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Torres S, Vieira AI, Vieira FM, Miller KM, Guerra MP, Lencastre L, Reis AC, Timóteo S, Nunes P, Barbosa MR. A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa. Nutrients 2024; 16:1787. [PMID: 38892718 PMCID: PMC11174434 DOI: 10.3390/nu16111787] [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: 05/13/2024] [Revised: 05/31/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Isabel Vieira
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Filipa Mucha Vieira
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Kylee M. Miller
- Child Development and Rehabilitation Center (CDRC), Institute on Development & Disability, Oregon Health & Science University, Portland, OR 97403, USA;
| | - Marina Prista Guerra
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Leonor Lencastre
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
| | - Ana Catarina Reis
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Sertório Timóteo
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Patrícia Nunes
- Department of Psychiatry, Centro Hospitalar de São João, 4200-319 Porto, Portugal; (A.C.R.); (S.T.); (P.N.)
| | - Maria Raquel Barbosa
- Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal; (F.M.V.); (M.P.G.); (L.L.); (M.R.B.)
- Center for Psychology at the University of Porto (CPUP), University of Porto, 4200-135 Porto, Portugal;
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Marazzi F, Orlandi M, De Giorgis V, Borgatti R, Mensi MM. The impact of family alexithymia on the severity of restrictive eating disorders in adolescent patients. Child Adolesc Psychiatry Ment Health 2023; 17:139. [PMID: 38115116 PMCID: PMC10731864 DOI: 10.1186/s13034-023-00692-x] [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: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Alexithymia is the inability to identify and describe one's own emotions. Adolescents who suffer from Restrictive Eating Disorders (REDs) show a higher prevalence of alexithymia than the general population. METHODS The study explored the correlation between levels of alexithymia in mothers, fathers, and adolescents affected by REDs and patients' ability to recognize their emotions. The study also aimed to evaluate if patients' emotional distress can significantly impact the severity of their disorder and functioning measured by the Clinical Global Impression Scale - Severity (CGI-S) and the Children's Global Assessment Scale (CGAS). We enrolled 67 families of adolescents affected by REDs. Parents and patients' levels of alexithymia were assessed through the Toronto Alexithymia Scale (TAS-20). Spearman's correlation shows a statistically significant correlation between mothers and patients' levels of alexithymia. RESULTS Our findings also suggest that fathers and mothers' TAS scores correlate with each other. However, there is no statistically significant relationship between the influence of the TAS scores of fathers and sons/daughters. CONCLUSIONS In conclusion, mothers' level of alexithymia could influence both fathers and patients' difficulty in identifying and describing their own emotions. This relationship can be investigated further when considering externally oriented thinking. However, the severity of the disease and overall functioning do not appear to be affected by patients' levels of alexithymia.
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Affiliation(s)
- Francesca Marazzi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Marika Orlandi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Valentina De Giorgis
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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Saure E, Raevuori A, Laasonen M, Lepistö-Paisley T. Emotion recognition, alexithymia, empathy, and emotion regulation in women with anorexia nervosa. Eat Weight Disord 2022; 27:3587-3597. [PMID: 36258146 PMCID: PMC9803740 DOI: 10.1007/s40519-022-01496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is associated with challenges in recognizing, understanding, and interpreting one's own and other's emotional states, feelings, and thoughts. It is unknown whether difficulties in emotion processing occur independently of common comorbid symptoms of AN and predict acute eating disorder characteristics. We aimed to examine emotion recognition, alexithymia, emotion regulation, and empathy in individuals with AN and to assess whether these predict eating disorder symptoms independently from comorbid symptoms. METHODS Participants included 42 women with AN and 40 healthy control (HC) women between 18-30 years. Basic and complex emotion recognition was assessed with face photos and video clips. Alexithymia, empathy, emotion regulation, and comorbid symptoms (anxiety, depressive, and obsessive-compulsive symptoms and ASD traits) were assessed with self-assessment questionnaires. RESULTS Participants with AN exhibited difficulties in basic and complex emotion recognition, as well as increased alexithymia, decreased empathy, and challenges in emotion regulation when compared to HCs. After controlling for comorbid symptoms, differences remained only in complex emotion recognition. Challenges in emotion recognition were associated with lower body mass index, and increased alexithymia was associated with increased eating disorder symptoms. Increased challenges in emotion regulation were associated with a shorter duration of illness, higher body mass index, and increased eating disorder symptoms. CONCLUSIONS Participants with AN displayed widespread deficit in emotion processing, but only challenges in complex emotion recognition occurred independently from comorbid symptoms. Deficits in emotion processing may contribute to the illness severity and thus could be an important treatment target. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland.
