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Murray SB, Diaz‐Fong JP, Mak VWT, Feusner JD. Assessing midbrain neuromelanin and its relationship to reward learning in anorexia nervosa: Stage 1 of a registered report. Brain Behav 2024; 14:e3573. [PMID: 38898625 PMCID: PMC11186843 DOI: 10.1002/brb3.3573] [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: 03/05/2024] [Accepted: 05/06/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a debilitating and potentially chronic eating disorder, characterized by low hedonic drive toward food, which has been linked with perturbations in both reward processing and dopaminergic activity. Neuromelanin-sensitive magnetic resonance imaging (MRI) is an emerging method to index midbrain neuromelanin-a by-product of dopaminergic synthesis. The assessment of midbrain neuromelanin, and its association with AN psychopathology and reward-related processes, may provide critical insights into reward circuit function in AN. METHODS This study will incorporate neuromelanin-sensitive MRI into an existing study of appetitive conditioning in those with AN. Specifically, those with acute and underweight AN (N = 30), those with weight-restored AN (N = 30), and age-matched healthy controls (N = 30) will undergo clinical assessment of current and previous psychopathology, in addition to structural neuromelanin-sensitive MRI, diffusion MRI, and functional MRI (fMRI) during appetitive conditioning. CONCLUSION This study will be among the first to interrogate midbrain neuromelanin in AN-a disorder characterized by altered dopaminergic activity. Results will help establish whether abnormalities in the midbrain synthesis of dopamine are evident in those with AN and are associated with symptomatic behavior and reduced ability to experience pleasure and reward.
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Affiliation(s)
- Stuart B. Murray
- Department of Psychiatry & Behavioral SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Joel P. Diaz‐Fong
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- Institute of Medical Science, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral ScienceUniversity of California, Los AngelesLos AngelesCaliforniaUSA
| | | | - Jamie D. Feusner
- Centre for Addiction and Mental HealthTorontoOntarioCanada
- Institute of Medical Science, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral ScienceUniversity of California, Los AngelesLos AngelesCaliforniaUSA
- Department of Psychiatry, Temerty Faculty of MedicineUniversity of TorontoTorontoOntarioCanada
- Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
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Roithmeier L, Fuchshuber J, Prandstätter T, Andres D, Schmautz B, Schwerdtfeger A, Unterrainer HF. Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms? Front Psychol 2024; 15:1372756. [PMID: 38756495 PMCID: PMC11098276 DOI: 10.3389/fpsyg.2024.1372756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives Primary emotion traits and attachment patterns, have been linked to various mental disorders. This study aims to shed more light on the less studied relationship with eating disorder (ED) symptoms. Methods A total of 921 non-clinical subjects (69.9% females) were assessed for primary emotions traits (B-ANPS-GL), attachment insecurity (ECR-RD8), and eating disorder pathology (EDE-Q8). A theoretically derived model was evaluated by means of a path analysis with attachment anxiety as assumed mediator variable. Results Global problematic eating behavior showed negative correlations with the positive emotions PLAY, CARE, and LUST (r = -0.10 to -0.24), positive correlations with the negative primary emotions ANGER, FEAR, and SADNESS (r = 0.12-0.27), as well as with attachment anxiety (r = 0.22, all p < 0.01). Path analyses revealed direct effects between eating behavior pathology with LUST (β = -0.07 to -0.15) and FEAR (β = 0.12-0.19; all p < 0.05). The association of SADNESS and Weight (β = 0.05) and Shape Concern (β = 0.06, p < 0.001) was fully mediated by attachment anxiety. Overall, the path model explained 17% of the variance for attachment anxiety and 6% of the Restraint, 13% for Eating, 10% for Weight and 14% for Shape Concern Subscales. Discussion The findings shed light on the multifactorial relationship between affective traits, attachment security, and eating disorder pathology. In line with previous research, the results emphasize the role of attachment and affective functioning in ED symptoms.
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Affiliation(s)
- Lisa Roithmeier
- Institute of Psychology, University of Graz, Graz, Austria
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Jürgen Fuchshuber
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University Vienna, Vienna, Austria
| | | | - Deborah Andres
- Institute of Psychology, University of Graz, Graz, Austria
| | - Beate Schmautz
- Institute of Psychology, University of Graz, Graz, Austria
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | | | - Human-Friedrich Unterrainer
- Institute of Psychology, University of Graz, Graz, Austria
- University Clinic of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
- Faculty of Psychotherapy Science, Sigmund Freud Private University, Vienna, Austria
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Eickman K, Maxwell R, McGinnis LK, Stanczyk F, Legro R, Lindheim SR. Total and bioavailable 25-hydroxyvitamin D is not associated with improved sexual dysfunction following vitamin D supplementation in women with polycystic ovarian syndrome: a pilot study. J Sex Med 2024; 21:240-247. [PMID: 38303661 PMCID: PMC10906494 DOI: 10.1093/jsxmed/qdad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 11/13/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Vitamin D (Vit D) deficiency has been linked to symptoms of polycystic ovary syndrome (PCOS), yet little is known about Vit D supplementation as a treatment for sexual dysfunction (SDy) in women with PCOS. AIM To explore the implications of serum total 25-hydroxyvitamin D (25[OH]D) and bioavailable 25[OH]D (bio-25[OH]D) status and replacement on women with PCOS and SDy. METHODS Reproductive-age women with PCOS who were not desiring fertility were eligible provided that they also had SDy, as assessed by the Female Sexual Function Index (FSFI), and were without severe depression, as evaluated by the Beck Depression Inventory II (BDI-II). Participants were given the recommended dietary allowance of Vit D (600 IU daily) plus hormonal contraception (HC; cyclic ethinyl estradiol/drospirenone) or no HC for 6 months. Comparisons between groups were analyzed by chi-square test and t-test, and Pearson's correlation coefficient analyzed correlations between FSFI with demographics, BDI-II, androgen levels, and total and bio-25[OH]D. OUTCOMES The outcomes included SDy (FSFI <26.55), total and serum bio-25[OH]D levels, and total and free testosterone. RESULTS A total of 42 women without severe depression completed the FSFI, with 28 (66.7%) having SDy. All FSFI domains, including arousal, lubrication, orgasm, and pain, were significantly lower as compared with women without SDy, with no associations with respect to demographics, total and free testosterone, or total and bio-25[OH]D. Vit D replacement was initiated with HC (n = 18) or no HC (n = 10), and for those completing the study, FSFI improved (score >26.55) in 61% (11/18) regardless of the treatment group. A time-treatment effect showed a significant change for the domain of orgasm, suggesting that HC had more of an impact than Vit D replacement. Improvement in sexual function as a dichotomous variable was not associated with age, body mass index, other demographics, total and free testosterone, total and bio-25[OH]D, or HC use. CLINICAL IMPLICATIONS Due to the prevalence of SDy in women with PCOS, efficacious treatment options are necessary. STRENGTHS AND LIMITATIONS This study is the first to analyze the effect of Vit D supplementation on SDy in women with PCOS. Limitations included the small number of participants who completed the study, thus limiting meaningful conclusions and generalizability. CONCLUSION Vit D status was not associated with SDy and BDI-II. While HC may have played a role, standard Vit D supplementation could not account for the noted improvement in FSFI in women with PCOS.
