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Menzies RE, Richmond B, Sharpe L, Skeggs A, Liu J, Coutts-Bain D. The 'revolving door' of mental illness: A meta-analysis and systematic review of current versus lifetime rates of psychological disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:178-196. [PMID: 38197576 DOI: 10.1111/bjc.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta-analysis was to test this hypothesis. METHODS A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta-analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only. RESULTS Meta-analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders. CONCLUSIONS These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention.
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Affiliation(s)
| | | | - Louise Sharpe
- The University of Sydney, Sydney, New South Wales, Australia
| | - Amira Skeggs
- The University of Sydney, Sydney, New South Wales, Australia
| | - Janessa Liu
- The University of Sydney, Sydney, New South Wales, Australia
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2
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Gu SJ, Aimufua I, Pagliaccio D, Shankman SA, Steinglass JE, Auerbach RP, Walsh BT, Ranzenhofer LM. Self-referential processing in anorexia nervosa. Int J Eat Disord 2024; 57:1234-1244. [PMID: 38436447 PMCID: PMC11093709 DOI: 10.1002/eat.24176] [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: 11/29/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric comorbidity and impairment. Theoretical models of AN and self-report studies suggest that negative self-evaluation (i.e., low self-esteem) is related to the development and maintenance of AN. The goal of this study was to extend findings from self-report methodology using a neurocognitive task that probes self-evaluation implicitly and explicitly. METHOD We compared female adolescent and adult patients with AN (n = 35) and healthy controls (HC, n = 38) on explicit (i.e., endorsement of words as self-relevant), implicit (recall, recognition, reaction time), and composite (i.e., valence index, bias score, drift rates) indices of self-evaluation. We applied a drift-diffusion model to compute the drift rates, reflecting participants' decision-making process as to whether words were self-relevant. The association between self-evaluation indices and eating disorder severity was examined. RESULTS There were significant Group × Condition interaction effects for all explicit and implicit measures (all p's ≤ .01), where the AN group endorsed, recalled, and recognized more negative relative to positive words than HC. The AN group had more negative valence index and bias scores, and slower drift rate away from negative words, reflecting more negative self-evaluation. The finding for recall was attenuated when individuals with depression were excluded. Measures of self-evaluation bias were not related to eating disorder severity. DISCUSSION Using a neurocognitive approach that includes explicit and implicit indices of bias, results suggest that patients with AN have more negative self-evaluation. Due to the cross-sectional design, additional studies are needed to further evaluate directionality. PUBLIC SIGNIFICANCE Negative self-evaluation/low self-esteem is thought to contribute to eating disorder symptoms. Findings of this study using a neurocognitive task to probe self-evaluation suggested that individuals with anorexia nervosa have more negative self-evaluation, reflected by endorsing and remembering more negative (than positive) words compared to healthy controls, and doing so faster. Targeting the construct of negative self-evaluation in treatment of AN may be warranted.
