, such that those with both higher negative urgency and body shame had more frequent bulimic symptomatology. CONCLUSIONS Results suggest that those college women higher in both BMI and negative urgency are likely to experience higher levels of bulimic symptoms. These women may benefit from emotion regulation interventions targeted at preventing, as well as coping effectively with, the experience of body shame. LEVEL OF EVIDENCE V: cross-sectional descriptive study.
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Chugani CD, Fuhrman B, Abebe KZ, Talis J, Miller E, Coulter RWS. Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course. BMJ Open 2020; 10:e036833. [PMID: 32565475 PMCID: PMC7311003 DOI: 10.1136/bmjopen-2020-036833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION College students' mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, 'Wellness and Resilience for College and Beyond'. METHODS AND ANALYSIS During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18-24 will self-select into the course and control subjects receiving 'university as usual' will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality. ETHICS AND DISSEMINATION All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative. TRIAL REGISTRATION NUMBER NCT04338256.
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Affiliation(s)
- Carla D Chugani
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Barbara Fuhrman
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kaleab Z Abebe
- School of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Elizabeth Miller
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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17
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Aloi M, Rania M, Carbone EA, Calabrò G, Caroleo M, Carcione A, Nicolò G, Semerari A, Segura-Garcia C. The role of self-monitoring metacognition sub-function and negative urgency related to binge severity. EUROPEAN EATING DISORDERS REVIEW 2020; 28:580-586. [PMID: 32419220 DOI: 10.1002/erv.2742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/31/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dysregulation in patients with binge eating disorder (BED). METHOD Forty non-BED-obese and 46 BED-obese patients completed a battery of tests assessing metacognition and psychopathology. To test our hypothesized model, a structural equation model (SEM) using maximum likelihood estimation was conducted. RESULTS BED-obese patients had significantly higher scores in BES, UPPS-P Negative urgency, and DERS total score, and lower MSAS self-monitoring than non-BED-obese, while no differences emerged in the MSAS others-monitoring subscale. The structural model demonstrated very good fit indexes (χ2 = 1.377, df = 2; p = .502, CMIN/DF = 0.688, CFI = 1.000, RMSEA = 0.000, TLI = 1.047) and all paths were significant in the predicted directions. CONCLUSIONS These preliminary findings show that, low self-monitoring and high negative urgency lead BED-obese patients to express the worsening of binge severity through the mediation of emotional dysregulation. This knowledge may be helpful in the clinical practice to develop a tailor-made treatment. Accordingly, an approach through Metacognitive Interpersonal Therapy could be attempted in BED-obese patients with these characteristics. Highlights Patients with BED exhibited low self-monitoring and high negative urgency. Binge severity was mediated by high level of emotional dysregulation. Metacognitive Interpersonal Therapy may be useful for BED patients.
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Affiliation(s)
- Matteo Aloi
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira A Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppina Calabrò
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Marino J, Hardin R, Gasbarro A, Dansereau VA, Fischer S. Outpatient treatment for adults with complex eating disorders and co-morbid conditions: a decision making model and case example. Eat Disord 2020; 28:171-183. [PMID: 32129726 DOI: 10.1080/10640266.2020.1723372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although Cognitive Behavioral Therapy (CBT-E) for eating disorders has the most empirical support for the outpatient treatment of adult eating disorders (EDs), this model does not include a focus on intense emotion dysregulation, suicidality, and non-suicidal self-injury (NSSI). Furthermore, a subset of patients do not achieve sustained remission with CBT-E. Given that Dialectical Behavior Therapy (DBT) was designed for treatment refractory, complex patients, clinicians must be able to use assessment information to determine which type of treatment to use. The aims of this manuscript are to 1) describe a DBT-based and research-informed conceptual model for treatment decision making for an outpatient non-academic setting, 2) present a case example of a client with significant ED symptoms and complex medical and psychiatric comorbidities, using this decision making model and 3) present descriptive data from a private practice setting in which patients are referred to DBT vs. CBT-E according to this decision making model.