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Affiliation(s)
- Kira Eickman
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, United States
| | - Rose Maxwell
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Fairborn, OH 45324, United States
| | - Lynda K McGinnis
- Department of Obstetrics and Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Frank Stanczyk
- Department of Obstetrics and Gynecology, Keck School of Medicine of University of Southern California, Los Angeles, CA 90033, United States
| | - Richard Legro
- Department of Obstetrics and Gynecology, College of Medicine, Penn State University, State College, PA 16801, United States
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, University of Central Florida, Orlando, FL 32827, United States
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Fairborn, OH 45324, United States
- Center for Reproductive Medicine, Renji Hospital; School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China
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Martin GM, Tremblay J, Gagnon-Girouard MP. Sexual self-concept, functioning, and practices of women with binge eating episodes. Eat Weight Disord 2023; 28:37. [PMID: 37069446 PMCID: PMC10108796 DOI: 10.1007/s40519-023-01565-0] [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: 12/04/2022] [Accepted: 03/21/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE Positive sexuality has received little empirical attention in relation to eating disorders. Two tendencies related to sexuality have been identified among women with anorexia nervosa (avoidance) and bulimia nervosa (disinhibition), but it is unclear if they also apply to women with binge eating episodes without compensatory behaviors. This study aimed at (1) exploring the sexual self-concept, functioning, and practices of women with binge eating episodes with or without comorbid restrictive and/or compensatory behaviors, considering past experiences of violence, and (2) verifying the presence of distinct profiles of sexual dispositions among this population. METHODS In total, 253 women reporting recurrent episodes of loss of control related to food intake in the past 5 years, completed a web-based questionnaire. Descriptive and correlational analyses were conducted to outline participants' sexual self-concept, functioning, and practices and to examine the relationship between these factors. A two-step cluster analysis was also performed to determine whether participants presented distinct profiles of sexual dispositions. RESULTS Participants were generally characterized by a negative sexual self-concept and poor sexual functioning. While a first subgroup of participants displayed a pattern of sexual difficulties and avoidance, a second subgroup had a positive sexual self-concept, better sexual functioning and a wider range of sexual practices. Subgroups did not differ relative to binge eating. CONCLUSIONS Sexuality offers a platform for positive embodiment, which can lead to the improvement of body image and mind-body connection and may thus constitute an essential clinical target to improve treatment related to binge eating episodes. LEVEL OF EVIDENCE Level II: The experimental study is a non-randomized controlled trial.
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Affiliation(s)
- Geneviève Manuela Martin
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, G1V 0A6, Québec, Canada.
| | - Jérôme Tremblay
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
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Gerges S, Obeid S, Hallit S. Associations Between Eating Attitudes, Mental Health, and Sexual Dysfunction during Pregnancy. JOURNAL OF SEX & MARITAL THERAPY 2022:1-16. [PMID: 36433682 DOI: 10.1080/0092623x.2022.2149937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This cross-sectional study looked into sexual dysfunctions in a sample of Lebanese pregnant women (N = 433) while assessing their psychopathological correlates. It was a first attempt in research to examine the role of disordered eating attitudes in pregnancy, using the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale. The pre/post comparison in terms of sexual functioning was based on the women's recall, using the Pregnancy Sexual Response Inventory. According to the pregnant persons perceptions of their sexual functioning before and during pregnancy, 66.1% of the participants reported a lower frequency of sexual activity during pregnancy, 52.7% lower sexual desire, and 47.3% dyspareunia; 33% were sexually satisfied contrasted to 70% before pregnancy. Pregnancy was significantly associated with lower sexual outcomes compared to before. Higher anxiety and more disordered eating attitudes during pregnancy were significantly associated with lower sexuality composite scores. Our study accentuates the need for rigorous medical guidance on sexual activity during pregnancy and highlights dysfunctional eating behaviors and anxiety disorders as pejorative predictors of the sexual response among pregnant women. It thus sustains the hypothesis that mental health disorders pertain to the pathogenesis of sexual problems and should therefore be targeted in sexual health promotion during prenatal care.
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Affiliation(s)
- Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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Hernández-Rivero I, Blechert J, Miccoli L, Eichin KN, Fernández-Santaella MC, Delgado-Rodríguez R. Emotional reactivity to binge food and erotic cues in women with bulimia nervosa symptoms. J Eat Disord 2021; 9:120. [PMID: 34583783 PMCID: PMC8479974 DOI: 10.1186/s40337-021-00475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Studies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features in this population, which justify their inclusion as a research target. Here, we study responses to erotic cues-alongside food, neutral and aversive cues-to gain an understanding of specificity to food versus a generalized sensitivity to primary reinforcers. METHODS We recorded peripheral psychophysiological indices -the startle reflex, zygomaticus, and corrugator responses-and self-reported emotional responses (valence, arousal, and dominance) in 75 women completing the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by self-reported and psychophysiological responses to food versus neutral and erotic versus neutral images. RESULTS The results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues. CONCLUSIONS The results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments. We examined appetitive and aversive cue responses in college women to investigate how bulimic symptoms relate to primary reinforcers such as food and erotic images. We recorded peripheral psychophysiological indices (the startle reflex, zygomaticus, and corrugator responses) and self-reported emotional responses (valence, arousal, and dominance) in 75 college women that were presented with the Spanish version of the Bulimia Test-Revised. The results showed that bulimic symptoms increase both psychophysiological defensiveness toward food cues and subjective pleasure toward erotic cues. The findings suggest a generalized sensitivity to primary reinforcers in the presence of bulimic symptoms, and emphasize the relevance of adopting a wider framework in research and treatment on bulimia nervosa.