- BABA Center and Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Anu Raevuori
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Family Dysfunctional Interactive Patterns and Alexithymia in Adolescent Patients with Restrictive Eating Disorders. CHILDREN 2022; 9:children9071038. [PMID: 35884021 PMCID: PMC9323591 DOI: 10.3390/children9071038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
Adolescents diagnosed with Restrictive Eating Disorders (REDs) are at risk for alexithymia. REDs patients’ families show dysfunctional interactive patterns, and childhood family environment influences alexithymia development. We aimed to assess the relationship between family dysfunctional interactive patterns and patients’ alexithymia in a sample of adolescents diagnosed with REDs. Forty-five patients and their parents were enrolled. They participated in the clinical version of the Lausanne Triadic Play (LTPc), a standardized observational procedure to assess family functioning. We used the self-report questionnaire Toronto Alexithymia Scale (TAS-20) to assess patients’ alexithymia. The TAS-20 provides a multi-factorial measure of patients’ alexithymia: Difficulty in Identifying Feelings, DIF; Difficulty in Describing Feelings, DDF; Externally-oriented Thinking, EOT) and a total (TOT) score. DDF and EOT scores were significantly higher than DIF score. Patients’ families showed dysfunctional interactive patterns, with a predominance of collusive alliance. Patients from families characterized by collusive alliance had higher TOT scores compared to counterparts from families exhibiting a different interactive dysfunctional pattern. In families characterized by a collusive triadic alliance, the dysfunctional interactive pattern was linked with the risk of alexithymia in patients with REDs. Assessment of family relationships should be included in the routine consultation with adolescent patients affected by REDs.
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The Florence Emotional Eating Drive (FEED): a validation study of a self-report questionnaire for emotional eating. Eat Weight Disord 2022; 27:751-759. [PMID: 34043180 PMCID: PMC8933357 DOI: 10.1007/s40519-021-01216-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Emotional eating is a trans-diagnostic dimension in eating disorders and is present in many other conditions that could affect eating attitudes. At present, there is no instrument that measures emotional eating evaluating both the intensity and the frequency of emotion-induced desire to eat. The aim of the study was the validation of the Florence Emotional Eating Drive (FEED). METHODS A sample of healthy volunteers was initially enrolled to explore internal consistency and test-retest reliability. The Emotional Eating Scale (EES), Eating Disorders Evaluation-Questionnaire (EDE-Q), Binge Eating Scale (BES) and Symptom Checklist-90 (SCL-90-R), together with the final version of FEED, were administered to a clinical sample composed by patients with eating disorders, obesity, and type 2 diabetes, to explore the underlying structure of the questionnaire and verify its validity. RESULTS FEED showed excellent internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (r = 0.93). FEED scores were higher in patients with BN and BED than in AN patients, negatively correlated with age and positively with BES and EES. Multiple regression analysis showed that FEED, but not EES, was independently associated with SCL-90-R and EDE-Q scores. CONCLUSION FEED internal consistency and test-retest reliability were excellent. The addition of specific questions on the frequency of behaviours led to a better component structure and robustness compared to EES. A tool that reliably and specifically assesses eating behaviours driven by emotional states may be extremely useful in clinical settings. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Castro TF, Miller K, Araújo MX, Brandão I, Torres S. Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:955-968. [PMID: 34472158 DOI: 10.1002/erv.2858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This 15 years longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term recovery from anorexia nervosa (AN), and its link to anxiety and depression. METHOD Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, emotion regulation difficulties (ER; only assessed in recovery phase), and completed an experimental task to analyse emotional experience. RESULTS In spite of significant improvement in alexithymia, anxiety, and depression with AN recovery, some emotion functioning difficulties did not normalize. The occurrence of comorbid anxiety and depression explained the reduced ability to identify, understand, and accept emotions in long-term recovery (relative to controls), but not the increased global difficulty in using ER strategies, which revealed a more stable nature of deficit. With recovery, negative emotions linked to situations addressing food and body weight are felt more intensely. CONCLUSIONS Managing emotions, especially the negative ones, remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behaviour can serve as an affect regulatory function, increasing the risk of relapse. Emotional education is an important avenue in protecting long-term AN relapse.