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Affiliation(s)
- Serena J. Gu
- New York State Psychiatric Institute, New York, New York, USA
| | - Ivieosa Aimufua
- New York State Psychiatric Institute, New York, New York, USA
| | - David Pagliaccio
- New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Stewart A. Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Randy P. Auerbach
- New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - B. Timothy Walsh
- New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa M. Ranzenhofer
- New York State Psychiatric Institute, New York, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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3
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Luo Y, Pluta D, Brodrick BB, Palka JM, McCoy J, Lohrenz T, Gu X, Vannucci M, Montague PR, McAdams CJ. Diminished Adaptation, Satisfaction, and Neural Responses to Advantageous Social Signals in Anorexia Nervosa and Bulimia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:305-313. [PMID: 37951540 PMCID: PMC10939989 DOI: 10.1016/j.bpsc.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Development and recurrence of 2 eating disorders (EDs), anorexia nervosa and bulimia nervosa, are frequently associated with environmental stressors. Neurobehavioral responses to social learning signals were evaluated in both EDs. METHODS Women with anorexia nervosa (n = 25), women with bulimia nervosa (n = 30), or healthy comparison women (n = 38) played a neuroeconomic game in which the norm shifted, generating social learning signals (norm prediction errors [NPEs]) during a functional magnetic resonance imaging scan. A Bayesian logistic regression model examined how the probability of offer acceptance depended on cohort, block, and NPEs. Rejection rates, emotion ratings, and neural responses to NPEs were compared across groups. RESULTS Relative to the comparison group, both ED cohorts showed less adaptation (p = .028, ηp2 = 0.060), and advantageous signals (positive NPEs) led to higher rejection rates (p = .014, ηp2 = 0.077) and less positive emotion ratings (p = .004, ηp2 = 0.111). Advantageous signals increased neural activations in the orbitofrontal cortex for the comparison group but not for women with anorexia nervosa (p = .018, d = 0.655) or bulimia nervosa (p = .043, d = 0.527). More severe ED symptoms were associated with decreased activation of dorsomedial prefrontal cortex for advantageous signals. CONCLUSIONS Diminished neural processing of advantageous social signals and impaired norm adaptation were observed in both anorexia nervosa and bulimia nervosa, while no differences were found for disadvantageous social signals. Development of neurocognitive interventions to increase responsivity to advantageous social signals could augment current treatments, potentially leading to improved clinical outcomes for EDs.
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Affiliation(s)
- Yi Luo
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Dustin Pluta
- Department of Statistics, Rice University, Houston, Texas
| | - Brooks B Brodrick
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jayme M Palka
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jordan McCoy
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Terry Lohrenz
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - P Read Montague
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; Department of Physics, Virginia Tech, Blacksburg, Virginia; Virginia Tech-Wake Forest School of Biomedical Engineering and Mechanics, Blacksburg, Virginia
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas.
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4
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Schutzeichel F, Waldorp LJ, Aan Het Rot M, Glashouwer KA, Frey MI, Wiers RW, de Jong PJ. Life meaning and feelings of ineffectiveness as transdiagnostic factors in eating disorder and comorbid internalizing symptomatology - A combined undirected and causal network approach. Behav Res Ther 2024; 172:104439. [PMID: 38056085 DOI: 10.1016/j.brat.2023.104439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/18/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
The field of eating disorders is facing problems ranging from a suboptimal classification system to low long-term success rates of treatments. There is evidence supporting a transdiagnostic approach to explain the development and maintenance of eating disorders. Meaning in life has been proposed as a promising key transdiagnostic factor that could potentially not only bridge between the different eating disorder subtypes but also explain frequent co-occurrence with symptoms of comorbid psychopathology, such as anxiety and depression. The present study used self-report data from 501 participants to construct networks of eating disorder and comorbid internalizing symptomatology, including factors related to meaning in life, i.e., presence of life meaning, perceived ineffectiveness, and satisfaction with basic psychological needs. In an undirected network model, it was found that ineffectiveness is a central node, also bridging between eating disorder and other psychological symptoms. A directed network model displayed evidence for a causal effect of presence of life meaning both on the core symptomatology of eating disorders and depressive symptoms via ineffectiveness. These results support the notion of meaning in life and feelings of ineffectiveness as transdiagnostic factors within eating disorder symptomatology in the general population.