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Affiliation(s)
- Isabel Hernández-Rivero
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Campus de Cartuja s/n, 18071, Granada, España
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron-University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
| | - Laura Miccoli
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Campus de Cartuja s/n, 18071, Granada, España
| | - Katharina Naomi Eichin
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron-University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
| | - M Carmen Fernández-Santaella
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Campus de Cartuja s/n, 18071, Granada, España
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Meneguzzo P, Collantoni E, Bonello E, Vergine M, Behrens SC, Tenconi E, Favaro A. The role of sexual orientation in the relationships between body perception, body weight dissatisfaction, physical comparison, and eating psychopathology in the cisgender population. Eat Weight Disord 2021; 26:1985-2000. [PMID: 33090374 PMCID: PMC8292238 DOI: 10.1007/s40519-020-01047-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Body weight dissatisfaction (BWD) and visual body perception are specific aspects that can influence the own body image, and that can concur with the development or the maintenance of specific psychopathological dimensions of different psychiatric disorders. The sexual orientation is a fundamental but understudied aspect in this field, and, for this reason, the purpose of this study is to improve knowledge about the relationships among BWD, visual body size-perception, and sexual orientation. METHODS A total of 1033 individuals participated in an online survey. Physical comparison, depression, and self-esteem was evaluated, as well as sexual orientation and the presence of an eating disorder. A Figure Rating Scale was used to assess different valences of body weight, and mediation analyses were performed to investigated specific relationships between psychological aspects. RESULTS Bisexual women and gay men reported significantly higher BWD than other groups (p < 0.001); instead, higher body misperception was present in gay men (p = 0.001). Physical appearance comparison mediated the effect of sexual orientation in both BWD and perceptual distortion. No difference emerged between women with a history of eating disorders and without, as regards the value of body weight attributed to attractiveness, health, and presence on social media. CONCLUSION This study contributes to understanding the relationship between sexual orientations and body image representation and evaluation. Physical appearance comparisons should be considered as critical psychological factors that can improve and affect well-being. The impact on subjects with high levels of eating concerns is also discussed. LEVEL OF EVIDENCE Level III: case-control analytic study.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Elisa Bonello
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Mariantonietta Vergine
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Simone C. Behrens
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Department of Perceiving Systems, Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
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Audier-Bourgain M, Baubet T, Pham-Scottez A, Corcos M, Nicolas I. Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course. Brain Behav 2021; 11:e02196. [PMID: 34142465 PMCID: PMC8413734 DOI: 10.1002/brb3.2196] [Citation(s) in RCA: 3] [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: 11/15/2019] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Among medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety. This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non-ED group. METHOD Patients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE-Q), the Brief Index of Sexual Functioning for Women (BISF-W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS). RESULTS We found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non-ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month. DISCUSSION This study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.
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Affiliation(s)
- Marie Audier-Bourgain
- Department of Children and Adolescents, Psychopathology, Avicenna Hospital, General Psychiatry and Addictology Specialized, Bobigny, France
| | - Thierry Baubet
- Department of Children and Adolescents, Psychopathology, Avicenna Hospital, General Psychiatry and Addictology Specialized, Bobigny, France
| | - Alexandra Pham-Scottez
- Psychiatric Orientation And Reception Center, GHU Paris Psychiatry and Neurosciences, Paris Cedex 14, France
| | - Maurice Corcos
- Department of adolescent and young adult psychiatry, Institut Mutualiste Montsouris, Paris cedex 14, France
| | - Isabelle Nicolas
- Department of adolescent and young adult psychiatry, Institut Mutualiste Montsouris, Paris cedex 14, France
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Szkodziak F, Krzyżanowski J, Szkodziak P. Psychological aspects of infertility. A systematic review. J Int Med Res 2021; 48:300060520932403. [PMID: 32600086 PMCID: PMC7328491 DOI: 10.1177/0300060520932403] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective Fertility may be defined as a capacity to conceive and produce offspring. Infertility is characterized by failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse. Infertility concerns an estimated 8–12% of the global population, and is associated with factors including time of unwanted non-conception, age of female partner and number of diseases impacting fertility. Unexplained infertility is described as idiopathic. This study aimed to analyse and evaluate the influence of mental disorders, often considered as reasons for idiopathic infertility, on female and male fertility, including stress, depression, sleep and eating disorders, and addictions. Methods This systematic review comprised a search of MEDLINE, Cochrane and PubMed databases for relevant articles that were analysed by two independent reviewers. Results A total of 106 articles published between 1955–2019 were included. Mental disorders modify endocrine gland and immune system functioning at both the tissue and cellular level, and are negatively associated with female and male fertility. Conclusion Mental disorders may negatively impact female and male fertility. Further studies are required to explain the exact role and contribution of mental disorders to fertility.