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Affiliation(s)
- Joanna Marino
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | - Rebecca Hardin
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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19
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Seow LLY, Page AC, Hooke GR. Severity of borderline personality disorder symptoms as a moderator of the association between the use of dialectical behaviour therapy skills and treatment outcomes. Psychother Res 2020; 30:920-933. [PMID: 32013808 DOI: 10.1080/10503307.2020.1720931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
A core aspect of Dialectical Behaviour Therapy (DBT) is the acquisition and use of DBT skills to replace maladaptive behaviours. However, it is unclear whether DBT skill use is associated with differential reductions in psychological distress across individuals with varying severities of borderline personality disorder (BPD) symptoms. In the current study, moderated mediation analyses were conducted to examine the relationships among DBT skill use and attitudes towards skill use, pre-treatment BPD symptom severity and changes in psychological distress over the course of a 12-week DBT-informed program in a sample of outpatients with mixed psychopathology (N = 102), including a minority with BPD (N = 16). It was predicted that (i) self-reported use of the four types of DBT skills (mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness) and (ii) patient attitudes towards these skills (confidence and perceived effectiveness) would be associated with greater improvements in psychological distress in individuals with higher levels of BPD symptoms compared to individuals with lower levels of BPD symptoms. Results supported this hypothesis, indicating that self-reported DBT skill use and attitudes towards DBT skills are associated with differential patterns of reductions in psychological distress.
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Affiliation(s)
- Lillian L Y Seow
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Andrew C Page
- School of Psychological Science, The University of Western Australia, Crawley, Australia
| | - Geoff R Hooke
- School of Psychological Science, The University of Western Australia, Crawley, Australia.,Perth Clinic, West Perth, Australia
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20
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Newton JR. Borderline personality disorder and eating disorders: a trans-diagnostic approach to unravelling diagnostic complexity. Australas Psychiatry 2019; 27:556-558. [PMID: 31154810 DOI: 10.1177/1039856219852297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This opinion paper considers co-morbid borderline personality disorder (BPD) and eating disorders and proposes that a trans-diagnostic approach looking at presenting problems and treatment approaches may be of value. CONCLUSIONS Trans-diagnostic elements can be identified across the two syndromes. Trans-diagnostic elements appear to include some shared aetiological factors as well as some shared syndromal components. The shared syndromal components include problems with affect, interpersonal problems, problems with self-concept and impulsivity. The pathoplastic effects of culture, attitudes to fatness and the neurobiology of starvation and/or restriction of intake are crucial to integrate into the understanding of co-morbidity of these two disorders. Trans-diagnostic approaches to treatment lead to trans-diagnostic improvements across the two disorders.
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Affiliation(s)
- J Richard Newton
- Adjunct Professor, Department of Psychiatry, Monash University Clinical School, Melbourne, VIC, and; Clinical Director, Peninsula Health, Mental Health Service, Frankston, VIC, Australia
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21
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Fine J, Lackner R, Samudrala R, Chopra G. Computational chemoproteomics to understand the role of selected psychoactives in treating mental health indications. Sci Rep 2019; 9:13155. [PMID: 31511563 PMCID: PMC6739337 DOI: 10.1038/s41598-019-49515-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
We have developed the Computational Analysis of Novel Drug Opportunities (CANDO) platform to infer homology of drug behaviour at a proteomic level by constructing and analysing structural compound-proteome interaction signatures of 3,733 compounds with 48,278 proteins in a shotgun manner. We applied the CANDO platform to predict putative therapeutic properties of 428 psychoactive compounds that belong to the phenylethylamine, tryptamine, and cannabinoid chemical classes for treating mental health indications. Our findings indicate that these 428 psychoactives are among the top-ranked predictions for a significant fraction of mental health indications, demonstrating a significant preference for treating such indications over non-mental health indications, relative to randomized controls. Also, we analysed the use of specific tryptamines for the treatment of sleeping disorders, bupropion for substance abuse disorders, and cannabinoids for epilepsy. Our innovative use of the CANDO platform may guide the identification and development of novel therapies for mental health indications and provide an understanding of their causal basis on a detailed mechanistic level. These predictions can be used to provide new leads for preclinical drug development for mental health and other neurological disorders.
