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Lee SE, Valerio Montero D, Sanico A, Haynos AF. Reward responsivity and habit formation in the co-occurrence of restrictive eating and nonsuicidal self-injury. J Psychiatr Res 2024; 175:29-33. [PMID: 38701609 DOI: 10.1016/j.jpsychires.2024.04.042] [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: 12/19/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Dysfunctions in reward and/or habit formation have been proposed as factors contributing individually to the maintenance of restrictive eating and nonsuicidal self-injury (NSSI). However, despite the high comorbidity between these behaviors, the associations between reward and habit formation in their co-occurrence remains unclear. This study examined self-reported reward responsivity and habit strength among individuals with co-occurring restrictive eating and NSSI (Comorbid group; n = 108) and those with one behavior only (One-behavior group; n = 113). Hierarchical logistic regression analyses assessed the association between reward and habit features and the co-occurrence of restrictive eating and NSSI, accounting for the effects of impulsivity (a characteristic commonly considered to underlie co-occurring disordered eating and NSSI). Partial correlations examined the relationships between these features and the severity of eating disorder and NSSI symptoms, also controlling for impulsivity. Lower reward responsivity was associated with the co-occurrence of restrictive eating and NSSI, even after accounting for impulsivity (p = 0.017). In exploratory analyses, this relationship was no longer significant after accounting for self-reported depression. No significant associations were found regarding habit formation and restrictive eating and NSSI co-occurrence. Lower reward responsivity was linked to increased NSSI frequency and versatility in both groups and associated with severity of eating pathology in the Comorbid group (ps < 0.05). Our findings suggest that blunted reward responsivity may relate to the co-occurrence of restrictive eating, NSSI, and depressive symptoms, as well as the severity of restrictive eating and NSSI. Reward disturbances may serve as a crucial target in the treatment of multiple self-destructive behaviors.
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Affiliation(s)
- Soo-Eun Lee
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Ashley Sanico
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ann F Haynos
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
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Patarinski AGG, Smith GT, Davis HA. Eating disorder-related functional impairment predicts greater depressive symptoms across one semester of college. Eat Behav 2024; 53:101873. [PMID: 38579503 PMCID: PMC11144091 DOI: 10.1016/j.eatbeh.2024.101873] [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: 10/25/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
Eating disorder (ED) behaviors and depression are associated with numerous negative outcomes, including lower quality of life and functional impairment. College women are at elevated risk for both. Prior research indicates ED behaviors, including binge eating, self-induced vomiting, and fasting, predict increases in future depressive symptoms. However, symptom heterogeneity in EDs is common, and all disordered eating, or its associated distress, cannot be captured by the endorsement of behaviors. Impairment that results from ED behaviors may be a comparable, or stronger, predictor of depressive symptoms. We sought to characterize the longitudinal relationship between ED-related functional impairment, ED behaviors, and depressive symptoms. College-aged women [N = 304; 72 % white, mean (SD) age = 18.45 (0.88)] completed an online survey in August (baseline), and then three months later in November (follow-up). Baseline ED-related functional impairment, but not baseline ED behaviors, significantly predicted depressive symptoms at follow-up, controlling for baseline depressive symptoms, negative affect, and body mass index. Findings indicate ED-related functional impairment is a risk factor for increases in depressive symptoms across one semester of college, irrespective of ED behavior engagement, weight status, and dispositional negative affect. Intervening upon ED-related functional impairment may reduce or prevent future depressive symptoms among college-aged women.
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Affiliation(s)
- Anna Gabrielle G Patarinski
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregory T Smith
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Heather A Davis
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
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Davis HA, Smith ZR, Smith GT. Longitudinal transactions between negative urgency and fasting predict binge eating. Appetite 2024; 192:107113. [PMID: 37924849 DOI: 10.1016/j.appet.2023.107113] [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: 06/19/2023] [Revised: 09/11/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023]
Abstract
Fasting and negative urgency (the disposition to act rashly when distressed) are risk factors for binge eating. It may be that each influences the other over time to predict binge eating. OBJECTIVE This study tested whether (1) fasting predicts binge eating through negative urgency, and (2) negative urgency predicts binge eating through fasting. METHOD Path analysis and mediation tests were used to investigate objectives in n = 302 college women assessed three times over eight months. We controlled for each variable at the previous time point, and concurrent negative affect and body mass index at each time point. RESULTS Time 1 (T1) fasting predicted elevated negative urgency three months later at Time 2 (T2) and T2 negative urgency predicted increases in binge eating five months later at Time 3 (T3). T2 negative urgency mediated the relationship between T1 fasting and T3 binge eating. T1 negative urgency predicted increases in T2 fasting, which then predicted increases in T3 binge eating. T2 fasting mediated the relationship between T1 negative urgency and T3 binge eating. DISCUSSION Findings suggest fasting and negative urgency transact to predict binge eating among college women. Interventions targeting negative urgency may prevent or reduce both fasting and binge eating.
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Affiliation(s)
- Heather A Davis
- Department of Psychology, Virginia Polytechnic Institute and State University, USA.