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Affiliation(s)
- Filip Szkodziak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Jarosław Krzyżanowski
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - Piotr Szkodziak
- 3rd Chair and Department of Gynaecology, Medical University of Lublin, Lublin, Poland
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Michels N, De Backer F, Dimakopoulou M, Mane K, Indave I, Huybrechts I. Eating disorders and the risk of developing cancer: a systematic review. Eat Weight Disord 2021; 26:1021-1035. [PMID: 33025526 DOI: 10.1007/s40519-020-01020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. METHODS A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. RESULTS From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). CONCLUSIONS The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex). LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Fien De Backer
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | | | - Katerina Mane
- International Agency for Research on Cancer, Lyon, France
| | - Iciar Indave
- International Agency for Research on Cancer, Lyon, France
| | - Inge Huybrechts
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
- International Agency for Research on Cancer, Lyon, France
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Cassioli E, Rossi E, Castellini G, Sensi C, Mancini M, Lelli L, Monteleone AM, Ricca V, Stanghellini G. Sexuality, embodiment and attachment style in anorexia nervosa. Eat Weight Disord 2020; 25:1671-1680. [PMID: 31679143 DOI: 10.1007/s40519-019-00805-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/22/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Recent studies hypothesized that sexual dysfunctions represent not just complications of eating disorders (EDs), rather they should be attributed to the core psychopathology of these disorders. Therefore, disorders of the embodiment and insecure attachment may play a role in maintaining an abnormal sexual functioning, given their known relations with core ED features. The aim of the study was to investigate the relationship between sexual dysfunctions and both disorders of the embodiment and attachment style in people with anorexia nervosa (AN). METHODS 111 adult women with AN and 120 healthy subjects completed the Symptom Checklist-90, Eating Disorder Examination Questionnaire, Identity and Eating Disorders, Attachment Style Questionnaire and the Childhood Trauma Questionnaire-Short Form. RESULTS Patients reported worse scores than controls in all areas assessed. In patients, low sexual desire was found to be associated with general and ED-specific psychopathology, and with disorders of embodiment and attachment style. Sexual dysfunctions had no associations with traumatic experiences. Dietary restriction showed an association with low sexual desire through embodiment disorder and Discomfort with Closeness, as confirmed by the serial mediation model. CONCLUSION The present study suggests that disorders of embodiment maintained by pathological eating behaviours have a key role in the development of sexual dysfunctions in EDs, through the compromise of intimacy. LEVEL OF EVIDENCE Level III, cross-sectional study with comparisons between cases and controls.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Carolina Sensi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Milena Mancini
- Department of Psychological, Humanistic and Territorial Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Stanghellini
- Department of Psychological, Humanistic and Territorial Sciences, University "G. d'Annunzio", Chieti, Italy
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12
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Castellini G, D'Anna G, Rossi E, Cassioli E, Appignanesi C, Monteleone AM, Rellini AH, Ricca V. Dysregulated Sexuality in Women with Eating Disorders: The Role of Childhood Traumatic Experiences. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:793-806. [PMID: 32938329 DOI: 10.1080/0092623x.2020.1822484] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The present study explored the psychopathological, behavioral, and putative biological underpinnings of dysregulated sexuality in eating disorders (EDs), focusing on the role of childhood trauma - evaluated with the Childhood Trauma Questionnaire (CTQ). The comparison between Binge-Purging and Restricting patients outlined the predominance of markers of dysregulated sexuality in the first subgroup. In the clinical sample, hypersexuality - measured through the Hypersexual Behavior Inventory (HBI) - was associated with severe psychopathology, emotion dysregulation, childhood trauma, adverse consequences, and higher ghrelin levels. Moderation analyses showed that hypersexuality was associated with emotion dysregulation and psychopathology only in those patients reporting childhood traumatic experiences.
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Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Appignanesi
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatric Unit, Department of Health Sciences, University of Florence, Florence, Italy
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13
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Price T, Zebitz M, Giraldi A, Lokind TS, Treasure J, Sjögren JM. Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review. Int J Eat Disord 2020; 53:1377-1399. [PMID: 32449544 DOI: 10.1002/eat.23299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN. METHOD We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded. RESULTS N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions. DISCUSSION Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.
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Affiliation(s)
- Tom Price
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Martin Zebitz
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet Capitol Region of Denmark Psychiatry Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea Stine Lokind
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Jan Magnus Sjögren
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Fergus KB, Cohen AJ, Cedars BE, Rowen TS, Patino G, Breyer BN. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020; 8:501-509. [PMID: 32439324 PMCID: PMC7471064 DOI: 10.1016/j.esxm.2020.03.007] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Sexual pain is common among women but little is known about associations with exercise and physical activity. AIM To determine the prevalence of sexual pain among physically active women and to evaluate cycling and other potential risk factors. METHODS This is a secondary data analysis of a study on the urinary and sexual wellness of physically active women recruited through sporting clubs and targeted social media advertising. We used multivariable logistic regression to assess the role of cycling and exercise in reporting any, frequent, or severe sexual pain, controlling for demographic, relationship, and health risk factors. MAIN OUTCOME MEASURE Sexual pain, including frequency and severity, was measured using the Female Sexual Function Index. RESULTS A total of 2,039 women were included, with 1,097 (54%) reporting any level of sexual pain, 364 (18%) experiencing frequent pain, and 378 (19%) reporting severe pain. Less than 5% of women reported diabetes or hypertension, and the cohort had a median body mass index of 23.3 (interquartile range 21.4-25.7). Increasing age and body mass index were protective against any sexual pain, as was cycling (odds ratio [OR] 0.73 [95% CI 0.59-0.90]). Participants who reported being "moderately satisfied" (OR 0.53 [95% CI 0.31-0.91]) or "very satisfied" (OR 0.33 [95% CI 0.19-0.56]) with their emotional closeness to a sexual partner had decreased odds of any sexual pain. CONCLUSION Experiencing any sexual pain is common in physically active women, with a prevalence of over 50%; however, weekly energy expenditure from exercise was not associated with sexual pain. Cycling participation and higher levels of emotional closeness and intimacy were associated with less pain. Patients between the ages of 18 and 30 years who were normal or underweight incurred the highest risk of sexual pain. Fergus KB, Cohen AJ, Cedars BE, et al. Risk Factors for Sexual Pain Among Physically Active Women. Sex Med 2020;8:501-509.
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Affiliation(s)
- Kirkpatrick B Fergus
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Andrew J Cohen
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Benjamin E Cedars
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA
| | - Tami S Rowen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA
| | - German Patino
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Hospital San Ignacio, Bogota, Colombia
| | - Benjamin N Breyer
- Department of Urology, University of California-San Francisco, San Francisco, CA, USA; Department of Biostatistics and Epidemiology, University of California-San Francisco, San Francisco, CA, USA.
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15
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Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00236-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Dunkley CR, Gorzalka BB, Brotto LA. Associations Between Sexual Function and Disordered Eating Among Undergraduate Women: An Emphasis on Sexual Pain and Distress. JOURNAL OF SEX & MARITAL THERAPY 2020; 46:18-34. [PMID: 31216244 DOI: 10.1080/0092623x.2019.1626307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The limited body of research on sexuality in eating disorders supports the occurrence of considerable sexual concerns. The aim of the present study was to examine eating disorder symptoms in relation to sexual function, and sexual pain in particular. Female undergraduate students completed a series of online questionnaires. All domains of sexual function were predicted by aspects of disordered eating, with disordered eating generally being associated with more sexual difficulties. Psychological characteristics common to those with eating pathology were also associated with sexuality variables, such that psychological maladjustment was associated with poorer sexual function. Psychological maladjustment was found to mediate the association between eating disorder risk and sexual function. The results of this study suggest that sexual function should be addressed during eating disorder care.