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Affiliation(s)
- Jonathan Fine
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Rachel Lackner
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ram Samudrala
- Department of Biomedical Informatics, SUNY, Buffalo, NY, USA.
| | - Gaurav Chopra
- Department of Chemistry, Purdue University, West Lafayette, IN, USA.
- Purdue Institute for Drug Discovery, Purdue Institute for Integrative Neuroscience, Purdue Institute for Integrative Neuroscience, Purdue Institute for Immunology, Inflammation and Infectious Disease, Integrative Data Science Initiative, Purdue Center for Cancer Research, West Lafayette, IN, USA.
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22
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Chapuis-de-Andrade S, Moret-Tatay C, Costa DB, Abreu da Silva F, Irigaray TQ, Lara DR. The Association Between Eating-Compensatory Behaviors and Affective Temperament in a Brazilian Population. Front Psychol 2019; 10:1924. [PMID: 31551850 PMCID: PMC6736602 DOI: 10.3389/fpsyg.2019.01924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
Eating-compensatory behaviors are associated with biological and psychological complications, with high rates of morbidity and mortality. Different elements may contribute to the development of eating-compensatory behaviors, such as genetic, physiological, environmental, and temperamental factors. Therefore, the aim of this study was to examine the association between affective temperaments and eating-compensatory behaviors. A sample of 27,501 volunteers, between 18 and 55 years old, mean age 28.9 ± 8.7 years (69.6% women), were assessed by the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). The results showed that eating-compensatory behaviors were associated with distinctive affective temperaments. Cyclothymic types were more associated with eating-compensatory behaviors. The avoidant and irritable types presented lower percentages of eating-compensatory behaviors in women and men, respectively. In conclusion, this study highlighted that participants who adopted frequent eating-compensatory behaviors are more likely to have dysfunctional affective traits. Consequently, the affective temperaments should be considered as a strategy to build capacity for prevention, treatment, and care of eating-compensatory behaviors.
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Affiliation(s)
| | - Carmen Moret-Tatay
- Departamento de Neuropsicobiología, Metodología y Psicología Social, Facultad de Psicología, Universidad Católica de Valencia "San Vicente Mártir," Sede de San Juan Bautista, Valencia, Spain
| | - Dalton Breno Costa
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | | | | | - Diogo R Lara
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol 2019; 54:813-821. [PMID: 30756148 DOI: 10.1007/s00127-019-01667-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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Barney JL, Murray HB, Manasse SM, Dochat C, Juarascio AS. Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2019; 27:352-380. [PMID: 30887695 PMCID: PMC6570825 DOI: 10.1002/erv.2673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.
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Affiliation(s)
| | - Helen B Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
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25
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Pennell A, Webb C, Agar P, Federici A, Couturier J. Implementation of Dialectical Behavior Therapy in a Day Hospital Setting for Adolescents with Eating Disorders. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:21-29. [PMID: 31001348 PMCID: PMC6457442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/22/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This article discusses the implementation and preliminary outcomes of a Dialectical Behaviour Therapy (DBT) informed program integrated with Family Based Therapy (FBT) for adolescents with eating disorders within a day hospital program (DHP). METHOD A retrospective analysis of hospital records between 2013-2015 provided descriptive characteristics of patients. Weight and percentage ideal body weight at admission and discharge, frequency of binge and purge episodes at discharge and readmissions were analysed. RESULTS Analysis of patient characteristics indicated a broad range of eating disorder and comorbid psychiatric diagnoses among patients. Preliminary outcomes revealed increased weight and percentage of ideal body weight, decreased binge-purge status and few readmissions to the program over the two-year period studied. CONCLUSIONS The implementation of a DBT informed DHP with integration of FBT is associated with improved patient outcomes. Ongoing challenges with respect to the implementation of DBT include modifying DBT to address varying developmental levels, ages and diagnoses and promoting adherence to the program by patients and families. Limitations include small sample size, uncontrolled chart review and the nature of DHP, which include a variety of components that may influence outcomes. This research will help to inform future implementation of treatment programs for adolescents with eating disorders.
