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Longo P, Scaliti E, Panero M, Toppino F, Brustolin A, Salis B, Lacidogna MC, Abbate-Daga G, Martini M. A quantitative study on peripersonal space in anorexia nervosa and healthy subjects: Role of social variables and association with psychopathology. Int J Clin Health Psychol 2024; 24:100476. [PMID: 39035050 PMCID: PMC11257834 DOI: 10.1016/j.ijchp.2024.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/31/2024] [Indexed: 07/23/2024] Open
Abstract
Objectives This study investigates peripersonal space (PPS) modulation in patients with anorexia nervosa (AN) versus healthy controls (HCs) and explores associations between PPS, eating-related, and general psychopathology. Method Forty-six patients and 42 HCs completed a computer-based task observing videos of an approaching actor (male or female) displaying different facial expressions along with a non-social condition. Then, participants completed self-report questionnaires assessing eating-related and general psychopathology. Results Mixed-models revealed that both groups adjusted PPS based on task conditions, with a gender effect favoring closer proximity to female actor. HCs reduced PPS amplitude progressively during the task, while patients did not show this effect. In patients, wider PPS correlated with lower self-esteem and facial expression identification accuracy, while in HCs, PPS was associated to body dissatisfaction and anxiety symptoms. Conclusion These findings enhance understanding of bodily self-consciousness, suggesting PPS consideration in therapeutic interactions with patients with AN and as a potential target in treatments addressing social impairment.
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Affiliation(s)
- Paola Longo
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Eugenio Scaliti
- Human Science and Technologies, University of Turin, Italy
- Department of Management “Valter Cantino”, University of Turin, Italy
| | - Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Federica Toppino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Annalisa Brustolin
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Benedetta Salis
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Maria Carla Lacidogna
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Matteo Martini
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
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Heled E, Ben-Baruch Polevoi B, Kushnir T, Gur E, Brener-Yaacobi R. Disentangling cognitive flexibility: a model-based assessment of women with anorexia nervosa. Eat Disord 2024:1-16. [PMID: 38937994 DOI: 10.1080/10640266.2024.2353427] [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] [Indexed: 06/29/2024]
Abstract
Cognitive flexibility (CF) has been proposed as a potential trait marker in anorexia nervosa (AN), although findings have been inconsistent. To address this inconsistency, we applied a model that distinguishes between three subtypes of CF: task switching, switching sets, and stimulus-response mapping, which we then assessed using a paradigm-based task battery. The aim of the study was to investigate how AN is associated with these three CF subtypes. Thirty-three women with AN and 37 age- and education-matched controls performed a battery of computerized cognitive tasks to assess the three CF subtypes. Compared to the control group, individuals with AN exhibited poorer performance on the task switching and switching sets subtypes, as measured by response time switch cost, but not on the stimulus-response mapping subtype. No differences were found between the groups in response accuracy. Furthermore, switching sets as compared to the task switching and stimulus-response mapping subtypes was found to better explain the differences between the groups. These findings indicate a domain-specific impairment in CF among patients with AN, reflecting deficits observed in subtypes related to the disorder's characteristics, particularly that associated with visual perception. Therefore, CF impairment in AN should not be viewed dichotomously, but rather as a relative impairment that varies depending on the specific CF subtype.
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Affiliation(s)
- Eyal Heled
- Department of Psychology, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eytan Gur
- The Adults Eating Disorders Department, Sheba Medical Center, Ramat-Gan, Israel
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Dang AB, Kiropoulos L, Castle D, Jenkins Z, Phillipou A, Rossell S, Krug I. Psychiatric comorbidity and severity in anorexia nervosa: a comparative study of the DSM-5, the ICD-11, and overvaluation of Weight/Shape severity ratings. Eat Disord 2024:1-17. [PMID: 38709163 DOI: 10.1080/10640266.2024.2346001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This study assessed the rate of a.) the total and b.) specific psychiatric comorbidities among the three severity ratings for Anorexia Nervosa (AN): DSM-5, ICD-11 and overvaluation of weight and shape (OWS). The sample comprised 312 treatment-seeking patients with AN (mean age = 26.9). Weight and height were taken at intake to calculate BMI, the foundation for the DSM-5 and ICD-11 severity indices. The EDE-Q was used to assess OWS, and the Mini International Neuropsychiatric Interview was conducted to assess psychiatric comorbidities. For the DSM-5, the mild severity group showed a higher total number of psychiatric comorbidities, especially for panic, social anxiety, generalised anxiety, and post-traumatic stress disorders compared to the severe and extremely severe groups. ICD-11 and OWS severity groups did not significantly differ in total comorbidities, except for major depressive disorder and obsessive-compulsive disorders being more prevalent in the "significantly low BMI" ICD-11 group. The high OWS group displayed a notably higher rate of major depressive disorder than the low OWS group. The study underscores inconsistent patterns across the three severity systems, emphasising the need to recognise the current limitations of the assessed severity classification systems in AN assessment and guiding treatment.