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Affiliation(s)
- Franziska Schutzeichel
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | - Lourens J Waldorp
- Department of Psychological Methods, University of Amsterdam, the Netherlands
| | - Marije Aan Het Rot
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands; Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Mirjam I Frey
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Reinout W Wiers
- Department of Developmental Psychology, University of Amsterdam, the Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
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5
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 DOI: 10.1186/s40337-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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6
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Gorrell S, Hail L, Reilly EE. Predictors of Treatment Outcome in Eating Disorders: A Roadmap to Inform Future Research Efforts. Curr Psychiatry Rep 2023; 25:213-222. [PMID: 36995577 PMCID: PMC10360436 DOI: 10.1007/s11920-023-01416-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE OF REVIEW With the current review, we provide a brief summary of recent literature that tests clinically observable characteristics at baseline that may impact treatment response, across eating disorder diagnoses. We then provide a critical discussion regarding how researchers may shift their approach to this research to improve treatment implications and generalizability of these findings. RECENT FINDINGS Recent work has broadly replicated prior findings suggesting a negative impact of lower weight status, poor emotion regulation, and early-life trauma on eating disorder treatment outcomes. Findings are more mixed for the relative contributions of illness duration, psychiatric comorbidity, and baseline symptom severity. Recent studies have begun to explore more specific domains of previously tested predictors (e.g., specific comorbidities) as well as previously neglected identity-related and systemic factors. However, recent research continues to use similar sampling techniques and approaches to analysis used in prior work. We propose that resolving remaining questions and illuminating predictors of treatment outcome in eating disorders requires a new approach to research sampling and study design. Suggested changes that can be applied within a traditional clinical trial framework may yield new insights with relevance across transdiagnostic eating disorder presentations.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA.
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
| | - Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18Th St, CA, 94143, San Francisco, USA
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Examination of perfectionism and self-concept constructs across stages of eating disorder recovery in men: An exploratory study. Eat Behav 2022; 46:101658. [PMID: 35981487 PMCID: PMC9812292 DOI: 10.1016/j.eatbeh.2022.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study examined perfectionism and self-concept constructs across eating disorder recovery stages in men, using a conceptualization of recovery that encompasses physical, behavioral, and cognitive recovery. METHOD Participants were 35 men with an eating disorder history (Mage = 26.60 years, SD = 10.81), categorized as in full recovery, in partial recovery, or with a current eating disorder diagnosis/pathology, and 27 men with no eating disorder history (controls; Mage = 26.44 years, SD = 10.08). Data for determining recovery status were collected from surveys, interviews, and measured weight and height; perfectionism and self-concept were assessed via surveys. RESULTS Among the perfectionism constructs, the greatest magnitude of effect sizes involving the fully recovered group was for socially prescribed perfectionism where this group had lower levels of perfectionism than the eating disorder diagnosis/pathology group (Hedge's g = -1.72) or the partially recovered group (Hedge's g = -1.56). For the self-concept constructs, effect sizes involving the fully recovered group and the other recovery status groups were all large (absolute values: 0.76-1.58) and reflected a large magnitude of difference with fully recovered men having higher self-esteem and self-efficacy and lower social comparison than men with a current eating disorder diagnosis or pathology or those partially recovered. CONCLUSION Full recovery in men was associated with healthy self-concept constructs and with low socially prescribed perfectionism. Future research with larger samples should seek to replicate these findings and, using a longitudinal design, examine these constructs as potential predictors or maintenance factors of comprehensive eating disorder recovery in men.
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8
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Novack K, Dufour R, Picard L, Booij L, Chadi N. An Intensive Ambulatory Care Program for Adolescents with Eating Disorders Combining In-Person and Virtual Care: Protocol for a Single-Site Naturalistic Trial (Preprint). JMIR Res Protoc 2022; 11:e37420. [DOI: 10.2196/37420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
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9
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Pauls A, Dimitropoulos G, Marcoux-Louie G, Singh M, Patten SB. Psychological characteristics and childhood adversity of adolescents with atypical anorexia nervosa versus anorexia nervosa. Eat Disord 2022; 30:210-222. [PMID: 33103622 DOI: 10.1080/10640266.2020.1836907] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The assessment and diagnosis of atypical anorexia nervosa (AAN) is an ongoing challenge for clinicians. This study aims to examine psychological morbidity and exposure to childhood adversity in adolescents with AAN compared to adolescents with anorexia nervosa, restricting type (AN-R). This registry-based study compared 42 adolescents with AAN to 79 adolescents with AN-R on a variety of psychosocial measures at the time of presentation to a specialized eating disorder program. In contrast to AN-R, adolescents with AAN had more severe drive for thinness (p =.011), body dissatisfaction (p =.038), and lower quality of life (p =.047), but had better global functioning (p =.032). Adolescents who had high Adverse Childhood Experiences (ACE) Questionnaire scores (ACE score ≥ 4) had over 5 times higher odds of having AAN than those who did not have high ACE scores (p =.008). There was no significant difference between groups on measures of low self-esteem and non-accidental self-injury. Adolescents with AAN presented with similar or more severe psychosocial distress compared to their peers with AN-R across a majority of the measures. The findings highlight the need to address trauma, body-related difficulties, and quality of life in the assessment and treatment of adolescents with AAN.