| | - Zoe R Smith
- Department of Psychology, Loyola University Chicago, USA
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D'Adamo L, Smolar L, Balantekin KN, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: a cross-sectional study. J Eat Disord 2023; 11:214. [PMID: 38049869 PMCID: PMC10694964 DOI: 10.1186/s40337-023-00939-0] [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: 05/31/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen. METHODS Among 50,082 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. RESULTS 2378 (4.7%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than most other diagnoses and higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). CONCLUSIONS Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders, at risk for an eating disorder, or at low risk. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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Affiliation(s)
- Laura D'Adamo
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA, 19104, USA
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, NY, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, 14214, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
- Center for m2Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA, 94022, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
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Schlissel AC, Richmond TK, Eliasziw M, Leonberg K, Skeer MR. Anorexia nervosa and the COVID-19 pandemic among young people: a scoping review. J Eat Disord 2023; 11:122. [PMID: 37474976 PMCID: PMC10360262 DOI: 10.1186/s40337-023-00843-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The extent to which the recent global COVID-19 Pandemic has impacted young people with restrictive eating disorders [i.e., anorexia nervosa (AN) and atypical anorexia nervosa (AAN)] is unclear. We conducted a scoping review of the literature to identify how the pandemic has impacted this population and to identify gaps in the current literature to inform future research efforts. MAIN BODY We searched PubMed, EMBASE, the Web of Science, The Cochrane Library, PsycInfo, ProQuest Dissertations and Theses Global, LitCovid, Google Scholar, and relevant agency websites from 2019 to 2022. We included studies that focused on young people with AN/AAN globally. Of the 916 unduplicated articles screened, 17 articles met the inclusion criteria, reporting on 17 unique studies including 4,379 individuals. Three key findings were identified. First, an increase in hospitalizations related to eating disorders was found during COVID-19 among young people with AN and AAN. Multiple studies cited increased medical instability, even though the overall duration of disease was shorter compared to pre-pandemic levels. Second, changes in eating disorder-related symptomology during the pandemic were reported in this population, as well as poorer overall behavioral and mental health. Suggested reasons behind changes included boredom or minimal distraction from pathological thoughts, increased social isolation, increased social media and online use (e.g., reading blogs or watching YouTube), gym and school closures, changes in routines due to lockdowns and quarantines, and worries over gaining the "Quarantine 15". Third, there was an increase in the use of telemedicine as a treatment modality for the treatment of AN. Challenges were reported by both clinicians and patients regardless of past experience using telemedicine. When compared to no treatment, telemedicine was recognized as the best option during COVID-19 lockdowns; however some individuals expressed the preference for in-person treatment and planned to return to it once it became available. CONCLUSION The pandemic significantly impacted young people with restrictive eating disorders as seen by increased hospitalizations and requests for outpatient care. A primary driver of the changes in eating disorder symptomatology may be lockdowns and quarantines. Further research investigating how the series of lockdowns and re-openings impacted individuals with AN/AAN is warranted.
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Affiliation(s)
- Anna C. Schlissel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Tracy K. Richmond
- Division of Adolescent Medicine, Boston Children’s Hospital, 6th Floor, 333 Longwood Avenue, Boston, MA 02115 USA
- Harvard Medical School, Pediatrics, 25 Shattuck Street, Boston, MA 02115 USA
| | - Misha Eliasziw
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
| | - Kristin Leonberg
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Jaharis Family Center for Biomedical and Nutrition Sciences, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Margie R. Skeer
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111 USA
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Clapham R, Laves E, Fergerson A, Nichols P, Brausch A. Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1612-1621. [PMID: 34242545 PMCID: PMC8742842 DOI: 10.1080/07448481.2021.1944165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/14/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
Objective: Interoceptive deficits have been linked to suicidality and eating disorders. The relationship between disordered eating symptoms and suicidality may depend on the level of interoceptive deficits. It was expected that interoceptive deficits would moderate the relationship between disordered eating symptoms (oral control, dieting, and bulimia) and suicidality (suicide attempts, ideation, and communication) when interoceptive deficits were high. Methods: University students (N = 417, Mage = 19.75, 78.2% white, 72.4% female) completed self-report measures that assessed disordered eating, interoceptive deficits, and suicide history. Results: Interoceptive deficits emerged as a significant moderator only in the association between bulimia symptoms and suicidality, when interoceptive deficits were high. Conclusions: The results of this study indicate that bulimia symptoms may have a unique interaction with interoceptive deficits and suicidality. Future research should focus on targeting interoceptive deficits in treatment to help reduce disordered eating symptoms and suicide risk, particularly for students with bulimia symptoms.
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Affiliation(s)
- Rebekah Clapham
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Eliza Laves
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Ava Fergerson
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
- Ava Fergerson is now in the School of Psychology, University of Southern Mississippi, Hattiesburg, MS
| | - Paige Nichols
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
| | - Amy Brausch
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY
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Izquierdo AM, Nelson JD, Daza A, Gasbarro A, Hardin R, Marino J, Fischer S. Predictors of current suicidal ideation in a multi-diagnostic sample of individuals with eating disorders. J Eat Disord 2023; 11:94. [PMID: 37291663 DOI: 10.1186/s40337-023-00789-w] [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: 07/31/2022] [Accepted: 04/20/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Individuals with eating disorders (EDs) have high rates of suicidal ideation (SI) and attempts (SA). Fasting, body dissatisfaction, binge eating and purging have been associated with SI in non-clinical samples, individuals with anorexia nervosa or low-weight EDs, and a multi-diagnostic sample. However, few studies have examined how ED symptoms contribute to risk for SI in conjunction with other well-established risk factors, such as nonsuicidal self-injury (NSSI) and past SA. The aim of this study was to examine which ED symptoms contribute unique risk for current SI in a multi-diagnostic, clinical sample when statistically adjusting for gender, NSSI, past SA, and past SI. METHODS We conducted a chart review of 166 individuals who presented for ED treatment at an outpatient facility and signed informed consent. Initial intake interviews were coded for the presence versus absence of fasting, fear of weight gain, binge eating, purging, excessive exercise, restriction, body checking, self-weighing, and body dissatisfaction, as well as NSSI, past SA, past SI, and current SI. RESULTS A total of 26.5% of the sample endorsed current SI. In a logistic regression analysis, identifying as male (n = 17) or having a non-binary gender identity (n = 1), the presence of fasting, and past SI were all significantly associated with increased odds of current SI, whereas excessive exercise significantly decreased odds of current SI. Fasting was equally common across all diagnostic groups. CONCLUSIONS Future research should establish the temporal relationship between fasting and SI to better inform intervention.