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Affiliation(s)
- Cara R Dunkley
- Department of Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Boris B Gorzalka
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lori A Brotto
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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18
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McNabney SM, Wiese GN, Rowland DL. From Table to Bedroom: Nutritional Status, Dietary Interventions, and Women’s Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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van Zutphen L, Maier S, Siep N, Jacob GA, Tüscher O, van Elst LT, Zeeck A, Arntz A, O'Connor MF, Stamm H, Hudek M, Joos A. Intimate stimuli result in fronto-parietal activation changes in anorexia nervosa. Eat Weight Disord 2019; 24:1155-1164. [PMID: 29397562 DOI: 10.1007/s40519-017-0474-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/18/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intimacy is a key psychological problem in anorexia nervosa (AN). Empirical evidence, including neurobiological underpinnings, is however, scarce. OBJECTIVE In this study, we evaluated various emotional stimuli including intimate stimuli experienced in patients with AN and non-patients, as well as their cerebral response. METHODS Functional magnetic resonance imaging was conducted using stimuli with positive, neutral, negative and intimate content. Participants (14 AN patients and 14 non-patients) alternated between passive viewing and explicit emotion regulation. RESULTS Intimate stimuli were experienced less positively in AN patients compared to non-patients. AN patients showed decreased cerebral responses in superior parietal cortices in response to positive and intimate stimuli. Intimate stimuli led to stronger activation of the orbitofrontal cortex, and lower activation of the bilateral precuneus in AN patients. Orbitofrontal responses decreased in AN patients during explicit emotion regulation. CONCLUSIONS These results show that intimate stimuli are of particular importance in AN patients, who show experiential differences compared to non-patients and altered activation of orbitofrontal and parietal brain structures. This supports that AN patients have difficulties with intimacy, attachment, self-referential processing and body perception. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- L van Zutphen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - S Maier
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N Siep
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - G A Jacob
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - O Tüscher
- Department of Psychiatry and Psychotherapy, University of Mainz, Mainz, Germany
| | - L Tebartz van Elst
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - A Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - M-F O'Connor
- Department of Psychology, University of Arizona, Tucson, USA
| | - H Stamm
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - M Hudek
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg Faculty of Medicine, University of Freiburg, Hauptstraße 8, 79104, Freiburg, Germany. .,Department of Psychotherapeutic Neurology, Kliniken Schmieder Gailingen, Gailingen, Germany.
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20
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Maier S, Spiegelberg J, Zutphen L, Zeeck A, Tebartz van Elst L, Hartmann A, Holovics L, Reinert E, Sandholz A, Lahmann C, Domschke K, Glauche V, Tüscher O, Joos AA. Neurobiological signature of intimacy in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:315-322. [DOI: 10.1002/erv.2663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/08/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Simon Maier
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Julia Spiegelberg
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Linda Zutphen
- Department of Clinical Psychological ScienceMaastricht University Maastricht The Netherlands
| | - Almut Zeeck
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Ludger Tebartz van Elst
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Armin Hartmann
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Lukas Holovics
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Elke Reinert
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Angelika Sandholz
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Claas Lahmann
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Katharina Domschke
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Volkmar Glauche
- Faculty of Medicine, Department of NeurologyMedical Center—University of Freiburg Freiburg Germany
| | - Oliver Tüscher
- Department of Psychiatry and PsychotherapyUniversity of Mainz Mainz Germany
| | - Andreas A.B. Joos
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
- Department of Psychotherapeutic NeurologyKliniken Schmieder Gailingen Germany
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21
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Hill JW, Elias CF. Neuroanatomical Framework of the Metabolic Control of Reproduction. Physiol Rev 2019; 98:2349-2380. [PMID: 30109817 DOI: 10.1152/physrev.00033.2017] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A minimum amount of energy is required for basic physiological processes, such as protein biosynthesis, thermoregulation, locomotion, cardiovascular function, and digestion. However, for reproductive function and survival of the species, extra energy stores are necessary. Production of sex hormones and gametes, pubertal development, pregnancy, lactation, and parental care all require energy reserves. Thus the physiological systems that control energy homeostasis and reproductive function coevolved in mammals to support both individual health and species subsistence. In this review, we aim to gather scientific knowledge produced by laboratories around the world on the role of the brain in integrating metabolism and reproduction. We describe essential neuronal networks, highlighting key nodes and potential downstream targets. Novel animal models and genetic tools have produced substantial advances, but critical gaps remain. In times of soaring worldwide obesity and metabolic dysfunction, understanding the mechanisms by which metabolic stress alters reproductive physiology has become crucial for human health.
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Affiliation(s)
- Jennifer W Hill
- Center for Diabetes and Endocrine Research, Departments of Physiology and Pharmacology and of Obstetrics and Gynecology, University of Toledo College of Medicine , Toledo, Ohio ; and Departments of Molecular and Integrative Physiology and of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
| | - Carol F Elias
- Center for Diabetes and Endocrine Research, Departments of Physiology and Pharmacology and of Obstetrics and Gynecology, University of Toledo College of Medicine , Toledo, Ohio ; and Departments of Molecular and Integrative Physiology and of Obstetrics and Gynecology, University of Michigan , Ann Arbor, Michigan
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22
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Sweitzer MM, Watson KK, Erwin SR, Winecoff AA, Datta N, Huettel S, Platt ML, Zucker NL. Neurobiology of social reward valuation in adults with a history of anorexia nervosa. PLoS One 2018; 13:e0205085. [PMID: 30513084 PMCID: PMC6279022 DOI: 10.1371/journal.pone.0205085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/19/2018] [Indexed: 12/12/2022] Open
Abstract
Objective Anorexia nervosa (AN) is a disorder characterized by atypical patterns of reward valuation (e.g. positive valuation of hunger). Atypical reward processing may extend into social domains. If so, such findings would be of prognostic significance as impaired social functioning predicts worse outcome. We explore neural circuits implicated in social reward processing in individuals with a history of AN who are weight-restored relative to controls and examine the effects of illness course on the experience of social value. Method 20 weight-restored individuals with a history of AN (AN-WR) and 24 healthy control (HC) participants were assessed using fMRI tasks that tapped social reward: smiling faces and full human figures that varied in attractiveness and weight. Results AN-WR differed from HC in attractiveness ratings by weight (negatively correlated in AN-WR). While there were no significant differences when viewing smiling faces, viewing full figures resulted in decreased activation in regions implicated in reward valuation (the right caudate) for AN-WR and this region was negatively correlated with a sustained course of the disorder. Exploratory whole brain analyses revealed reduced activation in regions associated with social reward, self-referential processing, and cognitive reappraisal (e.g., medial prefrontal cortex, striatum, and nucleus accumbens) with sustained disorder course. Discussion The rewarding value of full body images decreases with a sustained disorder course. This may reflect an extension of atypical reward processing documented in AN-WR, perhaps as a function of starvation dampening visceral motivational signals; the deployment of cognitive strategies that lessen the experience of reward; and/or the nature of the stimuli themselves as provocative of eating disorder symptoms (e.g., thin bodies). These findings did not extend to smiling face stimuli. Advances in technology (e.g., virtual avatars, text messaging) may provide novel means to build relationships, including therapeutic relationships, to support improved social connections without threats to symptom provocation.