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Affiliation(s)
- An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Department of health, Tasmanian Centre for Mental Health Service Innovation Hobart, Tasmania, Australia
- Department of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
- Iverson Institute, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
| | - Susan Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Wang L, Sheng J, Duan S, Lin S, Li Y, Li Z, Li S, Sataer Y, Chen J. How Society Anxiety Influences Attention Control in College Students: The Moderated Mediation Effect of Cognitive Flexibility and Resting-state Electroencephalography Activity. J Cogn Neurosci 2024; 36:327-339. [PMID: 38060259 DOI: 10.1162/jocn_a_02095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Social anxiety is a prevalent issue among college students, adversely affecting their overall well-being. Drawing from the cognitive model of social anxiety and attention control theory, heightened levels of social anxiety may correspond to poorer attention control ability. However, little is known about the underlying cognitive mechanisms of the relationship between social anxiety and attention control. To address this research gap, the current study recruited a sample of 156 college students (56 women) who underwent self-report measures of social anxiety, cognitive flexibility, and attention control, followed by a resting-state EEG recording. The results revealed a significant negative predictive effect of social anxiety on attention control, with cognitive flexibility partially mediating this relationship. Furthermore, resting-state theta power emerged as a significant moderator, accentuating the negative impact of social anxiety on cognitive flexibility among individuals with lower theta power. In addition, frontal alpha asymmetry (FAA) demonstrated a moderating effect, with lower FAA intensifying the predictive influence of cognitive flexibility on attention control. Taken together, these results suggested that social anxiety can predict attention control either directly or indirectly via the mediating role of cognitive flexibility, and lower theta power and FAA has a risk amplification effect, which provide novel insights into the treatment and prevention of social anxiety and its negative impact on college students.
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Affiliation(s)
- Li Wang
- South China Normal University
| | | | | | | | | | - Zhe Li
- South China Normal University
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5
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Miles S, Nedeljkovic M, Phillipou A. Investigating differences in cognitive flexibility, clinical perfectionism, and eating disorder-specific rumination across anorexia nervosa illness states. Eat Disord 2023; 31:610-631. [PMID: 37128671 DOI: 10.1080/10640266.2023.2206751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Cognitive inflexibility, clinical perfectionism, and eating disorder (ED)-specific rumination are common characteristics reported in anorexia nervosa (AN) and may contribute to the maintenance of the illness. It is suggested that clinical perfectionism and rumination may mediate the relationship between cognitive flexibility and AN pathology; however, research to date has not investigated all these factors together. The aim of the current study was to explore the relationships between these factors and how they may relate to ED symptoms in AN. METHODS Participants included 15 women with a current diagnosis of AN, 12 women who had a past diagnosis of AN and were currently weight-restored, and 15 healthy controls (HCs). RESULTS The results revealed that participants with both acute and weight-restored AN self-reported poorer cognitive flexibility than HCs, but the groups did not differ in performance on objective assessments of cognitive flexibility. Participants with AN also reported significantly greater clinical perfectionism and ED-specific rumination than HC. A parallel mediation analysis found that ED-specific rumination mediated the relationship between subjective cognitive flexibility and ED symptoms. Further, subjective cognitive flexibility directly influenced ED symptoms. However, the mediation model was not significant for objective cognitive flexibility. CONCLUSION The findings of this study have implications for potential treatment barriers and factors which might contribute to the risk of relapse.