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Affiliation(s)
- Alyssa M Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Daza
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | | | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Potomac Behavioral Solutions, Arlington, VA, USA
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D'Adamo L, Smolar L, Balantekin K, Taylor CB, Wilfley D, Fitzsimmons-Craft E. Prevalence, Characteristics, and Correlates of Avoidant/Restrictive Food Intake Disorder among Adult Respondents to the National Eating Disorders Association Online Screen: A Cross-Sectional Study. RESEARCH SQUARE 2023:rs.3.rs-3007049. [PMID: 37333103 PMCID: PMC10274940 DOI: 10.21203/rs.3.rs-3007049/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Background Avoidant/restrictive food intake disorder (ARFID) is a serious, albeit under-researched, feeding or eating disorder. This exploratory study utilized data from adult respondents to the National Eating Disorders Association (NEDA) online eating disorder screen to validate items assessing the presence of ARFID and examine the prevalence, clinical characteristics, and correlates of a positive ARFID screen compared to other probable eating disorder/risk categories. Methods Among 47,705 adult screen respondents between January 2022 and January 2023, the prevalence of a positive ARFID screen was calculated. Chi-square tests and t-tests compared demographics, eating disorder attitudes and behaviors, suicidal ideation, current eating disorder treatment status, and eating disorder treatment-seeking intentions between respondents with possible ARFID and other eating disorder diagnostic and risk categories. Clinical characteristics of respondents with possible ARFID were also examined. Results 2,378 (5.0%) adult respondents screened positive for ARFID. Respondents with possible ARFID tended to be younger, male, and have lower household income, and were less likely to be White and more likely to be Hispanic/Latino than most other diagnostic/risk groups. They had lower weight/shape concerns and eating disorder behaviors than all other diagnoses but higher BMI than those with AN. 35% reported suicidal ideation, 47% reported intentions to seek treatment for an eating disorder, and 2% reported currently being in treatment. The most common clinical feature of ARFID was lack of interest in eating (80%), followed by food sensory avoidance (55%) and avoidance of food due to fear of aversive consequences (31%). Conclusions Findings from this study indicated that ARFID was prevalent among adult screen respondents and more common among individuals who were younger, male, non-White, Hispanic, and lower income relative to those with other eating disorders or at risk for an eating disorder. Individuals with possible ARFID frequently reported suicidal ideation and were rarely in treatment for an eating disorder. Further research is urgently needed to improve advances in the assessment and treatment of ARFID and improve access to care in order to prevent prolonged illness duration.
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Wang Y, Wang J, Geng J, Wang H, Lei L. Body talk on social networking sites and restrained eating among adolescents: A test of a multiple mediation model. Body Image 2023; 45:145-152. [PMID: 36924748 DOI: 10.1016/j.bodyim.2023.03.002] [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: 08/31/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023]
Abstract
The present study aimed to examine the link between body talk on social networking sites (SNS body talk) and restrained eating as well as the mediating roles of fear of negative appearance evaluation (FNAE) and body shame in this relationship. Furthermore, the moderating role of gender in the mediation model was also examined. A sample of 1481 Chinese middle and high school students (720 girls, mean age = 15.49 ± 1.84) completed self-reported measures of SNS body talk, FNAE, body shame, and restrained eating. Results showed that SNS body talk was positively associated with restrained eating. FNAE and body shame mediated the association between SNS body talk and restrained eating, separately and serially. Furthermore, gender difference emerged in the path from SNS body talk to body shame and the path from FNAE to body shame. Findings of the present study enrich the literature on social media and body image and eating behaviors, and have important implications for reducing negative body image and disordered eating among adolescents.
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Affiliation(s)
- Yuhui Wang
- Faculty of Humanities and Social Sciences, Beijing University of Technology, Beijing 100124, China; Beijing Social Governance Research Center, Beijing University of Technology, Beijing 100124, China
| | - Jing Wang
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Jingyu Geng
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Hongxia Wang
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Li Lei
- School of Education, Renmin University of China, Beijing 100872, China.
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Zu P, Xu SJ, Shi CY, Zhao YQ, Huang ZH, Tao FB. Perceived rather than objective weight status is associated with suicidal behaviors among Chinese adolescents: a school-based study. J Public Health (Oxf) 2023; 45:75-83. [PMID: 35226755 DOI: 10.1093/pubmed/fdac015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/22/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We aimed to explore the relationship between body mass index (BMI) and body weight perception (BWP) with suicidal behaviors among mainland Chinese adolescents. METHODS A nationally representative sample (N = 10 110) of Chinese adolescents was assessed in this study. Suicidal behaviors (ideation, plan and attempt) were evaluated by four self-reported questions. Generalized linear mixed model was used to estimate the adjusted odds ratios (ORs) for the association between BWP/BMI with suicidal behaviors. RESULTS The prevalence of suicidal ideation, suicidal plan and suicidal attempt was 12, 5 and 2.1%, respectively. After adjusting potential covariates, perceiving oneself as obese was significantly associated with increased risks of suicidal ideation (OR: 2.4, 95% confidence intervals, CI: 1.6-4.0, P = 0.001), suicidal plan (OR: 3.1, 95% CI: 1.5-6.3, P = 0.002) and suicidal attempt (OR: 3.7, 95% CI: 1.5-9.1, P = 0.001) compared with perceiving as normal weight among male adolescents; the effect attenuated to null among female adolescents. Perceiving oneself as underweight and overweight both exhibited significant adverse effect on suicidal behaviors (only suicidal ideation and suicidal plan) compared with perceiving oneself as normal weight among male adolescents, but not among female adolescents. The actual measured BMI was not significantly associated with suicidal behaviors among neither gender. CONCLUSIONS Self-perception of their body image rather than actual measured weight may have a gender-specific adverse effect on suicidal behaviors among Chinese adolescents.