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Affiliation(s)
- Telma Fontão Castro
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Kylee Miller
- Department of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Xavier Araújo
- Department of Psychology and Education, University Portucalense, Porto, Portugal.,Department of Psychology, Centro Hospitalar S. João, Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar S. João, Porto, Portugal
| | - Sandra Torres
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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Thomas R, Siliquini R, Hillegers MH, Jansen PW. The association of adverse life events with children's emotional overeating and restrained eating in a population-based cohort. Int J Eat Disord 2020; 53:1709-1718. [PMID: 32702148 PMCID: PMC7589411 DOI: 10.1002/eat.23351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Life adversities are recognized risk factors for eating disorders, in adolescents and adults, but whether such adversities are also associated with particular eating behaviors earlier in life is still unclear. Our aim was to assess whether experiencing adverse life events in early childhood is associated with emotional overeating and restrained eating at age 10. METHODS Emotional overeating and restrained eating were assessed in 4,653 10-years-old children using the mother-reported Children's Eating Behavior Questionnaire and Dutch Eating Behavior Questionnaire. Mothers also reported on 24 different life events during childhood, those with moderate or severe impact being categorized as adverse life events. Regression analyses were performed to investigate relationships between adverse life events and eating behaviors in the total sample. RESULTS Adjusted for covariates, adverse life events were associated with more emotional overeating and restrained eating in children (p-values for trend <.01). Specifically, mothers who reported that their child experienced 3+ adverse life events, also reported significantly higher emotional overeating (B = 0.20; 95% confidence interval [CI], 0.06-0.33) and restrained eating (B = 0.21; 95% CI, 0.08-0.33) in their children relative to children who did not experience adverse life events. These results did not differ by sex. DISCUSSION Our results based on mother-reported data suggest that children's experiences of life adversities are associated with emotional overeating and restrained eating at age 10 years. We recommend future prospective studies using multi-informant assessments of both adverse life events and eating behaviors to further describe the nature and developmental course of this relationship.
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Affiliation(s)
- Robin Thomas
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands,Department of Public HealthUniversity of TorinoTorinoItaly
| | | | - Manon H. Hillegers
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands
| | - Pauline W. Jansen
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC‐University Medical CenterRotterdamThe Netherlands,Department of Psychology, Education, and Child StudiesErasmus University RotterdamRotterdamThe Netherlands
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8
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Simonsen CB, Jakobsen AG, Grøntved S, Kjaersdam Telléus G. The mentalization profile in patients with eating disorders: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:311-322. [PMID: 31910059 DOI: 10.1080/08039488.2019.1707869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Context: Patients with eating disorders (EDs) may have a lower mentalization ability. To the best of our knowledge, no meta-analysis has so far addressed the multidimensional mentalization profile within these patients.Objective: To summarize the existing evidence of the mentalization profile and its association with EDs.Data sources: We searched for articles in PsychINFO, Embase and PubMed using the search terms mentalization, reflective function, adult attachment interview, alexithymia, Toronto Alexithymia Scale, eye test, Reading the Mind in the Eyes Test, Theory of Mind, mind-mindedness, mind-blindness, facial expression recognition, metacognition, ED, anorexia nervosa (AN) and bulimia nervosa (BN).Studies included: Quantitative studies including diagnosed patients with an ED, healthy controls (HCs) and relevant test methods.Data synthesis: Forty-four studies were included. Nine studies were eligible for the meta-analysis. Significantly lower mentalization ability about oneself was found in patients with an ED when compared to HCs. Groups were more comparable when dealing with mentalization ability of others. Non-significant but clinically relevant results include a tendency for a lower mentalization ability in patients with AN compared to patients with BN.Conclusion: The mentalization profile is complex and varies across dimensions of mentalization in patients with an ED. Different degrees of mentalization between various EDs were found, implying the necessity for further research on mentalization profiles in different ED diagnoses. The sparse existing literature was a limitation for this meta-analysis, emphasizing that further research on the mentalization profile in patients with EDs is needed.