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Affiliation(s)
- Alexandra Pennell
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
| | - Cheryl Webb
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario
| | - Paul Agar
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario
| | - Anita Federici
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario
| | - Jennifer Couturier
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, Ontario
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Navarro-Haro MV, Botella C, Guillen V, Moliner R, Marco H, Jorquera M, Baños R, Garcia-Palacios A. Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9906-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Brown TA, Cusack A, Anderson LK, Trim J, Nakamura T, Trunko ME, Kaye WH. Efficacy of a partial hospital programme for adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018. [DOI: 10.1002/erv.2589] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tiffany A. Brown
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Anne Cusack
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Leslie K. Anderson
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Julie Trim
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Tiffany Nakamura
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Mary Ellen Trunko
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
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28
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Potential psychological & neural mechanisms in binge eating disorder: Implications for treatment. Clin Psychol Rev 2018; 60:32-44. [DOI: 10.1016/j.cpr.2017.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 02/08/2023]
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29
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Conti C, Lanzara R, Scipioni M, Iasenza M, Guagnano MT, Fulcheri M. The Relationship between Binge Eating Disorder and Suicidality: A Systematic Review. Front Psychol 2017; 8:2125. [PMID: 29259574 PMCID: PMC5723427 DOI: 10.3389/fpsyg.2017.02125] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/21/2017] [Indexed: 11/27/2022] Open
Abstract
Background: We carried out a systematic review analyzing the relation between binge eating disorder (BED), a recent addition to the eating disorders in DSM-5, and suicidality (i.e., suicidal ideation or attempted and/or committed suicide) by synthesizing the relevant studies' qualitative data. Methods: We conducted, according to PRISMA guidelines, a systematic search of the literature on PubMed, Scopus, ISI Web of Science, PsycINFO, Google Scholar, and ScienceDirect. Search terms were “binge eating disorder” combined with the “AND” Boolean operator and “suicid*.” Results: The initial search identified 4,014 records, of which 17 research reports met the predefined inclusion criteria and were analyzed. BED was found to be significantly associated with a marked increase in suicidal behaviors and suicidal ideation (SI). The presence and severity of BED were found to be relevant predictive factors for suicidality, notably in association with mood disorders and specific psychological features, while a high body mass index (BMI) did not always affect suicidality. BED has usually been associated with suicide risk, particularly when occurring with another psychiatric disorder and/or in an adolescent population. Conclusion: Pursuant to these findings, it is necessary to consider both dysfunctional eating behavior and related psychopathological factors that may induce SI and suicidal behavior in BED, aiming to identify patients and subgroups of patients needing greater clinical psychological attention to most effectively prevent and treat suicidality.
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Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Roberta Lanzara
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Mattia Scipioni
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Marzia Iasenza
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Maria T Guagnano
- Department of Medicine and Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological, Health, and Territorial Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
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30
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Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clin Psychol Rev 2017; 58:125-140. [DOI: 10.1016/j.cpr.2017.10.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
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31
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Forbush KT, Hagan KE, Kite BA, Chapa DAN, Bohrer BK, Gould SR. Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Compr Psychiatry 2017; 79:40-52. [PMID: 28755757 DOI: 10.1016/j.comppsych.2017.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/22/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class. PURPOSE To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment. PROCEDURES Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207). FINDINGS The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED. CONCLUSIONS The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.