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Affiliation(s)
- Ping Zu
- Department of Economic Management, Anhui Vocational College of Press and Publishing. Hefei 230601, Anhui, China
| | - Shao-Jun Xu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Cheng-Ying Shi
- Department of Economic Management, Anhui Vocational College of Press and Publishing. Hefei 230601, Anhui, China
| | - Yu-Qiu Zhao
- Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, Anhui, China
| | - Zhao-Hui Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China
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Wang Y, Ma Z, Lu S, Duan Z, Wilson A, Jia Y, Yang Y, Chen R. Associations between sex differences, eating disorder behaviors, physical and mental health, and self-harm among Chinese adolescents. J Eat Disord 2023; 11:30. [PMID: 36850005 PMCID: PMC9972801 DOI: 10.1186/s40337-023-00754-7] [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: 08/11/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND AND AIM Eating Disorders (ED) result in impaired well-being, but there exist an insufficient number of studies that have focused on the influence of sex and sexual orientation disparities within ED behaviors. Thus, we aimed to investigate ED behaviors among male and female adolescents with different sexual orientations in a school sample to understand prevalence and correlates of different ED behaviors. METHOD Data was analysed from 11,440 Chinese school adolescents with a mean age of 14.74 years (SD = 1.46). Reported data was gathered on sociodemographic information including sexual orientation, ED behaviors, health factors (reported health, cognitive function), mental health factors (depression, anxiety, suicidal ideation, non-suicidal self-injurious behavior), and social functioning (school bully victimization, and school bully perpetration). Logistic regression models were used to estimate the associations with ED behaviors, using the heterosexual orientation as the reference group as they are the majority. RESULTS Compared to female adolescents, male adolescents reported lower anxiety symptoms (t = - 12.39, p < 0.001, Cohen's d = - 0.233), were more likely to be the perpetrator of school bullying (χ2 = 190.61, p < 0.001, φ = 0.129), and reported a lower likelihood of taking dietary restriction (χ2 = 290.08, p < 0.001, φ = 0.160). Overall, the prevalence of dietary restriction presented sex disparities. Adolescents who reported no sexual attraction were less likely to engage in ED behaviors. Using heterosexual orientation as the reference group, the group who reported no sexual attraction was associated with lower risk in dietary restriction and purging in both male and female adolescents. Using the heterosexual orientation as the reference group, female sexual minority groups were at high risk of ED behaviors, with bisexual orientation and gay/lesbian orientation having a higher likelihood of engaging in objective binge eating. CONCLUSIONS The results revealed significant sex and sexual orientation differences of ED behaviors. The study suggests that adolescents is a period of sexuality development and could be critical for understanding adolescents' eating behaviors. It is important to guide adolescents to healthy eating during their development and considerations should be made by clinicians when creating interventions for ED behaviors among the different sex and sexual orientation groups.
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Affiliation(s)
- Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, South China Normal University, Guangzhou, China.,Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Zhihao Ma
- Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Nanjing, 210023, China
| | - Su Lu
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Zhizhou Duan
- Preventive Health Service, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, Jiangxi, China
| | - Amanda Wilson
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Yinwei Jia
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou, China
| | - Yong Yang
- Suzhou Guangji Hospital, Affiliated Guangji Hospital of Soochow University, Soochow University, Suzhou, China.
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, No.30, Shuangqing Road, Haidian District, Beijing, China. .,Institute for Healthy China, Tsinghua University, Beijing, China.
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Diaz-Marsa M, Pemau A, de la Torre-Luque A, Vaz-Leal F, Rojo-Moreno L, Beato-Fernandez L, Graell M, Carrasco-Diaz A, Carrasco JL. Executive dysfunction in eating disorders: Relationship with clinical features. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110649. [PMID: 36181959 DOI: 10.1016/j.pnpbp.2022.110649] [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: 03/22/2022] [Revised: 09/09/2022] [Accepted: 09/25/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Eating disorders (ED) are severe mental disorders that may result in significant functional impairment and disability. Neuropsychological studies have consistently found impaired executive function (EF) among ED patients. EF is particularly involved in fundamental skills of daily living and in behavioral and emotional regulation. In this study, impairment of executive functioning is investigated in patients with eating disorders and the associations with clinical features and clinical subtypes are analyzed. METHOD 75 female patients (m = 22.01 years, sd = 9.15) with eating disorder (43 restrictive anorexia, 30 binge-eating anorexia and 13 bulimia nervosa) and 37 healthy controls (m = 18.54 years, sd = 4.21) were included in the study. An extensive assessment of executive function domains (verbal fluency, set shifting, attention span, selective attention, working memory, inhibitory control and processing speed) was carried out in both groups. Clinical scales for food intake restriction, binge-eating/purging, depression, anxiety and impulsivity were also administered and correlated with scores on executive function tests. RESULTS Patients with an ED had significantly lower scores than healthy controls in performance of several executive function tests, particularly in set shifting, interference control and processing speed (p < .01, in all three domains). Executive function impairment was related to anxious, depressive and eating disorder symptoms (p < .05), regardless of clinical subtype. CONCLUSIONS Executive function impairment in eating disorders is associated with greater ED symptomatic severity and might involve a negative treatment outcome. Therefore, cognitive remediation techniques should probably be considered in a number of severe patients with ED.
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Affiliation(s)
- Marina Diaz-Marsa
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Hospital Clínico San Carlos, Spain
| | - Andres Pemau
- Faculty of Psychology, Universidad Complutense de Madrid, Spain.
| | - Alejandro de la Torre-Luque
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain
| | | | | | | | - Montserrat Graell
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; Hospital Universitario Niño Jesus, Spain
| | | | - Jose Luis Carrasco
- Centre for Biomedical Research in Mental Health (CIBERSAM), Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Hospital Clínico San Carlos, Spain
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13
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Robison M, Rogers ML, Robertson L, Duffy ME, Manwaring J, Riddle M, Rienecke RD, Le Grange D, Duffy A, Plotkin M, Blalock DV, Mehler PS, Joiner TE. Avoidant restrictive food intake disorder and suicidal ideation. Psychiatry Res 2022; 317:114925. [PMID: 37732866 DOI: 10.1016/j.psychres.2022.114925] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 11/28/2022]
Abstract
Most DSM-5 eating disorder diagnoses are associated with elevated suicide risk; however, little is known about the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) and suicidal ideation. The aim of the current study was to examine suicidal ideation within an adult ARFID sample. Patients with eating disorders (N = 936), some of whom met criteria for a current DSM-5 diagnosis of ARFID (n = 79), completed the Beck Depression Inventory II Item 9, regarding suicidal ideation. The study was conducted within an eating disorder treatment facility that offers inpatient, residential, partial hospitalization program, and intensive outpatient levels of care. Findings suggest no significant pairwise differences in suicidal ideation prevalence between participants with ARFID and those with any other ED diagnosis. Thorough screening for suicidal thoughts and risk among those with ARFID is warranted at all levels of care. We suggest that future research expand upon this work in a larger adult ARFID sample.
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Affiliation(s)
- Morgan Robison
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA.