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Affiliation(s)
- Caroline Bach Simonsen
- Faculty of Psychology, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Simon Grøntved
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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9
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Ralph‐Nearman C, Achee M, Lapidus R, Stewart JL, Filik R. A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism. Brain Behav 2019; 9:e01458. [PMID: 31696674 PMCID: PMC6908865 DOI: 10.1002/brb3.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases. METHOD Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included. RESULTS Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies. CONCLUSIONS Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.
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Affiliation(s)
- Christina Ralph‐Nearman
- Laureate Institute for Brain ResearchTulsaOKUSA
- School of PsychologyUniversity of NottinghamNottinghamUK
| | | | | | - Jennifer L. Stewart
- Laureate Institute for Brain ResearchTulsaOKUSA
- Department of Community MedicineUniversity of TulsaTulsaOKUSA
| | - Ruth Filik
- School of PsychologyUniversity of NottinghamNottinghamUK
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Gramaglia C, Gambaro E, Zeppegno P. Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature. Front Psychiatry 2019; 10:991. [PMID: 32116818 PMCID: PMC7033613 DOI: 10.3389/fpsyt.2019.00991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/13/2019] [Indexed: 01/09/2023] Open
Abstract
Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients' ability to benefit from the adopted interventions. For this reason, in the last years new treatment approaches targeting emotion identification, expression, and regulation have been applied and tested. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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11
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Rotella F, Mannucci E, Gemignani S, Lazzeretti L, Fioravanti G, Ricca V. Emotional eating and temperamental traits in Eating Disorders: A dimensional approach. Psychiatry Res 2018; 264:1-8. [PMID: 29626825 DOI: 10.1016/j.psychres.2018.03.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 02/02/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
Growing evidence shows that temperamental features and emotional dysregulation are linked to Eating Disorders (EDs). Aim of this study was to explore the possible relationship between temperament and emotional eating (EE) from a dimensional standpoint, and the association of specific temperamental dimensions with overeating triggered by specific emotions. We enrolled 253 women with Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Of those, 189 (74.7%), 73 (28.8%), and 80 (31.6%) reported binge eating, purging, or restrictive behaviors, respectively (the categories are not mutually exclusive). Participants completed the Emotional Eating Scale (EES), the Temperament and Character Inventory, the Eating Disorder Examination Questionnaire (EDE-Q) and the Symptom Checklist 90-Revised (SCL-90-R). Higher Persistence scores were found in the Restriction group, while the Binge group reported lower Persistence and higher Novelty Seeking scores. The Purge group showed lower Reward Dependence, Self Directedness and Cooperativeness scores. Patients with Purge also reported lower BMI and higher scores on EDE-Q restriction and eating concern subscales as well as higher scores for all SCL 90-R subscales. Patterns of association between temperamental traits and specific emotions were found in each group. Therefore, some temperamental features could be considered predictors of specific associations between emotions and the tendency to eat.
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Affiliation(s)
- Francesco Rotella
- Psychiatric Unit, Careggi Teaching Hospital, Florence University School of Medicine, Largo Brambilla 3, Florence 50134, Italy.
| | - Edoardo Mannucci
- Diabetes Agency, Careggi Teaching Hospital, Via delle Oblate 4, Florence 50141, Italy
| | - Sara Gemignani
- Department of Health Sciences, Psychiatry Unity, Florence University School of Medicine, Largo Brambilla 3, Florence 50134, Italy
| | - Lisa Lazzeretti
- Department of Health Sciences, Psychiatry Unity, Florence University School of Medicine, Largo Brambilla 3, Florence 50134, Italy
| | - Giulia Fioravanti
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, via di San Salvi 12, Florence 50100, Italy
| | - Valdo Ricca
- Department of Health Sciences, Psychiatry Unity, Florence University School of Medicine, Largo Brambilla 3, Florence 50134, Italy
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12
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Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa. J Clin Psychol Med Settings 2018; 26:33-46. [DOI: 10.1007/s10880-018-9562-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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13
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Fernandes J, Ferreira-Santos F, Miller K, Torres S. Emotional processing in obesity: a systematic review and exploratory meta-analysis. Obes Rev 2018; 19:111-120. [PMID: 29024361 DOI: 10.1111/obr.12607] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022]
Abstract
The role of emotional functioning in the development and maintenance of obesity has been investigated, but the literature is poorly integrated. A systematic review and meta-analysis was performed to explore emotional processing impairments in obesity. PubMed, Web of Knowledge and PsycINFO databases were searched in March 2016, yielding 31 studies comparing emotional processing competencies in individuals with obesity, with or without binge eating disorder (BED), and control groups. Meta-analyses demonstrated that individuals with obesity had higher scores of alexithymia (d = 0.53), difficulty in identifying feelings (d = 0.34) and externally oriented thinking style (d = 0.31), when compared with control groups. On other competencies, patients with obesity, especially those with comorbid BED, reported lower levels of emotional awareness and difficulty in using emotion regulation strategies, namely, reduced cognitive reappraisal and acceptance, and greater suppression of expression. No evidence of impaired ability to recognize emotions in others or verbally express emotions was found. A general emotion-processing deficit in obesity was not supported. Instead, an emotional avoidance style may occur modulating later responses of emotion regulation. Additional research is needed to extend the comprehension of these conclusions and the role of BED in emotional functioning in obesity.