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Affiliation(s)
- Stephanie Miles
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health & Brain Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
- Department of Mental Health, Austin Health, Melbourne, Australia
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Puttevils L, De Bruecker M, Allaert J, Sanchez-Lopez A, De Schryver N, Vervaet M, Baeken C, Vanderhasselt MA. Attentional bias to food during free and instructed viewing in anorexia nervosa: An eye tracking study. J Psychiatr Res 2023; 164:468-476. [PMID: 37437319 DOI: 10.1016/j.jpsychires.2023.06.039] [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: 10/12/2022] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Previous research has shown that patients with anorexia nervosa (AN) show an attentional bias to food. However, due to different conceptualizations of attentional bias and the use of various paradigms, results are inconclusive and more precise insights into the exact nature of this attentional bias are needed. Therefore, an eye-tracking paradigm with food (low and high caloric) and non-food (objects) pictures was used to investigate biases in AN patients (n = 25) compared to healthy controls (n = 22). Several indices of visual attention were examined, both during free (initial orientation, fixation frequency, fixation time) and explicitly instructed (engagement, disengagement) viewing. Our results during the free viewing phase indicated that AN patients (as compared to healthy matched controls) looked less frequently and spent less time fixating on food stimuli, compared to the comparison group. No differences between both groups (n = 47) in initial orientation could be observed. Interestingly, during the instructed viewing phase, no differences between the patient and the comparison group were observed in engagement or disengagement to food stimuli. These results suggest an (initial) attentional avoidance of food in AN patients when closely investigating spontaneous attentional processes, while this could not be observed during gaze behaviour when receiving clear instructions. Hence, future research should look into how attentional bias during spontaneous gaze patterns could serve as a potential marker of AN, and how targeting this bias could be applied in treatment interventions.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
| | - Marie De Bruecker
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | - Jens Allaert
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | | | - Nele De Schryver
- Department of Psychiatry, Center for Eating Disorders, Ghent University Hospital, K12F, C. Heymanslaan 10, 9000, Ghent, Belgium
| | | | - Chris Baeken
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
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7
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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Sullivan M, Fernandez-Aranda F, Camacho-Barcia L, Harkin A, Macrì S, Mora-Maltas B, Jiménez-Murcia S, O'Leary A, Ottomana AM, Presta M, Slattery D, Scholtz S, Glennon JC. Insulin and Disorders of Behavioural Flexibility. Neurosci Biobehav Rev 2023; 150:105169. [PMID: 37059405 DOI: 10.1016/j.neubiorev.2023.105169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Behavioural inflexibility is a symptom of neuropsychiatric and neurodegenerative disorders such as Obsessive-Compulsive Disorder, Autism Spectrum Disorder and Alzheimer's Disease, encompassing the maintenance of a behaviour even when no longer appropriate. Recent evidence suggests that insulin signalling has roles apart from its regulation of peripheral metabolism and mediates behaviourally-relevant central nervous system (CNS) functions including behavioural flexibility. Indeed, insulin resistance is reported to generate anxious, perseverative phenotypes in animal models, with the Type 2 diabetes medication metformin proving to be beneficial for disorders including Alzheimer's Disease. Structural and functional neuroimaging studies of Type 2 diabetes patients have highlighted aberrant connectivity in regions governing salience detection, attention, inhibition and memory. As currently available therapeutic strategies feature high rates of resistance, there is an urgent need to better understand the complex aetiology of behaviour and develop improved therapeutics. In this review, we explore the circuitry underlying behavioural flexibility, changes in Type 2 diabetes, the role of insulin in CNS outcomes and mechanisms of insulin involvement across disorders of behavioural inflexibility.