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Lee Robertson
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
| | - Jamie Manwaring
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Megan Riddle
- ACUTE at Denver Health, Denver, CO, USA; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco School of Medicine, San Francisco, CA, USA; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL (Emeritus), USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center and Pathlight Mood and Anxiety Center, Denver, CO, USA; Department of Internal Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, 616 Wilson Ave, Apt A, Tallahassee, FL 32303, USA
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14
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Tural U, Iosifescu DV. Adiponectin in anorexia nervosa and its modifiers: A meta-regression study. Int J Eat Disord 2022; 55:1279-1290. [PMID: 35689560 DOI: 10.1002/eat.23753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Adiponectin, which is secreted from adipose tissue, is a protein hormone. Although a large body of studies have found that circulating adiponectin levels increase in anorexia nervosa (AN) and caloric restriction, the effect of subtypes of AN and modifiers of adiponectin in AN are not yet known. METHODS A systematic search of electronic databases was performed using the search terms "adiponectin," "anorexia nervosa," and "eating disorder" up to January 2021. All studies published in peer-reviewed journals, which included cases and control groups, were selected. The main outcome was the pooled standardized mean difference (SMD) in adiponectin levels between cases and controls, using the random-effects model. Modifiers of SMD were tested via meta-regression. Heterogeneity and publication bias were evaluated. RESULTS Thirty-four studies met all eligibility criteria. The total sample of AN participants (Hedges' g = .765, p < .0001), and specifically the binge-eating/purging (Hedges' g = 1.211, p < .00001) and restrictive subtypes (Hedges' g = .913, p < .00001) of AN have increased adiponectin plasma levels compared with healthy controls. Meta-regression determined that insulin, IGF-1, BMI, triglyceride, resistin, glucose, IL-6 levels are significant modifiers of adiponectin levels. DISCUSSION Compared with controls, adiponectin levels are higher in AN overall, and specifically in the binge-eating/purging and the restrictive AN subtypes. Many of metabolic parameters of glucose metabolism and pro-inflammatory molecules modify the relationship between AN and adiponectin levels. Adipose tissue is important to maintain metabolic stability. PUBLIC SIGNIFICANCE Anorexia nervosa is a psychiatric disorder associated with a severe decrease in body weight and multiple metabolic abnormalities, including an increase in the hormone adiponectin. In this paper, we used meta-analysis, a powerful statistical method, to aggregate data from 34 rigorously selected research reports. This enabled us to understand the value of adiponectin to differentiate clinical subtypes of anorexia nervosa and the relations between adiponectin and other important metabolic parameters.
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Affiliation(s)
- Umit Tural
- Clinical Research Division, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Dan V Iosifescu
- Clinical Research Division, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA.,Psychiatry Department, New York University School of Medicine, New York, New York, USA
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15
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Mereu A, Fantoni T, Caini S, Monzali F, Roselli E, Taddei S, Lucarelli S, Pisano T. Suicidality in adolescents with onset of anorexia nervosa. Eat Weight Disord 2022; 27:2447-2457. [PMID: 35277848 DOI: 10.1007/s40519-022-01384-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The mortality rate in patients with anorexia nervosa (AN) is 5 to 10 times higher than in general population and, suicide is one of the main causes of death. We evaluated the prevalence of suicidality (ideation, self-injurious behaviour, suicidal attempts) in 100 adolescents with onset of AN and we explored the correlation between suicidality, severity of AN symptoms and psychiatric comorbidity. METHODS We subdivided AN patients into restrictive (R-AN; n = 66) and restrictive atypical (A-AN; n = 34), according to the European Guidelines criteria. Assessment was performed using the eating disorder inventory 3rd version, the schedule for affective disorders and schizophrenia for school-age children-present and lifetime version interview, and the Columbia-suicide severity rating scale. Fisher's exact test and Mann-Whitney test (with correction for multiple testing) were used to compare the distribution of categorical and continuous variables between R-AN and A-AN patients, and between patients with vs. without suicidal behaviours. RESULTS Twenty-seven patients (27%) presented suicidality as clinical feature, expressed as at least one of the following: suicidal ideation (24%), self-cutting (19%), and suicidal attempt (6%). Patients with suicidality showed greater severity of psychiatric symptoms related to AN psychopathology and presented psychiatric comorbidity, especially depression, more often than patients who did not reported suicidality (70,4% vs 29,6%). No significant differences in terms of suicidal behaviours and AN-specific psychopathology were found between R-AN and A-AN. CONCLUSIONS Suicidality in adolescent patients with R-AN and A-AN seems to be related to ED symptoms. These data highlight the importance of screening for suicidality among adolescents at onset of AN, and confirms that A-AN should not be considered a milder disease. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies. (NB: Dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Affiliation(s)
- Alberta Mereu
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Teresa Fantoni
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Francesca Monzali
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Elena Roselli
- Dietetics Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Silvia Taddei
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
| | | | - Tiziana Pisano
- Child and Adolescent Psychiatry, Neuroscience Department, Children's Hospital A. Meyer-University of Florence, Via Cosimo il Vecchio 2, 50139, Florence, Italy
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16
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Kambanis PE, Harshman SG, Kuhnle MC, Kahn DL, Dreier MJ, Hauser K, Slattery M, Becker KR, Breithaupt L, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Differential comorbidity profiles in avoidant/restrictive food intake disorder and anorexia nervosa: Does age play a role? Int J Eat Disord 2022; 55:1397-1403. [PMID: 35848094 DOI: 10.1002/eat.23777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research comparing psychiatric comorbidities between individuals with avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) is limited. ARFID often develops in childhood, whereas AN typically develops in adolescence or young adulthood. Understanding how age may impact differential psychological comorbidity profiles is important to inform etiological conceptualization, differential diagnosis, and treatment planning. We aimed to compare the lifetime frequency of psychiatric comorbidities and suicidality between females with ARFID (n = 51) and AN (n = 40), investigating the role of age as a covariate. METHOD We used structured interviews to assess the comparative frequency of psychiatric comorbidities/suicidality. RESULTS When age was omitted from analyses, females with ARFID had a lower frequency of depressive disorders and suicidality compared to AN. Adjusting for age, only suicidality differed between groups. DISCUSSION This is the first study to compare comorbidities in a similar number of individuals with ARFID and AN, and a structured clinical interview to confer ARFID and comorbidities, covarying for age, and the first to compare suicidality. Although suicidality is at least three times less common in ARFID than AN, observed differences in other psychiatric comorbidities may reflect ARFID's relatively younger age of presentation compared to AN. PUBLIC SIGNIFICANCE Our results highlight that, with the exception of suicidality, which was three times less common in ARFID than AN irrespective of age, observed differences in psychiatric comorbidities in clinical practice may reflect ARFID's younger age at clinical presentation compared to AN.