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Affiliation(s)
- J Fernandes
- Centre for Psychology at University of Porto (CPUP), Porto, Portugal
| | - F Ferreira-Santos
- Laboratory of Neuropsychophysiology, University of Porto, Porto, Portugal.,Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - K Miller
- School Psychology, School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Torres
- Centre for Psychology at University of Porto (CPUP), Porto, Portugal.,Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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14
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Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K. Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res 2017; 99:66-81. [PMID: 28712432 PMCID: PMC5986724 DOI: 10.1016/j.jpsychores.2017.06.007] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups. METHOD Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs. RESULTS Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions. CONCLUSION Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.
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Affiliation(s)
- Heather Westwood
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Jess Kerr-Gaffney
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Daniel Stahl
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Biostatistics, London, UK.
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, UK; Ilia State University, Tbilisi, Georgia.
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15
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Gramaglia C, Ressico F, Gambaro E, Palazzolo A, Mazzarino M, Bert F, Siliquini R, Zeppegno P. Alexithymia, empathy, emotion identification and social inference in anorexia nervosa: A case-control study. Eat Behav 2016; 22:46-50. [PMID: 27086047 DOI: 10.1016/j.eatbeh.2016.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/21/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
Abstract
Alexithymia, difficulties in facial emotion recognition, poor socio-relational skills are typical of anorexia nervosa (AN). We assessed patients with AN and healthy controls (HCs) with mixed stimuli: questionnaires (Toronto Alexithymia Scale-TAS, Interpersonal Reactivity Index-IRI), photographs (Facial Emotion Identification Test-FEIT) and dynamic images (The Awareness of Social Inference Test-TASIT). TAS and IRI Personal Distress (PD) were higher in AN than HCs. Few or no differences emerged at the FEIT and TASIT, respectively. Larger effect sizes were found for the TAS results. Despite higher levels of alexithymia, patients with AN seem to properly acknowledge others' emotions while being inhibited in the expression of their own.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Francesca Ressico
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Anna Palazzolo
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | | | - Fabrizio Bert
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Roberta Siliquini
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy; AOU Maggiore della Carità, Corso Mazzini n° 18, 28100, Novara, Italy.
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16
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Sala M, Heard A, Black EA. Emotion-focused treatments for anorexia nervosa: a systematic review of the literature. Eat Weight Disord 2016; 21:147-64. [PMID: 26886827 DOI: 10.1007/s40519-016-0257-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The present review explores emotion-focused treatments for anorexia nervosa (AN). METHODS We conducted a systematic literature search across key databases (PsychINFO, PubMed/Medline, and Web of Science) prior to September 2015. Twenty studies were selected for systematic review. RESULTS The present review found initial evidence supporting the acceptability and feasibility of emotion-focused treatments for AN. Although preliminary results are promising, further controlled studies are necessary to establish the efficacy of emotion-focused treatments for AN. CONCLUSIONS Future controlled trials should compare emotion-focused treatments against each other and against other AN treatments. Future studies should also examine the mechanisms of action for the emotion-focused treatments and treatment moderators.