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32
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Kognitiv-affektive Neuropsychologie der Binge-Eating-Störung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Marco JH, Cañabate M, Pérez S, Llorca G. Associations Among Meaning in Life, Body Image, Psychopathology, and Suicide Ideation in Spanish Participants With Eating Disorders. J Clin Psychol 2017; 73:1768-1781. [PMID: 28419452 DOI: 10.1002/jclp.22481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/06/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this study were to (a) analyze whether participants with eating disorders have lower meaning in life than the nonclinical population; (b) discover whether participants with eating disorders with low meaning in life have more body image disturbances, more psychopathology, and higher suicide ideation than participants with high meaning in life; (c) analyze whether meaning in life is associated with eating disorder psychopathology; and (d) analyze whether meaning in life is able to predict eating disorder psychopathology and suicide ideation, when body image is controlled. METHOD The clinical sample comprised 247 Spanish participants diagnosed with eating disorders, and the nonclinical sample comprised Spanish 227 participants. RESULTS Participants with eating disorders had lower meaning in life than the nonclinical population. Patients with low meaning in life had higher psychopathology and suicide ideation than participants with high meaning in life. Meaning in life was a significant predictor of the eating disorder psychopathology and suicide ideation. CONCLUSION Low meaning in life is associated with eating disorder psychopathology in a Spanish sample with eating disorders.
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Affiliation(s)
- José H Marco
- Universidad Católica de Valencia San Vicente Mártir
| | | | - Sandra Pérez
- Universidad Católica de Valencia San Vicente Mártir
| | - Ginés Llorca
- Consorcio Hospitalario Provincial de Castellón
- Universitat Jaume I
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34
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Chugani CD. Adapting Dialectical Behavior Therapy for College Counseling Centers. JOURNAL OF COLLEGE COUNSELING 2017. [DOI: 10.1002/jocc.12059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carla D. Chugani
- Counseling and Psychological Services; Florida Gulf Coast University
- Now at Department of Pediatrics; Children's Hospital of Pittsburgh of UPMC; Pittsburgh Pennsylvania
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35
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Gallé F, Cirella A, Salzano AM, Onofrio VD, Belfiore P, Liguori G. Analyzing the Effects of Psychotherapy on Weight Loss after Laparoscopic Gastric Bypass or Laparoscopic Adjustable Gastric Banding in Patients with Borderline Personality Disorder: A Prospective Study. Scand J Surg 2017; 106:299-304. [DOI: 10.1177/1457496917701670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Aims: Personality disorders are frequently associated with eating disorders in obese patients and may negatively affect weight loss and maintenance after bariatric surgery. This non-randomized study aimed to assess the effects of different psychotherapeutic interventions on weight loss in a sample of patients with borderline personality disorder who underwent laparoscopic gastric bypass or laparoscopic adjustable gastric banding. Materials and Methods: A total of 153 bariatric patients meeting borderline personality disorder criteria were chosen voluntarily and consecutively to undergo an interpersonal individual treatment (n = 50), a dialectical behavioral group treatment (n = 50), or treatment as usual (n = 53) for a year after surgery. Their body mass index was measured before and at the end of each treatment. Results and Conclusion: A total of 12 patients (7.8%) dropped out of the study. Significantly higher body mass index reductions were registered in both experimental groups (−14.2 and −9.4 kg/m2, respectively) compared with the treatment as usual group (−2.1 kg/m2; p < 0.01). Treated patients who underwent laparoscopic gastric bypass (total n = 94) showed better outcomes than those who underwent laparoscopic adjustable gastric banding (total n = 45), while no differences were observed in untreated patients. This study demonstrates the role of pre-operative psychological assessment and post-operative psychotherapeutic support in improving weight loss among bariatric patients with borderline personality disorder. A randomized controlled trial is needed to confirm these preliminary findings.