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Affiliation(s)
- Mairéad Sullivan
- Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Lucía Camacho-Barcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Andrew Harkin
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
| | - Simone Macrì
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Bernat Mora-Maltas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Aet O'Leary
- University Hospital Frankfurt, Frankfurt, Germany
| | - Angela Maria Ottomana
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; Neuroscience Unit, Department of Medicine, University of Parma, 43100 Parma, Italy
| | - Martina Presta
- Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, 00161 Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, 00185 Rome, Italy
| | | | | | - Jeffrey C Glennon
- Conway Institute of Biomedical and Biomolecular Research, School of Medicine, University College Dublin, Dublin, Ireland
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Berchio C, Annen LC, Bouamoud Y, Micali N. Temporal dynamics of cognitive flexibility in adolescents with anorexia nervosa: A high-density EEG study. Eur J Neurosci 2023; 57:962-980. [PMID: 36683346 DOI: 10.1111/ejn.15921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/08/2022] [Accepted: 01/15/2023] [Indexed: 01/24/2023]
Abstract
Impairment in cognitive flexibility is a core symptom of anorexia nervosa (AN) and is associated with treatment resistance. Nevertheless, studies on the neural basis of cognitive flexibility in adolescent AN are rare. This study aimed to investigate brain networks underlying cognitive flexibility in adolescents with AN. To address this aim, participants performed a Dimensional Change Card Sorting task during high-density electroencephalography (EEG) recording. Anxiety was measured with the State-Trait Anxiety Inventory. Data were collected on 22 girls with AN and 23 controls. Evoked responses were investigated using global-spatial analysis. Adolescents with AN showed greater overall accuracy, fewer switch trial errors and reduced inverse efficiency switch cost relative to controls, although these effects disappeared after adjusting for trait and state anxiety. EEG results indicated augmented early visual orienting processing (P100) and subsequent impaired attentional mechanisms to task switching (P300b) in subjects with AN. During task switching, diminished activations in subjects with AN were identified in the posterior cingulate, calcarine sulcus and cerebellum, and task repetitions induced diminished activations in a network involving the medial prefrontal cortex, and several posterior regions, compared with controls. No significant associations were found between measures of cognitive flexibility and anxiety in the AN group. Findings of this study suggest atypical neural mechanisms underlying cognitive flexibility in adolescents with AN. More importantly, our findings suggest that different behavioural profiles in AN could relate to differences in anxiety levels. Future research should investigate the efficacy of cognitive training to rebalance brain networks of cognitive flexibility in AN.
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Affiliation(s)
- Cristina Berchio
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lucie Clémentine Annen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ynès Bouamoud
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Pediatrics, Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK.,Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Centre Ballerup, Ballerup, Denmark
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10
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Martini M, Marzola E, Musso M, Brustolin A, Abbate-Daga G. Association of emotion recognition ability and interpersonal emotional competence in anorexia nervosa: A study with a multimodal dynamic task. Int J Eat Disord 2023; 56:407-417. [PMID: 36373846 DOI: 10.1002/eat.23854] [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: 06/27/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Interpersonal difficulties are evidenced in Anorexia Nervosa (AN) and are thought to contribute to disease onset and maintenance, however, research in the framework of emotional competence is currently limited. Previous studies have often only used static images for emotion recognition tasks, and evidence is lacking on the relationships between performance-based emotional abilities and self-reported intra- and interpersonal emotional traits. This study aimed to test multimodal dynamic emotion recognition ability in AN and analyze its correlation with the psychometric scores of self- and other-related emotional competence. METHOD A total of 268 participants (128 individuals with AN and 140 healthy controls) completed the Geneva Emotion Recognition Test, the Profile of Emotional Competence, the Reading the Mind in the Eyes Test, and measures of general and eating psychopathology. Scores were compared between the two groups. Linear mixed effects models were utilized to examine the relationship between emotion recognition ability and self-reported measures and clinical variables. RESULTS Individuals with AN showed significantly poorer recognition of emotions of both negative and positive valence and significantly lower scores in all emotional competence dimensions. Beside emotion type and group, linear mixed models evidenced significant effects of interpersonal comprehension on emotion recognition ability. DISCUSSION Individuals with AN show impairment in multimodal emotion recognition and report their difficulties accordingly. Notably, among all emotional competence dimensions, interpersonal comprehension emerges as a significant correlate to emotion recognition in others, and could represent a specific area of intervention in the treatment of individuals with AN. PUBLIC SIGNIFICANCE In this study, we evidence that the ability to recognize the emotions displayed by others is related to the level of interpersonal emotional competence reported by individuals with anorexia nervosa. This result helps in understanding the social impairments in people with anorexia nervosa and could contribute to advancements in the application of the training of emotional competence in the treatment of this disorder.