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA.
| | - Amy Heard
- Department of Psychology, Loyola University Chicago, Chicago, USA
| | - Elizabeth A Black
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA
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17
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Reis MABMN, Horta MP. O papel das emoções na relação confiança-exatidão do testemunho. PSICOLOGIA USP 2015. [DOI: 10.1590/0103-656420140003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
<p>As emoções interferem com a evocação de acontecimentos importantes, afetando a relação confiança-exatidão (C-E) do testemunho. Foi avaliado o impacto das emoções após a visualização de imagens reais de acidentes de trânsito, bem como a sua influência na evocação posterior, tentando verificar como interferiram com a relação confiança-exatidão. A amostra foi constituída por 150 participantes voluntários com experiência de condução que preencheram questionários de autorrelato do impacto emocional e avaliação de detalhes relativos às imagens apresentadas. Os resultados demonstraram a ausência de relação entre confiança e exatidão no testemunho, tendo os participantes aceito com idêntica confiança conteúdos com informação verdadeira e com informação falsa. As emoções não se correlacionaram com a confiança, embora as emoções de nojo, desprezo e tristeza tenham apresentado uma correlação negativa com a exatidão. Os dados obtidos podem ser úteis no contexto forense.</p>
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18
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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19
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Rotella F, Fioravanti G, Godini L, Mannucci E, Faravelli C, Ricca V. Temperament and emotional eating: a crucial relationship in eating disorders. Psychiatry Res 2015; 225:452-7. [PMID: 25537489 DOI: 10.1016/j.psychres.2014.11.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/28/2014] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
Abstract
Specific personality traits are related to Eating Disorders (EDs) specific and general psychopathology. Recent studies suggested that Emotional Eating (EE) is a common dimension in all EDs, irrespective of binge eating. The present study was aimed to explore the relationship of temperamental features with EE and eating symptomatology in a sample of EDs patients, adjusting for general psychopathology. One hundred and sixty six female patients were enrolled at the Eating Disorders Outpatient Clinic of the Careggi Teaching-Hospital of Florence. Participants completed the emotional eating scale, the temperament and character inventory, the eating disorder examination questionnaire and the symptom checklist 90-revised. Novelty seeking and self directedness showed significant correlations with EE after adjustment for general psychopathology. Patients with binge eating displayed significant associations between EE and novelty seeking and self directedness. Among patients without binge eating, no significant correlation between EE and temperamental features was observed. Specific temperamental features are associated to EE in EDs. A clear, different pattern of association in patients with different eating attitudes and behavior was found. Considering that treatments of EDs are largely based on psychotherapeutic interventions, focused on emotions and cognitions, the present data provide some hints which could be helpful for the development of more appropriate psychotherapeutic strategies.
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Affiliation(s)
- Francesco Rotella
- Psychiatric Unit, Careggi Teaching Hospital, Florence University School of Medicine, Largo Brambilla 3, 50134 Florence, Italy.
| | - Giulia Fioravanti
- Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Lucia Godini
- Psychiatric Unit, Careggi Teaching Hospital, Florence University School of Medicine, Largo Brambilla 3, 50134 Florence, Italy.
| | - Edoardo Mannucci
- Diabetes Agency, Careggi Teaching Hospital, Via delle Oblate 4, 50141 Florence, Italy.
| | - Carlo Faravelli
- Department of Health Sciences, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy.
| | - Valdo Ricca
- Psychiatric Unit, Careggi Teaching Hospital, Florence University School of Medicine, Largo Brambilla 3, 50134 Florence, Italy.
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20
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Torres S, Guerra MP, Lencastre L, Miller K, Vieira FM, Roma-Torres A, Brandão I, Costa P. Alexithymia in anorexia nervosa: the mediating role of depression. Psychiatry Res 2015; 225:99-107. [PMID: 25467697 DOI: 10.1016/j.psychres.2014.10.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 07/03/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.
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Affiliation(s)
- Sandra Torres
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal.
| | | | - Leonor Lencastre
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - Kylee Miller
- Carolina Institute for Developmental Disabilities, School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Filipa Mucha Vieira
- Faculty of Psychology and Educational Sciences, University of Porto, Portugal
| | - António Roma-Torres
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Hospital S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B׳s, PT Government Associate Laboratory, Braga/Guimarães, Portugal; Faculty of Psychology and Educational Sciences, University of Porto, Portugal
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21
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Guillén V, Santos B, Muñoz P, Fernández de Corres B, Fernández E, Pérez I, González-Pinto AM, Yllá L, González-Pinto A. Toronto alexithymia scale for patients with eating disorder: [corrected] performance using the non-parametric item response theory. Compr Psychiatry 2014; 55:1285-91. [PMID: 24791683 DOI: 10.1016/j.comppsych.2014.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patient's condition. SUBJECTS AND METHODS We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale. RESULTS We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.