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Affiliation(s)
- F. Gallé
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope,” Naples, Italy
| | - A. Cirella
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope,” Naples, Italy
| | | | - V. Di Onofrio
- Department of Sciences and Technologies, University of Naples “Parthenope,” Naples, Italy
| | - P. Belfiore
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope,” Naples, Italy
| | - G. Liguori
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope,” Naples, Italy
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36
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Lee-Winn AE, Townsend L, Reinblatt SP, Mendelson T. Associations of neuroticism-impulsivity and coping with binge eating in a nationally representative sample of adolescents in the United States. Eat Behav 2016; 22:133-140. [PMID: 27289518 PMCID: PMC4983245 DOI: 10.1016/j.eatbeh.2016.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/09/2016] [Accepted: 06/01/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Binge eating behavior is a public health concern due to its negative physical and mental health consequences. Little is known about the interplay of personality traits, coping styles, and binge eating in the general adolescent population. We examined the associations among the combination of neuroticism and impulsivity (NI), maladaptive coping styles (poor problem solving, distraction, and escape-avoidance), and lifetime prevalence of binge eating in a nationally representative sample of U.S. adolescents. We also explored coping as a moderator of the NI-lifetime binge eating association and gender as a moderator of the NI-coping associations and coping-lifetime binge eating associations. METHODS We used data from the National Comorbidity Survey: Adolescent Supplement (NCS-A: 2001-2004), a cross-sectional nationally representative study of adolescents aged 13 to 18years (n=10,028). We studied the associations of NI and coping with lifetime binge eating using multivariate regression models. RESULTS High NI was significantly associated with all three coping styles, especially escape-avoidance (β=3.96, confidence interval [CI]=3.62, 4.29, p<0.001). Gender was a significant moderator of the NI-distraction coping association (β=-0.68, CI=-1.33, -0.03, p=0.041), indicating a stronger association in males (β=1.20, CI=0.81, 1.58, p<0.001) than females (β=0.53, CI=0.02, 1.03, p=0.042). Lifetime prevalence of binge eating was 1.13 times higher with increased escape-avoidance coping (CI=1.10, 1.18, p<0.001). DISCUSSION Our findings indicate significant associations among high NI, increased escape-avoidance coping, and higher lifetime prevalence of binge eating in adolescents. Findings of our study have potential to inform development of interventions that target modification of maladaptive personality traits and coping styles to reduce problematic eating.
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Affiliation(s)
- Angela E. Lee-Winn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA
| | - Lisa Townsend
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA.
| | - Shauna P. Reinblatt
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, 550 North Broadway, Room 206D, Baltimore, MD 21205 USA
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Baltimore, MD 21205, USA.
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Diedrich A, Schlegl S, Greetfeld M, Fumi M, Voderholzer U. Intensive inpatient treatment for bulimia nervosa: Statistical and clinical significance of symptom changes. Psychother Res 2016; 28:297-312. [DOI: 10.1080/10503307.2016.1210834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | | | - Markus Fumi
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
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Woznica A, Vickers K, Koerner N, Fracalanza K. Reactivity to 35% carbon dioxide in bulimia nervosa and panic disorder. Psychiatry Res 2015; 228:571-5. [PMID: 26141602 DOI: 10.1016/j.psychres.2015.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 03/11/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
The inhalation of 35% carbon dioxide (CO₂) induces panic and anxiety in people with panic disorder (PD) and in people with various other psychiatric disorders. The anxiogenic effect of CO₂ in people with eating disorders has received sparse attention despite the fact that PD and bulimia nervosa (BN) have several common psychological and neurobiological features. This study compared CO₂-reactivity across three groups of participants: females with BN, females with PD, and female controls without known risk factors for enhanced CO₂-reactivity (e.g., social anxiety disorder, first degree relatives with PD). Reactivity was measured by self-reported ratings of panic symptomatology and subjective anxiety, analyzed as both continuous variables (change from room-air to CO₂) and dichotomous variables (positive versus negative responses to CO₂). Analyses of each outcome measure demonstrated that CO₂-reactivity was similar across the BN and PD groups, and reactivity within each of these two groups was significantly stronger than that in the control group. This is the first study to demonstrate CO₂-hyperreactivity in individuals with BN, supporting the hypothesis that reactivity to this biological paradigm is not specific to PD. Further research would benefit from examining transdiagnostic mechanisms in CO₂-hyperreactivity, such as anxiety sensitivity, which may account for this study's results.