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Affiliation(s)
- Matteo Martini
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Maria Musso
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
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11
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Garcia-Burgos D, Wilhelm P, Vögele C, Munsch S. Food Restriction in Anorexia Nervosa in the Light of Modern Learning Theory: A Narrative Review. Behav Sci (Basel) 2023; 13:bs13020096. [PMID: 36829325 PMCID: PMC9952578 DOI: 10.3390/bs13020096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Improvements in the clinical management of anorexia nervosa (AN) are urgently needed. To do so, the search for innovative approaches continues at laboratory and clinical levels to translate new findings into more effective treatments. In this sense, modern learning theory provides a unifying framework that connects concepts, methodologies and data from preclinical and clinical research to inspire novel interventions in the field of psychopathology in general, and of disordered eating in particular. Indeed, learning is thought to be a crucial factor in the development/regulation of normal and pathological eating behaviour. Thus, the present review not only tries to provide a comprehensive overview of modern learning research in the field of AN, but also follows a transdiagnostic perspective to offer testable explanations for the origin and maintenance of pathological food rejection. This narrative review was informed by a systematic search of research papers in the electronic databases PsycInfo, Scopus and Web of Science following PRISMA methodology. By considering the number and type of associations (Pavlovian, goal-directed or habitual) and the affective nature of conditioning processes (appetitive versus aversive), this approach can explain many features of AN, including why some patients restrict food intake to the point of life-threatening starvation and others restrict calorie intake to lose weight and binge on a regular basis. Nonetheless, it is striking how little impact modern learning theory has had on the current AN research agenda and practice.
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Affiliation(s)
- David Garcia-Burgos
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Peter Wilhelm
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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12
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Serur Y, Dikstein H, Shilton T, Gothelf D, Latzer Y, Lewis Y, Enoch-Levy A, Pessach I, Gur E, Stein D. The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic. J Eat Disord 2022; 10:145. [PMID: 36209127 PMCID: PMC9547577 DOI: 10.1186/s40337-022-00668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions. METHODS Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls. RESULTS Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience. CONCLUSIONS Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.
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Affiliation(s)
- Yaffa Serur
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Hadar Dikstein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Tal Shilton
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Psychiatric Division, Eating Disorders Institution, Rambam Health Care Campus, Haifa, Israel
| | - Yael Lewis
- Shalvatah Mental Health Center, Hod Hasharon, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Itai Pessach
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Gur
- Center for the Treatment of Eating Disorders and Obesity, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Osorio Acuña LC, Franco Zuluaga A. Behavioural and emotional symptoms of adolescents consulting a specialised eating disorders programme. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:318-325. [PMID: 36446704 DOI: 10.1016/j.rcpeng.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.
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Affiliation(s)
- Lucia Carolina Osorio Acuña
- Especialista en psiquiatría infantil y del adolescente, Docente del Departamento de Psiquiatría, Universidad ICESI, Fundación Valle del Lili, Cali, Colombia.
| | - Alvaro Franco Zuluaga
- Especialista en psiquiatría infantil y del adolescente, Docente de psiquiatría de la Universidad El Bosque, Bogotá, Colombia
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14
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Longo P, Aloi M, Delsedime N, Rania M, Segura Garcia C, Abbate-Daga G, Marzola E. Different clusters of perfectionism in inpatients with anorexia nervosa and healthy controls. Eat Disord 2022; 30:540-555. [PMID: 34376118 DOI: 10.1080/10640266.2021.1938937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Perfectionism is a risk and maintaining factor for anorexia nervosa (AN) but studies on its classification are lacking. This study aimed to classify patients with AN and healthy controls (HCs) according to their perfectionism; to evaluate the association between perfectionism clusters and severity of general and eating psychopathology for both groups; to investigate the relationship between baseline perfectionism and hospitalization outcome for patients. A sample of 207 inpatients with AN and 292 HCs completed: Eating Disorders Inventory-2, Frost Multidimensional Perfectionism Scale, Beck Depression Inventory, and State- Trait Anxiety Inventory. Cluster analyses were run to classify participants according to their perfectionism scores. Three clusters (i.e., high, medium, low perfectionism) emerged for both patients with AN and HCs. The high perfectionism cluster was over-represented among patients. Both groups reported significant differences across clusters in eating-related difficulties. In AN, anxiety and depression severity varied across clusters according to perfectionism, but patients' baseline perfectionism was unrelated to hospitalization outcome. Inpatients with AN and HCs could be grouped in clusters of high, medium, and low perfectionism which also mirrored their eating psychopathology severity. Finally, hospitalization outcome was unrelated to inpatients' baseline perfectionism.