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Affiliation(s)
- Maggie M. Sweitzer
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Karli K. Watson
- Institute for Cognitive Neuroscience, University of Colorado, Boulder, Colorado, United States of America
| | - Savannah R. Erwin
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Amy A. Winecoff
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Nandini Datta
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States of America
| | - Scott Huettel
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
- Institute for Cognitive Neuroscience, University of Colorado, Boulder, Colorado, United States of America
- Medical Scientist Training Program, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Michael L. Platt
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Marketing Department, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Nancy L. Zucker
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, United States of America
- Institute for Cognitive Neuroscience, University of Colorado, Boulder, Colorado, United States of America
- * E-mail:
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Abstract
Fears about sexual maturity and intimacy were among early explanations for the etiology of eating disorders and related concerns, and research with clinical samples revealed a relationship between eating disorders and atypical sexual experiences. In contrast, feminist scholars offer explanations for both eating disorders and sexual dysfunction that emphasize societal pressures. As an alternative approach to understanding these difficulties, the authors empirically explored the relationship between the cognitive and affective aspects of sexuality and disordered eating among a nonclinical sample of 167 university women. Participants completed the Eating Attitudes Test–Revised and the Garos Sexual Behavior Index–Research Version. Women who experienced greater psychic conflict about their sexual behavior, obsessiveness about sex, and discomfort with sexual stimulation also reported increased levels of disordered eating behavior. These results suggest a need to consider the potential disturbances in certain cognitive and affective aspects of sexual functioning when treating women with disordered eating.
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Affiliation(s)
- Annette S. Kluck
- Special Education, Rehabilitation, & Counseling Department, Auburn University, Auburn, Alabama
| | - Sheila Garos
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Lucas Shaw
- Central Texas Veterans Health Care System, Olin E. Teague Veterans' Center, Austin, Texas
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Trauma in relation to psychological characteristics in women with eating disorders. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2017. [DOI: 10.5114/cipp.2017.67047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The aim of the article was to present the results of the author’s own study that sought relationships between having experienced psychological trauma and the psychological characteristics of people with eating disorders. The basic research question was the following: To what degree are the traumatic events experienced by females with various types of eating disorders related to these females’ psychological characteristics? <br />
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<b>Participants and procedure</b><br />
The sample comprised 120 females with eating disorders: 30 females aged between 20 and 26 diagnosed with bulimia nervosa, 31 females diagnosed with binge-eating disorder and 59 females aged between 20 and 26 diagnosed with anorexia nervosa. The research was carried out in the years 2007-2012 in outpatient clinics treating neuroses and eating disorders and mental health outpatient clinics in Poland. The study employed a clinical and psychometric (i.e., questionnaires for measuring psychological characteristics) approach.<br />
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<b>Results</b><br />
Statistical analysis confirmed the existence of significant differences between the females with eating disorders who have experienced relational trauma(s) in their lives (particularly in their childhood and adolescence) and those who did not reveal such experience. The females with anorexia and bulimia who have also experienced psychological, physical or sexual violence revealed a significantly different, higher level of bulimic thinking and tendencies for excessively uncontrolled, impulsive behaviors towards food and nutrition (i.e., vomit-provoking and other forms of body purgation, e.g. using purgative drugs and others) than did females with no relational trauma experience.<br />
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<b>Conclusions</b><br />
The frequency of relational trauma occurrence was significantly higher for females with bulimia and bulimic anorexia. For females with restrictive anorexia and binge-eating disorder, no significantly frequent occurrence of trauma was observed. <br />
Diagnosing the occurrence of relational trauma in patients’ histories is a key element that should be involved in the process of psychotherapy for people with eating disorders.
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Kirby JS, Fischer MS, Raney TJ, Baucom DH, Bulik CM. Couple-based interventions in the treatment of adult anorexia nervosa: A brief case example of UCAN. ACTA ACUST UNITED AC 2017; 53:241-50. [PMID: 27267510 DOI: 10.1037/pst0000053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adult anorexia nervosa (AN) is a serious and often fatal illness that significantly erodes quality of life for both the patient and loved ones. Treatment of adults with AN has focused largely on individual therapy, with recent findings suggesting that improvement is limited and dropout rates are high. In an effort to improve treatment response, we developed a couple-based intervention, Uniting Couples in the treatment of Anorexia Nervosa (UCAN) as an adjunct treatment to standard multidisciplinary care. UCAN leverages the support of a partner and the relationship in treatment by decreasing avoidance around AN, teaching the couple how to effectively address the eating disorder, and helping to foster a more satisfying relationship. This paper presents a case study of a couple who completed UCAN, "Laura and Steve," including their experiences in treatment and outcome measures at pretest, posttest, and 3-month follow-up. Laura showed clinically significant change on the Restraint subscale of the Eating Disorders Examination at follow-up, and both partners showed clinically significant improvements in relationship satisfaction, as well as on self-reported and observed communication. Both partners reported very high satisfaction with the treatment. A discussion of therapists' experiences in delivering UCAN is provided, including common challenges for therapists with primarily a couple therapy or an individual CBT for eating disorders background, as well as important factors for therapists to consider in order to optimally leverage the benefits of including partners in treatment for AN. (PsycINFO Database Record
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Affiliation(s)
- Jennifer S Kirby
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Melanie S Fischer
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Thomas J Raney
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Donald H Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill
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Taborelli E, Easter A, Keefe R, Schmidt U, Treasure J, Micali N. Transition to motherhood in women with eating disorders: A qualitative study. Psychol Psychother 2016; 89:308-23. [PMID: 26493834 DOI: 10.1111/papt.12076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to examine in depth the individual experience of transition from pregnancy to motherhood, among women with current eating disorders (EDs), focusing on differences between the first and subsequent pregnancies. DESIGN AND METHODS We analysed the narratives of 12 women with severe ED during pregnancy using interpretative phenomenological analysis. We employed a sequential structure, and the emerging themes were ordered according to consecutive pregnancy stages. RESULTS Our results indicate that experiences of pregnancy vary across pregnancy stages and in the first pregnancy compared to subsequent pregnancies. In particular, during their first pregnancy women with an ED seem to experience an inner conflict and questioned the continuity of their ED identity leading them to be more open to change. CONCLUSIONS The first pregnancy, during its early stages, should be considered a potentially unique window for intervention for women with current ED. PRACTITIONER POINTS Eating disorders (EDs) are known to seriously affect fertility, pregnancy, and pregnancy outcomes. Our research sheds a light on experiences of pregnancy in women with ED and ultimately helps to define a window for intervention. Our findings have important implications in understanding mechanisms of relapse in the post-partum period and consequently could help in tailoring an adequate intervention for women with ED and in preventing ED relapse.