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Affiliation(s)
- P Evelyna Kambanis
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie G Harshman
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Megan C Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Danielle L Kahn
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Melissa J Dreier
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kristine Hauser
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhusmita Misra
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, University of Geneva, Geneva, Switzerland.,Department of Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.,GOSH Institute, University College London, London, UK
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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17
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Breithaupt L, Kahn DL, Slattery M, Plessow F, Mancuso C, Izquierdo A, Dreier MJ, Becker K, Franko DL, Thomas JJ, Holsen L, Lawson EA, Misra M, Eddy KT. Eighteen-month Course and Outcome of Adolescent Restrictive Eating Disorders: Persistence, Crossover, and Recovery. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:715-725. [PMID: 35476589 PMCID: PMC9444807 DOI: 10.1080/15374416.2022.2034634] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE In adults, low-weight restrictive eating disorders, including anorexia nervosa (AN), are marked by chronicity and diagnostic crossover from restricting to binge-eating/purging. Less is known about the naturalistic course of these eating disorders in adolescents, particularly atypical AN (atyp-AN) and avoidant/restrictive food intake disorder (ARFID). To inform nosology of low-weight restrictive eating disorders in adolescents, we examined outcomes including persistence, crossover, and recovery in an 18-month observational study. METHOD We assessed 82 women (ages 10-23 years) with low-weight eating disorders including AN (n = 40; 29 restricting, 11 binge-eating/purging), atyp-AN (n = 26; 19 restricting, seven binge-eating/purging), and ARFID (n = 16) at baseline, nine months (9 M; 75% retention), and 18 months (18 M; 73% retention) via semi-structured interviews. First-order Markov modeling was used to determine diagnostic persistence, crossover, and recovery occurring at 9 M or 18 M. RESULTS Among all diagnoses, the likelihood of remaining stable within a given diagnosis was greater than that of transitioning, with the greatest probability among ARFID (0.84) and AN-R (0.62). Persistence of BP and atypical presentations at follow-up periods was less stable (AN-BP probability 0.40; atyp-AN-R probability 0.48; atyp-AN-BP probability, 0.50). Crossover from binge-eating/purging to restricting occurred 72% of the time; crossover from restricting to binge-eating/purging occurred 23% of the time. The likelihood of stable recovery (e.g., recovery at both 9 M and 18 M) was between 0.00 and 0.36. CONCLUSION Across groups, intake diagnosis persisted in about two-thirds, and recovery was infrequent, underscoring the urgent need for innovative treatment approaches to these illnesses. Frequent crossover between AN and atyp-AN supports continuity between typical and atypical presentations, whereas no crossover to ARFID supports its distinction.
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Affiliation(s)
- Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Danielle L. Kahn
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Franziska Plessow
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alyssa Izquierdo
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Melissa J. Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Laura Holsen
- Harvard Medical School, Boston, MA, USA
- Division of Women’s Health, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Lawson
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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18
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Brown ML, Levinson CA. Core eating disorder fears: Prevalence and differences in eating disorder fears across eating disorder diagnoses. Int J Eat Disord 2022; 55:956-965. [PMID: 35567750 DOI: 10.1002/eat.23728] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Fear and anxiety are key maintaining factors for eating disorder (ED) pathology. Maladaptive fears lead to ED behaviors and avoidance, which provide temporary relief, but ultimately reinforce the fear and contribute to a cycle that maintains the ED. To date, fears of food and weight gain are the most explored fears underlying ED pathology. However, recently other important ED fears have been identified, including fears of social consequences and personal consequences. METHOD The current study (N = 229 individuals with an ED) aimed to better characterize ED fears. Specifically, this study examined which ED fears were most endorsed across and within ED diagnoses, and if there were differences in ED fears by diagnosis and by weight status. RESULTS Overall, fear of gaining weight was the most frequently endorsed fear, followed by fear of food, and fear of judgment. Individuals with anorexia nervosa (AN) most frequently endorsed fear of food, individuals with atypical AN and bulimia nervosa: fear of gaining weight, and those with other specified feeding and eating disorder: fear of judgment. Limited differences were found between diagnoses. When examining by weight category, participants with underweight most frequently endorsed fear of food, participants with normal weight: fear of gaining weight, and participants with overweight and obesity: fear of judgment. DISCUSSION These findings suggest ED fears are heterogenous. Given such high heterogeneity, this work highlights the importance of assessing for specific ED fears at the beginning of treatment, which could be used to deliver personalized exposure treatment. PUBLIC SIGNIFICANCE STATEMENT Eating disorders (EDs) are serious mental illnesses with high rates of medical and psychiatric comorbidities. Fear plays an important role in the development and maintenance of EDs. The present study found fear of food, weight gain, and judgment are the most frequently endorsed fears for individuals with EDs and found few differences in fears based on ED diagnosis. These findings highlight the importance of assessing individuals' specific ED fears for treatment.
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Affiliation(s)
- Mackenzie L Brown
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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19
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Avci D, Kilic M, Akgul Gundogdu N. Relationship between suicide risk, and violence tendency and eating attitude in working and non-working adolescents: a comparative study. PSYCHOL HEALTH MED 2022; 27:626-637. [PMID: 34014774 DOI: 10.1080/13548506.2021.1921230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although adolescent suicide rates increase significantly, the suicide risk and associated factors in working adolescents is generally neglected. In the present study, it was aimed to determine suicide risk and related factors such as violence tendency and eating attitude in working and non-working adolescents. This case-control study was conducted with 325 adolescents (161 working adolescents, 164 non-working adolescents) between November 2018 and January 2019, in Turkey. Data were collected using the Personal Information Form, Suicide Probability Scale, Violence Tendency Scale and Eating Attitude Test. In the study, the suicide risk was significantly higher in working adolescents (80.79 ± 29.99) than in non-working adolescents (71.90 ± 26.46). Also, working adolescents were determined to be at more risk in terms of violence tendency, eating disorder and substance use than were non-working adolescents. According to linear regression analysis, sex, mother's attitude, presence of a physical or mental illness, alcohol use, violence tendency and eating attitude were statistically significant predictive factors of suicide risk in working adolescents. Researchers, healthcare professionals, educators and policymakers have important responsibilities to improve the mental health of working adolescents.