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Affiliation(s)
- Paola Longo
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Nadia Delsedime
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Marianna Rania
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura Garcia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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15
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Miles S, Phillipou A, Sumner P, Nedeljkovic M. Cognitive flexibility and the risk of anorexia nervosa: An investigation using self-report and neurocognitive assessments. J Psychiatr Res 2022; 151:531-538. [PMID: 35636028 DOI: 10.1016/j.jpsychires.2022.05.043] [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: 07/08/2021] [Revised: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Impaired cognitive flexibility has been suggested as a risk factor for the development of anorexia nervosa (AN). The current study aimed to 1) investigate cognitive flexibility in people at various levels of risk of AN; and 2) compare people with a history of AN to people at different levels of risk of AN in cognitive flexibility. The sample comprised of 262 community participants (79% female) and 36 participants with a lifetime diagnosis of AN (97.2% female) aged between 18 and 64 years old. Participants completed self-report (the Depression Anxiety Stress Scale short-form version, the Eating Disorders Examination-Questionnaire, the Neuroticism Scale, and the Cognitive Flexibility Inventory) and neurocognitive (the Trail Making Test and the Wisconsin Card Sorting Test) assessments online to evaluate eating disorder symptoms, depression, neuroticism, and cognitive flexibility. Using a cluster analysis, participants were allocated into low-, medium-, and high-risk of AN groups (n = 88, 128, 46, and 36 respectively). Although high-risk participants self-reported significantly poorer cognitive flexibility than the other risk groups, performance on the neurocognitive tasks was similar across groups. Further, participants with lifetime AN reported significantly poorer cognitive flexibility than the low-risk group. People at high-risk of AN may perceive themselves to have poorer cognitive flexibility compared to those at a lower risk of AN. These results have implications for early identification of people at high-risk of AN.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; Department of Mental Health, Austin Health, Melbourne, Victoria, Australia
| | - Philip Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
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16
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Babbott KM, Mitchison D, Basten C, Thornton C, Hay P, Byrne S, Goldstein M, Heruc G, van der Werf B, Consedine NS, Roberts M. Intuitive Eating Scale-2: psychometric properties and clinical norms among individuals seeking treatment for an eating disorder in private practice. Eat Weight Disord 2022; 27:1821-1833. [PMID: 34797555 DOI: 10.1007/s40519-021-01326-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Intuitive Eating (IE) is an approach to eating designed to facilitate a positive relationship with food. Its use in clinical settings and in the community is rapidly growing in popularity. The Intuitive Eating Scale 2 (IES-2) is a widely used measure that indexes intuitive eating motivations and behaviour, however evidence of its validity in populations with clinical eating disorders remains scarce. The objective of the proposed study was thus to evaluate the factor structure of the IES-2 in a large sample of individuals seeking treatment for eating disorders in private practice. METHODS Data collected from 569 women and men aged 12-68 years seeking treatment for an eating disorder in one of eight specialist private outpatient eating disorder clinics were examined using confirmatory factor analysis (CFA). Relationships between IES-2 scores and measures of psychopathology were also examined. RESULTS Results were relatively consistent with the purported four-factor structure of the IES-2. The measure displayed strong construct validity and good internal consistency. Scores on the IES-2 were inversely associated with scores of depression, anxiety, and disordered eating, providing evidence for divergent validity of the measure. Clinical norms are provided for anorexia nervosa (AN) spectrum disorders and bulimia nervosa (BN) spectrum disorders, as well as for the clinical sample as a whole. CONCLUSION Findings suggest that the IES-2 may be an appropriate measure for evaluating behaviours relating to IE in community outpatient eating disorder settings, and provide further evidence for the association between IE and positive health outcomes. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Katie M Babbott
- General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Chris Basten
- Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Phillipa Hay
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Sue Byrne
- University of Western Australia, Perth, Australia
| | - Mandy Goldstein
- Mandy Goldstein Psychology, Sydney, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Gabriella Heruc
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Appetite for Change, Sydney, Australia
| | - Bert van der Werf
- Department of Biostatistics, University of Auckland, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Marion Roberts
- General Practice and Primary Healthcare, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
- Nurture Psychology, Auckland, New Zealand
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17