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Affiliation(s)
- Emma Taborelli
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Abigail Easter
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Rosalind Keefe
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Ulrike Schmidt
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Janet Treasure
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
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28
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Pisetsky EM, Utzinger LM, Peterson CB. Incorporating Social Support in the Treatment of Anorexia Nervosa: Special Considerations for Older Adolescents and Young Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:316-328. [PMID: 27429544 DOI: 10.1016/j.cbpra.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently, research support is strongest for family-based treatment (FBT) for the treatment of anorexia nervosa (AN) in adolescents. However, a strong evidence base for treatments for older adolescents and young adults with AN is lacking. Emphasizing social support in the treatment of AN may be beneficial for older adolescents and young adults with AN. This paper provides a brief review of the literature on FBT for adolescent AN and provides a case example of adolescent AN treated with FBT. We then discuss novel treatments that have incorporated social support for older adolescents and young adults with AN, such as modified FBT and couples-based interventions. We provide case studies of each of these novel treatment approaches as well. Additionally, this paper highlights and discusses developmental considerations and challenges in working with older adolescents and young adults with AN.
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Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | | | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
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29
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Linville D, Cobb E, Shen F, Stadelman S. Reciprocal Influence of Couple Dynamics and Eating Disorders. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:326-340. [PMID: 26189490 DOI: 10.1111/jmft.12133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Little research has focused on the ways that eating disorder processes and adult couple dynamics influence one another. The purpose of this study was to investigate the reciprocal influence of couple dynamics and eating disorder illness and recovery processes. We conducted 51 interviews with 17 couples where one member identified as currently suffering or having recovered from an eating disorder. Using grounded theory analytical methods, findings include the systemic interplay of the eating disorder and relationship, both partners' perspectives on the eating disorder and its role in the relationship, the noneating disorder partner's impact on the eating disorder, and coping strategies for recovery as a couple. Clinical implications for supporting couples experiencing eating disorder illness and recovery are discussed.
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30
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Kimmel M, Ferguson E, Zerwas S, Bulik C, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 2016; 49:260-75. [PMID: 26711005 PMCID: PMC5683401 DOI: 10.1002/eat.22483] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. METHOD We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. RESULTS Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. DISCUSSION We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.
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Affiliation(s)
- M.C. Kimmel
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina,Correspondence to: M.C. Kimmel, Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina.
| | - E.H. Ferguson
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - S. Zerwas
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - C.M. Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
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31
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Olatunji BO, Kim SK, Wall D. Extracting body image symptom dimensions among eating disorder patients: the Profile Analysis via Multidimensional Scaling (PAMS) approach. Body Image 2015; 15:16-23. [PMID: 25996520 DOI: 10.1016/j.bodyim.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/23/2015] [Accepted: 04/25/2015] [Indexed: 11/16/2022]
Abstract
The present study employs Profile Analysis via Multidimensional Scaling (PAMS), a procedure for extracting dimensions, in order to identify core eating disorder symptoms in a clinical sample. A large sample of patients with eating disorders (N=5193) presenting for treatment completed the Eating Disorders Inventory-2 (EDI-2; Garner, 1991), and PAMS was then employed to estimate individual profile weights that reflect the degree to which an individual's observed symptom profile approximates the pattern of the dimensions. The findings revealed three symptom dimensions: Body Thinness, Body Perfectionism, and Body Awareness. Subsequent analysis using individual level data illustrate that the PAMS profiles properly operate as prototypical profiles that encapsulate all individuals' response patterns. The implications of these dimensional findings for the assessment and diagnosis of eating disorders are discussed.
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Affiliation(s)
| | - Se-Kang Kim
- Fordham University, Bronx, NY, United States
| | - David Wall
- Remuda Ranch Programs for Eating Disorders, Wickenburg, AZ, United States
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32
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Abstract
A significant number of adults with eating disorders fail to achieve relief from the disorder, with many dropping out of treatment or relapsing. The standard treatment remains individual therapy despite partners being negatively affected and typically wanting to help in an effective and loving way. We propose that couple-based interventions, which leverage the support of a partner and the relationship in treatment, may improve outcome and recovery rates for adults with eating disorders. In this article, we survey the empirical literature supporting the treatment of adults in a couple context and describe our existing and emerging couple-based interventions for eating disorders.
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Affiliation(s)
- Jennifer S Kirby
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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33
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Mellemkjaer L, Papadopoulos FC, Pukkala E, Ekbom A, Gissler M, Christensen J, Olsen JH. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland. PLoS One 2015; 10:e0128018. [PMID: 26000630 PMCID: PMC4441362 DOI: 10.1371/journal.pone.0128018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/21/2015] [Indexed: 11/30/2022] Open
Abstract
A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer) were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis.
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Affiliation(s)
- Lene Mellemkjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- * E-mail:
| | - Fotios C. Papadopoulos
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jane Christensen
- Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Jørgen H. Olsen
- Research Management, Danish Cancer Society Research Center, Copenhagen, Denmark
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Macpherson-Sánchez AE. Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic. Am J Public Health 2015; 105:e71-85. [PMID: 25713933 PMCID: PMC4358173 DOI: 10.2105/ajph.2014.302507] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/12/2022]
Abstract
Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.