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Affiliation(s)
- Ashley Pauls
- Departments of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Gisele Marcoux-Louie
- Calgary Eating Disorder Program, Alberta Children's Hospital, Alberta Health Services
| | - Manya Singh
- Mathison Centre for Mental Health Research & Education,Department of Psychiatry, University of Calgary
| | - Scott B Patten
- Departments of Psychiatry, University of Calgary, Calgary, Canada.,Departments of Psychiatry & Community Health Sciences, University of Calgary
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10
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Low self-esteem predicts orthorexia nervosa, mediated by spiritual attitudes among frequent exercisers. Eat Weight Disord 2021; 26:2481-2489. [PMID: 33502732 PMCID: PMC8602160 DOI: 10.1007/s40519-020-01095-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to measure how orthorexic tendencies relate to age, self-esteem, and spirituality. We conducted the study on a sample of Hungarian adults performing regular fitness activity. METHOD 175 participants completed a four-part online survey: demographics and training habits, the Rosenberg Self-Esteem Scale, the Eating Habits Questionnaire-Revised (EHQ-R), and one of the Spiritual Awareness questionnaire's subscale. We performed univariate linear regression to assess the predictor role of age on orthorexic tendencies. Mediation analysis was conducted to determine the effect of self-esteem on orthorexic tendencies and the mediator role of spiritual attitudes. RESULTS Age negatively correlated with EHQ-R, and there were no gender differences. Lower self-esteem was a predictor for orthorexic tendencies with the total effect of ß = -0.3046 (p < 0.0001). In part, this is a direct relationship, but it is mediated by spiritual awareness as well. DISCUSSION Among frequent exercisers, strict dieting is likely to originate from a lack of self-esteem due to perfectionist standards, social comparison, and the aspiration of being in control. In case self-esteem is achieved through spiritual approaches, individuals may experience positive changes in their attitudes toward eating and their bodies as well. In the future, it is important to confirm whether the EHQ-R indicates diagnostic boundaries. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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11
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Martín AD. Autoestima: Actualización y Mantenimiento. Un Modelo Teórico con Aplicaciones en Terapia. CLÍNICA CONTEMPORÁNEA 2021. [DOI: 10.5093/cc2021a16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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12
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Kot E, Grzegorzewski P, Kostecka B, Kucharska K. Self-disgust and disgust sensitivity are increased in anorexia nervosa inpatients, but only self-disgust mediates between comorbid and core psychopathology. EUROPEAN EATING DISORDERS REVIEW 2021; 29:879-892. [PMID: 34655142 DOI: 10.1002/erv.2862] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The possible role of abnormal disgust processing in the development and course of anorexia nervosa (AN) has been emphasized in theoretical models and research. However, disgust toward external stimuli and self-disgust have not yet been investigated together in a clinical sample of AN patients. Therefore, the purpose of the study was to measure these constructs and examine their role in shaping eating pathology in AN patients and healthy controls (HCs), considering comorbid depressive and anxiety psychopathology. The study also aimed at testing the possible mediational roles of both disgust types in the associations between comorbid psychopathology and eating disorders (EDs) characteristics. METHOD Altogether, 63 inpatients with AN and 57 HCs partook in the study. Participants completed the Eating Disorder Inventory-3, State-Trait Anxiety Inventory, Beck Depression Inventory-II, Disgust Scale-Revised and Self-Disgust Scale. RESULTS AN patients manifested higher self-disgust and disgust sensitivity than HCs. In addition, self-disgust predicted the severity of EDs characteristics and mediated the links of depressive symptoms and trait anxiety with EDs characteristics in both groups. DISCUSSION Our findings imply the putative role of self-disgust in the development of EDs psychopathology in HCs and in its maintenance in AN patients.
