Reward Dependence and Harm Avoidance among Patients with Binge-Purge Type Eating Disorders

Reinforcement sensitivity and bulimia symptoms: the role of emotion regulation

OBJECTIVE

Reinforcement Sensitivity Theory (RST) provides a theoretical foundation associated with various approach and avoidance behaviors and individual personality differences. Sensitivity to reward and punishment, two neural systems within the RST have been significantly associated with bingeing and purging behaviors. However, inconsistent findings are observed and specific factors mediating these relationships are not well understood. Deficits in emotion regulation may account for these relationships, as both negative urgency and distress tolerance have been independently associated with bulimia behaviors. Thus, this is an area that requires further investigation.

METHOD

The current study utilized various self-report inventories, including the Eating Disorder Inventory-3rd Edition to measure bulimia symptoms, as well as measures of negative affect, sensitivity to reward and punishment, distress tolerance, and negative urgency. These measures were used to assess whether distress tolerance and negative urgency mediated associations between sensitivity to reward and punishment and bulimia symptoms in a community sample of 394 young adults ranging from the ages of 18 to 25.

RESULTS

As expected, sensitivity to reward and punishment were significantly associated with decreased distress tolerance. Distress tolerance was also directly associated with greater negative urgency, which was significantly associated with increased bulimia symptoms. Consistent with hypotheses, indirect associations between sensitivity to reward and sensitivity to punishment to bulimia symptoms via distress tolerance and negative urgency were observed, controlling for gender and negative affect.

DISCUSSION

Results contribute to understanding specific contributions of risk factors within the relationship of sensitivity to reward and punishment and bulimia symptoms, measured by the EDI-3. Novel to existing literature, results indicate that reinforcement sensitivity significantly contributes to emotion regulation deficits. Thus, these findings may have important implications for understanding the development and treatment of bulimia symptoms.

LEVEL OF EVIDENCE

Level V, based on descriptive, cross-sectional data.

Personality characteristics and medical impact of stimulant laxative abuse in eating disorder patients-a pilot study

BACKGROUND

Stimulant laxative abuse as a purging behavior can be profound in those with eating disorders. However, the psychopathology leading to stimulant laxative abuse is poorly understood. Furthermore, the medical impact of stimulant laxative abuse has not been studied in this population.

METHODS

Six individuals abusing stimulant laxatives underwent a barium enema to assess for evidence of the cathartic colon syndrome and 29 individuals engaging in any purging behaviors completed the Tri-dimensional Personality Questionnaire-Short Form, Sensitivity to Punishment/Sensitivity to Reward Questionnaire-Short Form, Beck Depression Inventory, and the State Trait Anxiety Inventory questionnaires.

RESULTS

Three of the six patients completing the barium enema had the radiographic findings consistent with cathartic colon. Individuals engaging in laxative abuse showed higher Novelty Seeking compared to those engaging in other forms of purging, and those engaging in any form of purging behavior showed greater Sensitivity to Punishment compared to Sensitivity to Reward. There was also the presence of greater Harm Avoidance than Reward Dependence in this population.

CONCLUSION

There may be different psychopathology that contributes to the abuse of stimulant laxatives than that associated with other forms of purging. Regardless of the driving factor, further research is warranted to discover best therapeutic interventions given the potential to develop the cathartic colon syndrome with ongoing use of stimulant laxatives. Cathartic colon is a condition whereby the colon, or lower intestine, is converted into an inert tube incapable of propagating fecal matter. It is thought to develop due to over-use of stimulant laxatives. However, it is unclear if this condition truly exists and whether it contributes to the constipation experienced by individuals with eating disorders who have extensive past histories of abusing laxatives. It is also unclear if laxative abuse presents with different medical complications than other forms of purging. The purpose of this study is to determine whether radiographic evidence of cathartic colon can be found in eating disorder patients abusing stimulant laxatives, whether there are different medical complications with laxative abuse versus other forms of purging, and to examine the psychological composition of individuals who engage in severe laxative abuse. Specifically, the authors investigated the interrelationship between Harm Avoidance and Reward Dependence, with emphasis on gaining a better understanding of Reward Dependence by examining both Sensitivity to Reward and Sensitivity to Punishment in patients who engage in severe laxative abuse. Our findings suggest that stimulant laxative abuse may cause the development of cathartic colon changes and that there may be unique psychopathology that contributes to the abuse of stimulant laxatives. Given the higher Novelty Seeking personality-dimension in those abusing laxatives, it is possible that this purging behavior may be considered addiction-like in nature, which would have distinct treatment implications.