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Affiliation(s)
- Andrea Woznica
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Kristin Vickers
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
| | - Naomi Koerner
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Katie Fracalanza
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Olatunji BO, Cox R, Ebesutani C, Wall D. Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect. J Psychiatr Res 2015; 65:37-46. [PMID: 25868550 DOI: 10.1016/j.jpsychires.2015.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 11/24/2022]
Abstract
Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed.
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Affiliation(s)
| | | | | | - David Wall
- Remuda Ranch Programs for Eating Disorders, USA
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40
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Chugani CD. Dialectical Behavior Therapy in College Counseling Centers: Current Literature and Implications for Practice. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2015. [DOI: 10.1080/87568225.2015.1008368] [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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Johnston JAY, O'Gara JSX, Koman SL, Baker CW, Anderson DA. A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. J Clin Psychol 2015; 71:527-43. [PMID: 25867492 DOI: 10.1002/jclp.22176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
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Abstract
The present study examined relationships among negative affect, borderline personality features, and eating behavior through the experimental manipulation of mood. Undergraduate women (N = 307) completed a baseline mood assessment, viewed a 39-minute sad film either with or without concurrent food presentation, then completed a second mood assessment and questionnaires assessing personality and eating attitudes/behaviors. Women reporting more borderline personality features exhibited greater negative affect across time and were more reactive to the sad film. Food presentation appeared to have a small ameliorative effect on sadness and general negative affect. However, quantity of food consumption was associated with improvements in mood only for women reporting higher levels of borderline personality features. These data suggest that women with borderline personality characteristics may be at elevated risk for developing problems with binge eating, because consuming larger quantities of food appeared to have a tempering effect on their negative mood and feelings of sadness.
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Lock J. An Update on Evidence-Based Psychosocial Treatments for Eating Disorders in Children and Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 44:707-21. [PMID: 25580937 DOI: 10.1080/15374416.2014.971458] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.
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Affiliation(s)
- James Lock
- a Department of Psychiatry and Behavioral Science , Stanford University School of Medicine
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Chen EY, Segal K, Weissman J, Zeffiro TA, Gallop R, Linehan MM, Bohus M, Lynch TR. Adapting dialectical behavior therapy for outpatient adult anorexia nervosa--a pilot study. Int J Eat Disord 2015; 48:123-32. [PMID: 25346237 PMCID: PMC5670741 DOI: 10.1002/eat.22360] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorexia Nervosa (AN) is associated with excessive self-control. This iterative case series describes the augmentation of Dialectical Behavior Therapy (DBT) for outpatient adult AN with skills addressing emotional and behavioral overcontrol. An overly controlled style is theorized to develop from the transaction between an individual with heightened threat sensitivity and reduced reward sensitivity, interacting with an environment reinforcing overcontrol and punishing imperfection. METHOD Case Series 1 utilized standard DBT, resulting in retention of 5/6 patients and a body mass index (BMI) effect size increase of d = -0.5 from pre- to post-treatment. Case series 2, using standard DBT augmented with skills addressing overcontrol, resulted in retention of 8/9 patients with an effect size increase in BMI at post-treatment that was maintained at 6- and 12-months follow-up (d = -1.12, d = -0.87, and d = -1.12). DISCUSSION Findings suggest that skills training targeting rigidity and increasing openness and social connectedness warrant further study of this model and treatment for AN.
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Affiliation(s)
- Eunice Y. Chen
- Department of Psychology, Temple Eating Disorders Program, Temple University, Philadelphia, Pennsylvania,Correspondence to: Eunice Chen, TED - Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 N 13th Street Philadelphia, PA.