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Affiliation(s)
- Emilia Kot
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Piotr Grzegorzewski
- Department of Neuroses, Personality Disorders, and Eating Disorders, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
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13
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Schlegl S, Smith KE, Vierl L, Crosby RD, Moessner M, Neumayr C, Voderholzer U. Using network analysis to compare diagnosis-specific and age-specific symptom networks in eating disorders. Int J Eat Disord 2021; 54:1463-1476. [PMID: 33949717 DOI: 10.1002/eat.23523] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The network theory of mental disorders conceptualizes eating disorders (EDs) as networks of interacting symptoms. Network analysis studies in EDs mostly have examined transdiagnostic and/or mixed age samples. The aim of our study was to investigate similarities and differences of networks in adolescents and adults with anorexia nervosa (AN) or bulimia nervosa (BN). METHOD Participants were 2,535 patients (n = 991 adults with AN, n = 821 adolescents with AN, n = 473 adults with BN, and n = 250 adolescents with BN) who completed the Eating Disorder Inventory-2. Twenty-seven items were selected. Cross-sectional networks were estimated via Joint Graphical Lasso. Core symptoms were identified using strength centrality. Spearman correlations and network comparison tests (NCTs) were used to compare groups. RESULTS Across diagnoses and ages, feeling ineffective, desire to be thinner, worries that feelings will get out of control, guilt after overeating as well as doing things perfectly emerged as most central symptoms. There were moderate to high correlations between symptom profiles (0.62-0.97, mean: 0.78) as well as high correlations between network structures (0.83-0.93, mean: 0.87) and network strengths (0.73-0.95, mean: 0.85). Global strength significantly differed in two of the six NCTs, and 2.5-10% of edges differed between networks. DISCUSSION Considerable similarities in network structures and strengths across diagnoses and ages speak in favor of the transdiagnostic approach to EDs. Besides drive for thinness, ineffectiveness, emotion regulation difficulties, and perfectionism might be the most consistent factors in ED networks. These symptoms as well as their symptom connections should be especially focused in treatment regardless of age and diagnosis.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Science, University of Southern California, Los Angeles, California, USA
| | - Larissa Vierl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.,Schoen Clinic Roseneck, Prien, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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14
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Colmsee ISO, Hank P, Bošnjak M. Low Self-Esteem as a Risk Factor for Eating Disorders. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1027/2151-2604/a000433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract. Eating disorders are a major health concern and the identification of relevant risk factors is crucial for prevention. This meta-analysis aims to give insight into the relevance of low self-esteem in the development of pathological eating. Longitudinal and partial correlations were synthesized in a random-effects multilevel model. In total, 25 effect sizes were obtained from 13 primary studies. These mainly included females from late childhood to young adulthood. The results reveal a practically relevant effect of self-esteem on eating disorders ( r = −.23, ρ = −.09). This effect was significantly larger for females and for shorter time periods between measurements. Additionally, self-esteem and eating disorders are both temporally stable. It is concluded that low self-esteem acts as a universal risk factor for different eating disorders. Limitations are due to the reliance on bivariate correlations and a small number of effect sizes. The necessity of more high-quality research in this field is discussed.