The Mediating Role of Temperamental Traits on the Relationship between Age of Puberty and Eating Disorders: A Mediating Analysis through Structural Equation Modelling of Australian Eating Disorder Outpatients

The current study had the aim to assess whether temperamental traits mediate the relationship between time of puberty and eating disorder (ED) severity using a sample of 292 outpatients with EDs [68 with Anorexia Nervosa Restrictive Type (AN-R), 101 with Anorexia Nervosa Binge Purging Type (AN-BP), 72 with Bulimia Nervosa (BN) and 51 with Other Specified Feeding and Eating Disorder (OSFED)]. Age of puberty, the severity of EDs, and temperamental traits were assessed through Demographic and Medical History Form, Eating Disorder Examination 17.0d (EDE-17.0d) and Temperament and Character Inventory-Revised (TCI-R), with a focus on the temperament scales: novelty seeking (TCI-NS), harm avoidance (TCI-HA), reward dependence (TCI-RD) and persistence (TCI-P). One-way ANOVA, correlation, and mediating analyses through structural equation modeling were performed to test the relationship between variables under investigation and assess if the four temperamental traits act as mediators in the relationship between time of puberty and ED severity. The results show a full mediating effect of the temperamental sub-scales on the relationship between puberty and EDE-17. In particular, TCI-R HA showed a complementary mediation on the relationship between age of puberty and EDE-17.0d, meaning that age of puberty increases the level of TCI-R HA, which in turn increases the severity of ED, confirming that this temperamental trait plays an important role in the development of ED after puberty. To conclude, temperamental traits seem to play a full mediating role in the relationship between puberty and ED severity, but more research is needed.

Food Addiction among Female Patients Seeking Treatment for an Eating Disorder: Prevalence and Associated Factors

The concept of "food addiction" (FA) has aroused much focus because of evidence for similarities between overeating and substance use disorders (SUDs). However, few studies have explored this concept among the broad spectrum of eating disorders (ED), especially in anorexia nervosa (AN). This study aimed to assess FA prevalence in ED female patients and to determine its associated factors. We recruited a total of 195 adult women with EDs from an ED treatment center. The prevalence of FA diagnosis (Yale Food Addiction Scale) in the whole ED sample was 83.6%; AN restrictive type (AN-R), 61.5%; AN binge-eating/purging type (AN-BP), 87.9%; bulimia nervosa (BN), 97.6%; and binge-eating disorder (BED), 93.3%. The most frequently met criteria of FA were "clinically significant impairment or distress in relation to food", "craving" and "persistent desire or repeated unsuccessful attempts to cut down". An FA diagnosis was independently associated with three variables: presence of recurrent episodes of binge eating, ED severity, and lower interoceptive awareness. In showing an overlap between ED and FA, this study allows for considering EDs, and AN-R in particular, from an "addictive point of view", and thus for designing therapeutic management that draws from those proposed for addictive disorders.

Temperament and characteristics related to nomophobia

Nomophobia is defined as the fear of being out of mobile phone contact and is considered to be a phobia of the modern age. The current study set out to establish the relationship between temperament and personality and the development of nomophobia. The sample was composed of 968 participants selected from the Andalusian population, of which there were 182 males and 785 females aged from 23.19 years. The instruments used were the Questionnaire to Assess Nomophobia (QANIP; Olivencia-Carrión et al., 2018) and the Temperament and Character Inventory Revised (TCI-R; Cloninger et al., 1993). We found that cooperation is a characteristic that significantly reduces nomophobic levels, particularly for the two factors of Mobile Phone Addiction and Negative Consequences. Furthermore, Reward Dependence appears to be positively related to two of the factors involved in nomophobia, namely Mobile Phone Addiction and Loss of Control, suggesting a relationship between Nomophobia and personality. These findings are discussed in terms of their usefulness for identifying the personality predictors of nomophobia in order to develop preventive and intervention strategies.

The effects of temperament and character traits on perceived social support and quality of life in patients with epilepsy

OBJECTIVES

This study aimed to investigate the effect of temperament and character traits on perceived social support and quality of life in patients with epilepsy (PWE).

METHODS

Fifty-two PWE and 54 healthy controls were included in this study. Demographics and clinical data were recorded. Temperament and Character traits were investigated using Temperament and Character Inventory (TCI), Perceived Social Support was evaluated by Multidimensional Scale of Perceived Social Support Scale (MSPSS), and quality of life was assessed using a 36-Item Short-Form Health Survey (SF-36). Participants also completed the Hospital Anxiety Depression Scale (HADS).

RESULTS

TCI and MSPSS scores showed no significant difference between the groups (p>0.05). Mental and physical subscales of SF-36 were significantly lower in PWE than the controls (p=0.012, p=0.020, respectively). Multiple linear regression analysis indicated that Reward Dependence and Cooperativeness were independent predictors for perceived social support, and Persistence score was an independent predictor for the physical subscale of SF-36 even after adjustment for confounding background variables (p<0.05, for all).

CONCLUSION

Temperament and character traits may affect perceived social support and quality of life in PWE. Thus, an evaluation of temperament and character traits may play a significant role in preventing negative effects on perceived social support and quality of life in PWE.