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Affiliation(s)
- Dilek Avci
- Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Mahmut Kilic
- Faculty of Medicine, Bozok University, Yozgat, Turkey
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20
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Shahnaz A, Klonsky ED. Clarifying the association of eating disorder features to suicide ideation and attempts. J Clin Psychol 2021; 77:2965-2977. [PMID: 34668573 DOI: 10.1002/jclp.23266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/01/2021] [Accepted: 10/06/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We examine the relationships of eight eating disorder (ED) features to histories of suicide ideation and suicide attempts. METHOD Participants were 387 adults (62% female, mean age = 36 years) recruited via an online platform, and oversampled for the presence of ED features, who completed standardized self-report measures of study variables. RESULTS Different ED features predicted suicide ideation versus attempts. Specifically, Restrictive Eating (d = 0.44), Purging (d = 0.30), and Body Dissatisfaction (d = 0.27) were higher among ideators compared to nonsuicidal participants. In contrast, Muscle Building (d = 0.31), Excessive Exercise (d = 0.26), Cognitive Restraint (d = 0.23), and Restrictive Eating (d = 0.20) were higher among attempters compared to ideators-however, we note that the p-values for these effects range between 0.02 and 0.04 and it is unclear if they would replicate. Independent replication is important. CONCLUSION Findings have implications for the conceptualization of suicide risk in individuals with EDs.
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Affiliation(s)
- Arezoo Shahnaz
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Wang SB, Fox KR, Boccagno C, Hooley JM, Mair P, Nock MK, Haynos AF. Functional assessment of restrictive eating: A three-study clinically heterogeneous and transdiagnostic investigation. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:761-774. [PMID: 34780230 PMCID: PMC8597895 DOI: 10.1037/abn0000700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Restrictive eating is common and associated with negative psychological outcomes across the life span and eating disorder (ED) severity levels. Little is known about functional processes that maintain restriction, especially outside of narrow diagnostic categories (e.g., anorexia nervosa). Here, we extend research on operant four-function models (identifying automatic negative, automatic positive, social negative, and social positive reinforcement functions) that have previously been applied to nonsuicidal self-injury (NSSI), binge eating, and purging to restricting. We assessed restrictive eating functions in three samples: clinically heterogeneous adolescents (Study 1: N = 457), transdiagnostic adults (Study 2: N = 145), and adults with acute or recently weight-restored anorexia nervosa (Study 3: N = 45). Study 1 indicated the four-function model was a good fit for restricting (root mean square error of approximation [RMSEA] = .06, Tucker-Lewis index [TLI] = .88). This factor structure replicated in Study 2 (comparative fit index [CFI] = .97, RMSEA = .07, TLI = .97, standardized root mean square residual [SRMR] = .09). Unlike NSSI, binge eating, and purging, which have been found to primarily serve automatic negative reinforcement functions, all three present studies found automatic positive reinforcement was most highly endorsed (by up to 85% of participants). In Studies 1 and 3, automatic functions were associated with poorer emotion regulation (ps < .05). In Study 1, social functions were associated with less social support (ps < .001). Across studies, automatic functions were associated with greater restriction ps < .05). Functions varied slightly by ED diagnosis. Across ED presentation, severity, and developmental stage, restrictive eating may be largely maintained by automatic positive reinforcement, with some variability across presentations. Continued examination of restrictive eating functions will establish processes that maintain restriction, allowing more precise treatment targeting for these problematic behaviors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Kathryn R. Fox
- Department of Psychology, University of Denver, Denver, CO
| | | | - Jill M. Hooley
- Department of Psychology, Harvard University, Cambridge, MA
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA
| | | | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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22
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Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety. J Clin Med 2021; 10:jcm10174027. [PMID: 34501475 PMCID: PMC8432476 DOI: 10.3390/jcm10174027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022] Open
Abstract
In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety.
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23
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Hunt RA, Levinson CA. Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors. Behav Ther 2021; 52:1137-1144. [PMID: 34452668 DOI: 10.1016/j.beth.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one's own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.
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24
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Becker KR, Mancuso C, Dreier MJ, Asanza E, Breithaupt L, Slattery M, Plessow F, Micali N, Thomas JJ, Eddy KT, Misra M, Lawson EA. Ghrelin and PYY in low-weight females with avoidant/restrictive food intake disorder compared to anorexia nervosa and healthy controls. Psychoneuroendocrinology 2021; 129:105243. [PMID: 34049199 PMCID: PMC8363304 DOI: 10.1016/j.psyneuen.2021.105243] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) is characterized by restrictive eating and failure to meet nutritional needs but is distinct from anorexia nervosa (AN) because restriction is not motivated by weight/shape concerns. We examined levels of orexigenic ghrelin and anorexigenic peptide YY (PYY) in young females with ARFID, AN and healthy controls (HC). METHODS 94 females (22 low-weight ARFID, 40 typical/atypical AN, and 32 HC ages 10-22 years) underwent fasting blood draws for total ghrelin and total PYY. A subset also provided blood 30, 60 and 120 min after a standardized meal. RESULTS Females with ARFID ate less than those with AN or HC (ps<0.012); were younger (14.4 ± 3.2 years) than those with AN (18.9 ± 3.1 years) and HC (17.4 ± 3.1 years) (ps<0.003) and at a lower Tanner stage (3.1 ± 1.5) than AN (4.5 ± 1.1;) and HC (4.4 ± 1.1; ps<0.005), but did not differ in BMI percentiles or BMI Z-scores from AN (ps>0.44). Fasting and postprandial ghrelin were lower in ARFID versus AN (ps≤.015), but not HC (ps≥0.62). Fasting and postprandial PYY did not differ between ARFID versus AN or HC (ps≥0.13); ARFID did not demonstrate the sustained high PYY levels post-meal observed in those with AN and HC. Secondary analyses controlling age or Tanner stage and calories consumed showed similar results. Exploratory analyses suggest that the timing of the PYY peak in ARFID is earlier than HC, showing a peak PYY level 30 min post-meal (p = .037). CONCLUSIONS ARFID and AN appear to have distinct patterns of secretion of gut-derived appetite-regulating hormones that may aid in differential diagnosis and provide new treatment targets.