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Affiliation(s)
| | - Petra Hank
- Department of Psychology, University of Trier, Germany
| | - Michael Bošnjak
- Department of Psychology, University of Trier, Germany
- Leibniz Institute for Psychology Information (ZPID), Trier, Germany
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15
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Weineck F, Hauke G, Lindemann H, Lachenmeir K, Schnebel A, Karačić M, Meule A, Voderholzer U, Pollatos O. Using bodily postures in the treatment of anorexia nervosa: Effects of power posing on interoception and affective states. EUROPEAN EATING DISORDERS REVIEW 2020; 29:216-231. [PMID: 33252788 DOI: 10.1002/erv.2813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Power posing involves the adoption of an expansive bodily posture. This study examined whether power posing could benefit individuals with anorexia nervosa (AN) and women with normal weight in regards to interoceptive ability and affective states. METHOD Participants included 50 inpatients and outpatients with AN as well as 51 normal-weight women. Interoceptive accuracy (IAcc), measured by the heartbeat tracking task and interoceptive sensibility (IS), measured by confidence ratings, were assessed at baseline, after a single power posing session and after 1 week of daily training. Also, the short-term effects of power posing on subjective feelings of dominance, pleasantness, and arousal were investigated. RESULTS Both groups increased in their IAcc after one power posing session. Also, there was a significant main effect of time on feelings of dominance and pleasantness in the short-term. Women with AN displayed lower levels of IS, dominance, and pleasantness as well as higher levels of arousal than women without AN. DISCUSSION These findings suggest that power posing has the potential to increase IAcc, subjective feelings of power and pleasant affect in the short-term. Further research should investigate which mechanisms foster the effectiveness of this intervention to tailor it to the needs of women with AN.
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Affiliation(s)
- Felicitas Weineck
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Gernot Hauke
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
| | - Hanna Lindemann
- Department of Physical Medicine and Rehabilitation, Ludwig Maximilian University, Munich, Germany
| | - Karin Lachenmeir
- Treatment Center for Eating Disorders (TCE), Dritter Orden Hospital, Munich, Germany
| | | | | | - Adrian Meule
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Freiburg, Freiburg, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Ulm University, Ulm, Germany
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16
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Bardone-Cone AM, Miller AJ, Thompson KA, Walsh EC. Predicting a comprehensive operationalization of eating disorder recovery: Examining self-concept, personality, and negative affect. Int J Eat Disord 2020; 53:987-996. [PMID: 32343432 DOI: 10.1002/eat.23281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self-concept, personality, and negative affect. METHOD Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7-8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). RESULTS Logistic regression models revealed that self-esteem was a significant predictor of recovery status (OR = 1.12, p = .039) such that individuals with higher self-esteem at baseline demonstrated significantly greater odds of being in full recovery at follow-up. However, when self-esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. DISCUSSION These results highlight the potential importance of self-esteem in relation to recovery, with clinical implications related to bolstering self-esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery.
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Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine A Thompson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Walsh
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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17
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Olfaction is a Marker of Severity but Not Diagnosis in Anorexia Nervosa: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2020; 30:251-266. [DOI: 10.1007/s11065-020-09438-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
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18
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Monell E, Clinton D, Birgegård A. Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating. J Eat Disord 2020; 8:17. [PMID: 32377341 PMCID: PMC7193412 DOI: 10.1186/s40337-020-00294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed. METHODS This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable. RESULTS An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential. CONCLUSIONS Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.
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Affiliation(s)
- Elin Monell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute for Eating Disorders, Oslo, Sweden
| | - Andreas Birgegård
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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19
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Abstract
Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.
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Affiliation(s)
- Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tiago Antunes Duarte
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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20
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Forrest LN, Sarfan LD, Ortiz SN, Brown TA, Smith AR. Bridging eating disorder symptoms and trait anxiety in patients with eating disorders: A network approach. Int J Eat Disord 2019; 52:701-711. [PMID: 30900758 DOI: 10.1002/eat.23070] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features. METHOD We estimated a regularized partial correlation network in patients with mixed EDs (N = 296). ED symptoms were assessed with the Eating Disorder Examination-Questionnaire. Trait anxiety was assessed with the Trait subscale of the State-Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations. RESULTS Central ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self-confidence. DISCUSSION Avoidance of social eating and low self-esteem may be routes through which EDs and trait anxiety are linked.
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Affiliation(s)
| | | | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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