| | - Kay Segal
- The Center for Mindfulness and Behavior Therapy, Segal Behavioral Health, Deerfield, Illinois
| | | | | | - Robert Gallop
- Department of Mathematics, Westchester University, Westchester, Pennsylvania
| | - Marsha M. Linehan
- Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, Seattle, Washington State
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim, Heidelberg University, Germany
| | - Thomas R. Lynch
- Department of Psychology, Emotion and Personality Bio-Behavioural Laboratory, University of Southampton, Southampton, United Kingdom
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Atiye M, Miettunen J, Raevuori-Helkamaa A. A meta-analysis of temperament in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2014; 23:89-99. [PMID: 25546554 DOI: 10.1002/erv.2342] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/03/2014] [Accepted: 12/08/2014] [Indexed: 11/09/2022]
Abstract
Although suggested as an important contributor to the development and maintenance of eating disorders, temperament has not previously been studied adopting a meta-analytical approach. We therefore pooled data (N = 14 studies; N = 3315 cases, N = 3395 controls) on Cloninger's temperament traits (novelty seeking, harm avoidance, reward dependence and persistence) in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) and eating disorders not otherwise specified. Persistence was significantly higher than in the controls in all eating disorders except for BED the highest levels being observed in AN. Correspondingly, the highest effect sizes for harm avoidance were seen in AN. Novelty seeking was significantly elevated relative to the controls only in BN. Harm avoidance was significantly lower, and reward dependence was significantly higher in individuals who had recovered from AN than in those who remained ill. Future studies with a longitudinal design are needed to explore the temporal relationships between eating disorders and temperament traits.
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Affiliation(s)
- Minna Atiye
- Hjelt Institute, Department of Public Health, University of Helsinki, Finland
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46
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Perry RM, Hayaki J. Gender differences in the role of alexithymia and emotional expressivity in disordered eating. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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47
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Mindfulness-based interventions for binge eating: a systematic review and meta-analysis. J Behav Med 2014; 38:348-62. [DOI: 10.1007/s10865-014-9610-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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48
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Compare A, Tasca GA. The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge-Eating Disorder. Clin Psychol Psychother 2014; 23:24-34. [DOI: 10.1002/cpp.1932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo Compare
- Human and Social Science; University of Bergamo and Human Factors and Technology in Healthcare Research Centre; Bergamo Italy
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49
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Effects of Rumination and Acceptance on Body Dissatisfaction in Binge Eating Disorder. EUROPEAN EATING DISORDERS REVIEW 2014; 22:338-45. [DOI: 10.1002/erv.2312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 12/26/2022]
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50
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Wenzel KR, Weinstock J, Vander Wal JS, Weaver TL. Examining the role of negative urgency in a predictive model of bulimic symptoms. Eat Behav 2014; 15:343-9. [PMID: 25064279 DOI: 10.1016/j.eatbeh.2014.04.014] [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] [Received: 10/09/2013] [Revised: 01/30/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
The etiological dual pathway model of bulimia nervosa suggests that dietary restraint and negative affect are significant predictors of this disorder. Negative urgency, or the tendency to act rashly in response to negative emotionality, is also associated with bulimia nervosa; however, no study has examined the role of negative urgency within the context of the dual pathway model. The purpose of this study was to investigate the relationship between bulimic symptomatology and negative urgency in the context of dietary restraint and depressive affect. Participants (N=166) were college women recruited from a private mid-western university through an online participant registry. A self-report battery assessed depressive affect, dietary restraint, negative urgency, and bulimic symptoms. Participants' height and weight were measured in-person to determine body mass index. A significant main effect of negative urgency was found after controlling for depressive affect and dietary restraint. The interaction between depressive affect and negative urgency to predict bulimic symptoms approached significance; however, no statistically significant interaction between dietary restraint and negative urgency was observed. These results provide support for the inclusion of negative urgency as a significant factor in etiological frameworks of bulimia nervosa.
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Affiliation(s)
- Kevin R Wenzel
- Saint Louis University, Shannon Hall 228, 221 North Grand Blvd., St. Louis, MO 63103-2010 USA.
| | - Jeremiah Weinstock
- Saint Louis University, Shannon Hall 228, 221 North Grand Blvd., St. Louis, MO 63103-2010 USA
| | - Jillon S Vander Wal
- Saint Louis University, Shannon Hall 228, 221 North Grand Blvd., St. Louis, MO 63103-2010 USA
| | - Terri L Weaver
- Saint Louis University, Shannon Hall 228, 221 North Grand Blvd., St. Louis, MO 63103-2010 USA
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