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Affiliation(s)
- Kendra R Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
| | - Christopher Mancuso
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Melissa J Dreier
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America
| | - Elisa Asanza
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Franziska Plessow
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Switzerland; Department of Pediatrics Gynecology and Obstetrics, University of Geneva, Switzerland; GOSH Institute of Child Health, University College London, United Kingdom
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States of America; Department of Pediatrics, Harvard Medical School, Boston, MA, United States of America
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United States of America; Department of Medicine, Harvard Medical School, Boston, MA, United States of America
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25
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Izquierdo AM, Fischer S. Nonsuicidal self-injury and suicide attempts are uniquely associated with eating disorder pathology and behaviors over and above negative urgency. Eat Behav 2021; 41:101483. [PMID: 33631491 DOI: 10.1016/j.eatbeh.2021.101483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) and suicidal behaviors are prevalent in individuals with eating disorders (EDs). Negative urgency (NU; the tendency to act rashly when distressed) is a common correlate of NSSI, suicide, and ED pathology. The aim of this study was to examine whether lifetime history of NSSI and suicide attempts (SA) contributed unique variance to current ED pathology after controlling for the variance accounted for by NU. Undergraduate students (N = 871; 25.4% male) self-reported lifetime SA and completed a modified Deliberate Self-Harm Inventory to assess lifetime NSSI, the Eating Disorder Examination-Questionnaire (EDE-Q), and the NU scale of the UPPS Impulsive Behavior Scale-Revised. Hierarchical regression analyses indicated that lifetime NSSI but not SA was associated with higher Global EDE-Q scores (NSSI: β = 0.11, p < .001; SA: β = 0.007, p > .05) and restrictive eating (NSSI: β = 0.10, p < .001; SA: β = 0.05, p > .05) after controlling for NU. In addition, lifetime NSSI (OR = 2.98, 95% CI = 1.54-5.76) and SA (OR = 5.68, 95% CI = 1.90-17.02) were significantly associated with past month purging but not binge eating after controlling for NU. Results suggest that NSSI is uniquely associated with increased likelihood of past month ED pathology in a nonclinical sample. Study limitations included low rates of behavioral problems in the sample and no measures of suicidal ideation. Clinicians who treat EDs should regularly assess NSSI and suicidal ideation.
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Affiliation(s)
- Alyssa M Izquierdo
- George Mason University, Department of Psychology, Fairfax, VA, United States.
| | - Sarah Fischer
- George Mason University, Department of Psychology, Fairfax, VA, United States
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26
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Smith DMY, Lipson SM, Wang SB, Fox KR. Online Methods in Adolescent Self-Injury Research: Challenges and Recommendations. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 51:143-154. [DOI: 10.1080/15374416.2021.1875325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Diana M. Y. Smith
- Department of Psychology, University of California San Diego Medical School
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27
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Kambanis PE, Kuhnle MC, Wons OB, Jo JH, Keshishian AC, Hauser K, Becker KR, Franko DL, Misra M, Micali N, Lawson EA, Eddy KT, Thomas JJ. Prevalence and correlates of psychiatric comorbidities in children and adolescents with full and subthreshold avoidant/restrictive food intake disorder. Int J Eat Disord 2020; 53:256-265. [PMID: 31702051 PMCID: PMC7028456 DOI: 10.1002/eat.23191] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We aimed to characterize the current and lifetime prevalence of comorbid psychiatric diagnoses and suicidality in treatment- and nontreatment-seeking individuals with full and subthreshold avoidant/restrictive food intake disorder (ARFID). We also sought to examine unique associations between the three DSM-5 ARFID profiles (i.e., sensory sensitivity, fear of aversive consequences, and lack of interest in food or eating) and specific categories of psychiatric diagnoses and suicidality. METHOD We conducted structured clinical interviews with 74 children and adolescents with full or sub threshold ARFID to assess the presence of comorbid psychiatric diagnoses, suicidality, and the severity of each of the three ARFID profiles. RESULTS Nearly half of the sample (45%) met criteria for a current comorbid psychiatric diagnosis, and over half (53%) met criteria for a lifetime comorbid diagnosis. A total of 8% endorsed current suicidality and 14% endorsed lifetime suicidality. Severity in the sensory sensitivity profile was uniquely associated with greater odds of comorbid disorders in the neurodevelopmental, disruptive, and conduct disorders category; the anxiety, obsessive-compulsive, and trauma-related disorders category; and the depressive and bipolar-related disorders category. Severity in the fear of aversive consequences profile was associated with greater odds of disorders in the anxiety, obsessive-compulsive, and trauma-related disorders category. DISCUSSION Our findings underscore the severity of psychopathology among individuals with ARFID and related presentations, and also highlight the potential that shared psychopathology between specific ARFID profiles and other psychiatric disorders represent transdiagnostic constructs (e.g., avoidant behavior) that may be relevant treatment targets.
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Affiliation(s)
- P. Evelyna Kambanis
- Department of Psychology, University of Wyoming, Laramie, Wyoming, USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA
| | - Megan C. Kuhnle
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia B. Wons
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jenny H. Jo
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ani C. Keshishian
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA
| | - Kristine Hauser
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Department of Applied Psychology, Northeastern University, Massachusetts, USA
| | - Madhu Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Pediatric Endocrinology, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nadia Micali
- Département universitaire de psychiatrie, Université de Genève, 1211 Genève, Switzerland.,Department de Pediatrie, Gynecologie, Obstretrique, Université de Genève, 1211 Genève, Switzerland
| | - Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, USA,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA,Corresponding author: Jennifer J. Thomas, Ph.D., Eating Disorders Clinical & Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114; Phone: (617) 643-6306;
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28
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Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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