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Affiliation(s)
- Ann E Macpherson-Sánchez
- Ann E. Macpherson-Sánchez is with the Department of Agricultural Education, University of Puerto Rico, Mayagüez
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35
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Fischer MS, Baucom DH, Kirby JS, Bulik CM. Partner distress in the context of adult anorexia nervosa: the role of patients' perceived negative consequences of AN and partner behaviors. Int J Eat Disord 2015; 48:67-71. [PMID: 25087574 PMCID: PMC4342417 DOI: 10.1002/eat.22338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Romantic partners can play an important role in the recovery from anorexia nervosa (AN). It is important to understand partners' behaviors and variables associated with their own distress. The aim was to examine associations of patients' perceived negative consequences of AN, behavioral strategies employed by partners, and partner distress. METHOD We used a cross-sectional design to assess associations between self-reports of patients' perceived negative consequences of AN, partners' caregiver distress, negative affect, relationship satisfaction, and observational coding measures of partners' behavioral strategies of change promotion and acceptance/validation. Sixteen adult patient-partner dyads in committed relationships were assessed at baseline of a couple-based intervention for AN. RESULTS Partners' change promotion moderated the association between patients' perceived negative consequences of AN and partners' caregiver distress. Partners' acceptance/validation was associated with partners' negative affect. DISCUSSION This report represents the first description of specific partner behaviors in the context of AN. Partners who reported the least distress were those who were trying to promote changes in AN behaviors in patients who reported high negative consequences of AN, and partners who were trying to show understanding of the patients' experience. Future studies should examine the impact of partner behaviors on AN treatment outcome.
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Affiliation(s)
- Melanie S Fischer
- Department of Psychology, University of North Carolina, Chapel Hill, North Carolina
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36
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Body mass index and subjective well-being in young adults: a twin population study. BMC Public Health 2013; 13:231. [PMID: 23496885 PMCID: PMC3691623 DOI: 10.1186/1471-2458-13-231] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/27/2013] [Indexed: 01/30/2023] Open
Abstract
Background Body mass index (BMI) is associated with subjective well-being. Higher BMI is believed to be related with lower well-being. However, the association may not be linear. Therefore, we investigated whether a nonlinear (U-shaped) trend would better describe this relationship, and whether eating disorders might account for the association in young adults. Methods FinnTwin16 study evaluated multiple measures of subjective well-being, including life satisfaction, General Health Questionnaire (GHQ-20), satisfaction with leisure time, work, and family relationships, and satisfaction with sex life in young adulthood in the 1975–79 birth cohorts of Finnish twins (n=5240). We studied the relationship between indicators of subjective well-being and BMI both in full birth cohorts and in subgroups stratified by lifetime DSM-IV eating disorders. Results We found an inverse U-shaped relationship between all indicators of subjective well-being and BMI in men. There was no overall association between BMI and subjective well-being in women. However, there was an inverse U-shaped relationship between BMI and indicators of subjective well-being in women with a lifetime eating disorder and their healthy female co-twins. Subjective well-being was optimal in the overweight category. Conclusions Both underweight and obesity are associated with impaired subjective well-being in young men. The BMI reflecting optimal subjective well-being of young men may be higher than currently recognized. Categorization of body weight in terms of BMI may need to be reassessed in young men. BMI and subjective well-being are related in women with a lifetime eating disorder, but not in the general population of young women.
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Maxwell M, Thornton LM, Root TL, Pinheiro AP, Strober M, Brandt H, Crawford S, Crow S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Keel P, Klump KL, LaVia M, Mitchell JE, Plotnicov K, Rotondo A, Woodside DB, Berrettini WH, Kaye WH, Bulik CM. Life beyond the eating disorder: education, relationships, and reproduction. Int J Eat Disord 2011; 44:225-32. [PMID: 20143323 PMCID: PMC2888627 DOI: 10.1002/eat.20804] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We investigated the sociodemographic characteristics in women with and without lifetime eating disorders. METHOD Participants were from a multisite international study of eating disorders (N = 2,096). Education level, relationship status, and reproductive status were examined across eating disorder subtypes and compared with a healthy control group. RESULTS Overall, women with eating disorders were less educated than controls, and duration of illness and age of onset were associated with educational attainment. Menstrual status was associated with both relationship and reproductive status, but eating disorder subtypes did not differ significantly from each other or from healthy controls on these dimensions. DISCUSSION Differences in educational attainment, relationships, and reproduction do exist in individuals with eating disorders and are differentially associated with various eating disorder symptoms and characteristics. These data could assist in educating patients and family members about long-term consequences of eating disorders.
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Affiliation(s)
- Millie Maxwell
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Tammy L. Root
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Harry Brandt
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Steve Crawford
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Scott Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | - Manfred M. Fichter
- Klinik Roseneck, Hospital for Behavioral Medicine and University of Munich (LMU), Munich, Germany
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, New York
| | - Craig Johnson
- Laureate Psychiatric Clinic and Hospital, Tulsa, Oklahoma
| | - Allan S. Kaplan
- Department of Psychiatry, The Toronto Hospital, Toronto, Canada
| | - Pamela Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Maria LaVia
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - James E. Mitchell
- Department of Psychology, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Kathy Plotnicov
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alessandro Rotondo
- Department of Psychiatry, Pharmacology and Biotechnologies, University of Pisa, Pisa, Italy
| | | | - Wade H. Berrettini
- Department of Psychiatry, University of Pennsylvania, School of Medicine, Philadelphia, Pennsylvania
| | - Walter H. Kaye
- Department of Psychiatry, University of California, San Diego, California
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Department of Nutrition, University of North Carolina at Chapel Hill
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38
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Bulik CM, Baucom D, Kirby J, Pisetsky E. Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). Int J Eat Disord 2011; 44:19-28. [PMID: 20063308 PMCID: PMC2889168 DOI: 10.1002/eat.20790] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the development of a novel couple-based cognitive-behavioral intervention for adult anorexia nervosa (AN) called Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). METHOD We review the state of the science for the treatment of adult AN, the nature of relationships in AN, our model of couple functioning in AN, and the development of the UCAN intervention. RESULTS We present the UCAN treatment for patients with AN and their partners and discuss important considerations in the delivery of the intervention. DISCUSSION With further evaluation, we expect that UCAN will emerge to be an effective, acceptable, disseminable, and developmentally tailored intervention that will serve to improve both core AN pathology as well as couple functioning.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, North Carolina.
| | - Donald Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Jennifer Kirby
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Emily Pisetsky
- Department of Psychology, University of North Carolina at Chapel Hill
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