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Affiliation(s)
- Virginia Guillén
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Bizkaia Mental Health Network (RSMB), Basque Health Service-Osakidetza, Spain
| | - Borja Santos
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain
| | - Pedro Muñoz
- Bizkaia Mental Health Network (RSMB), Basque Health Service-Osakidetza, Spain
| | - Blanca Fernández de Corres
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain
| | - Esther Fernández
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain
| | - Isabel Pérez
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain
| | - Ana Ma González-Pinto
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain.
| | - Luis Yllá
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain
| | - Asunción González-Pinto
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain
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22
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Fioravanti G, Castellini G, Lo Sauro C, Ianni S, Montanelli L, Rotella F, Faravelli C, Ricca V. Course and moderators of emotional eating in anorectic and bulimic patients: a follow-up study. Eat Behav 2014; 15:192-6. [PMID: 24854803 DOI: 10.1016/j.eatbeh.2014.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/10/2013] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
Abstract
Emotion dysregulation has been found to be associated with specific eating attitudes and behavior in Eating Disorder (ED) patients. The present study evaluated whether emotional eating profile of ED patients changes over time and the possible effects of a psychotherapeutic intervention on the emotional eating dimension. One hundred and two ED patients (28 with Anorexia Nervosa restricting type [AN-R], 35 with Anorexia Nervosa binge/purging subtype [AN-B/P] and 39 with Bulimia Nervosa [BN]) were evaluated at baseline, at the end of a Cognitive Behavioral Therapy, at 3 and 6 year follow-up. The Structured Clinical Interview for DSM IV Axis I Disorders, the Emotional Eating Scale (EES) and several self-reported questionnaires for eating specific and general psychopathology were applied. A control group of 86 healthy subjects was also studied, in order to compare psychopathological variables at baseline. A significant EES total score reduction was observed among AN-B/P and BN patients, whereas no significant change was found in the AN-R group. Mixed Models analyses showed that a significant effect on EES total score variation was found for cocaine or amphetamine abuse (b = .25; p < .01). Patients who assumed these substances reported no significant EES reduction across time, unlike other patients. The present results suggest that ED patients with a history of cocaine or amphetamine abuse represent a sub-population of patients with lasting dysfunctional mood modulatory mechanisms.
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Affiliation(s)
- Giulia Fioravanti
- Department of Health Sciences, Section of Psychology and Psychiatry, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Giovanni Castellini
- Psychiatric Unit, Careggi Teaching Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Carolina Lo Sauro
- Department of Health Sciences, Section of Psychology and Psychiatry, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Sirio Ianni
- Psychiatric Unit, Careggi Teaching Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Luca Montanelli
- Psychiatric Unit, Careggi Teaching Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Francesco Rotella
- Psychiatric Unit, Careggi Teaching Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Carlo Faravelli
- Department of Health Sciences, Section of Psychology and Psychiatry, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Valdo Ricca
- Psychiatric Unit, Careggi Teaching Hospital, Largo Brambilla 3, 50134 Florence, Italy.
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23
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Khiar Zerrouk A, Sibeoni J, Blanchard B, Lachal J, Taïeb O, Moro MR, Revah-Levy A. Place de la nourriture dans les relations familiales d'adolescents présentant une anorexie mentale : étude qualitative par la photographie. PSYCHIATRIE DE L ENFANT 2014. [DOI: 10.3917/psye.572.0631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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24
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Nowakowski ME, McFarlane T, Cassin S. Alexithymia and eating disorders: a critical review of the literature. J Eat Disord 2013; 1:21. [PMID: 24999402 PMCID: PMC4081716 DOI: 10.1186/2050-2974-1-21] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/25/2013] [Indexed: 02/05/2023] Open
Abstract
Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.
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Affiliation(s)
- Matilda E Nowakowski
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Traci McFarlane
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada ; Eating Disorder Program, The Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
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