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Sourlier P, Bozzi S, Kabuth B, Lamourette M, Ligier F. Experiences of parents and patients hospitalised in a child psychiatric unit for anorexia nervosa after reorganisation of care imposed by the COVID-19 Pandemic in France: a qualitative study-The QUALICOVID study. J Eat Disord 2022; 10:57. [PMID: 35468851 PMCID: PMC9035507 DOI: 10.1186/s40337-022-00579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a serious, albeit common mental illness that generally occurs during adolescence. Although outpatient care is recommended, hospitalisation is sometimes required. There is a dedicated hospitalisation unit caring for children and adolescents presenting with anorexia nervosa in Nancy, France. However, on 16 March 2020, a national lockdown was declared by the French government as the COVID-19 pandemic escalated in France. This resulted in the adjustment of hospital admissions accompanied by premature discharge and an intensive outpatient care programme. In the light of such changes, consideration should be given to the potential impact of changes in the care pattern for anorexic patients and their parents. The purpose of our study was to explore the experiences of anorexia nervosa patients hospitalised in the unit, and their parents, following changes in the care strategy. METHODS The study was conducted between weeks four and eight after lockdown was announced. The study cohort included all the patients treated for anorexia nervosa and hospitalised in the treatment unit before 16 March 2020 and their parents. A qualitative method was used and every subject was offered a semi-structured interview. Data were analysed by means of inductive thematic analysis. RESULTS Seven superordinate themes were identified: positive aspects, concerns, preparation, loss of landmarks and hospital security, gradual return to a "normal" life, relational aspects and the likelihood of disease progression. Moreover, all the parents and patients were satisfied with the intensive outpatient care offered on discharge. CONCLUSION Despite initial ambivalence, all patients and their parents viewed this unexpected hospital discharge positively in these exceptional conditions. This suggests that restructuring the care programme could prove beneficial with increasing use of outpatient management, thereby reducing the length of the hospital stay and adjusting the return to school. TRIAL REGISTRATION ID-RCB 2020-A01101-38-This project was approved by the Comité de Protection des Personnes (CPP) Sud Méditerranée IV [South Mediterranean IV Ethics Committee (EC)] on 5 May 2020.
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Affiliation(s)
- Pauline Sourlier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France. .,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France.
| | - Sophie Bozzi
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Bernard Kabuth
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4432 PRISME, Université de Lorraine, 54000, Nancy, France
| | - Marilou Lamourette
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
| | - Fabienne Ligier
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Psychothérapique de Nancy, 1 Rue du Docteur Archambault, 54520, Laxou, France.,EA 4360 APEMAC, Université de Lorraine, 54000, Nancy, France
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18
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Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway. Drug Alcohol Depend 2022; 231:109275. [PMID: 35030506 DOI: 10.1016/j.drugalcdep.2022.109275] [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: 10/12/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. OBJECTIVE To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). METHODS Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. RESULTS Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. CONCLUSION Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.
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19
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Aparicio Flores MP, Vicent M, Freire Andino RO, Sanmartín R, Gonzálvez C, García-Fernández JM. Profiles of Perfectionistic Automatic Thoughts and Aggression. Psychol Rep 2022:332941211069519. [PMID: 35084233 DOI: 10.1177/00332941211069519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent years, the study of perfectionistic automatic thoughts (PAT) has increased given its maladaptive nature since it is link to numerous psychological disorders. From our knowledge, no previous research has addressed the relationship between PAT and the four components of aggressive behavior (anger, hostility, verbal aggression, and physical aggression. This study had a double goal. The first aim was to identify distinct profiles of PAT in a sample of 3060 Ecuadorian undergraduates (Mage=22.7, SD = 2.46. The second aim of this study was to determine whether or not statistically significant differences exist between these profiles, based on the four components of aggressive behavior. The Perfectionism Cognitions Inventory (PCI) and the Aggression Questionnaire (AQ) were used. Five profiles with different intensities in the dimensions of perfectionistic automatic thoughts were identified by Latent Class Analysis (1. No-Perfectionistic Automatic Thoughts, 2. Low Perfectionistic Automatic Thoughts, 3. High Perfectionistic Demands, 4. Moderate Perfectionistic Automatic Thoughts, and 5. High Perfectionistic Automatic Thoughts). The moderate and high perfectionistic automatic thoughts profiles obtained the highest mean scores for all components of aggressive behavior (i.e., the four factors that make up AQ: Physical Aggression, Verbal Aggression, Anger, and Hostility), while the No-perfectionistic automatic thoughts and Low perfectionistic automatic thoughts profiles had the lowest mean scores. These results provide new knowledge about the prevalence of PAT in the context of Ecuador. Also, they suggest further research on the topic given the positive relationship of PAT and aggressive behavior.
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Affiliation(s)
| | - María Vicent
- Department of Developmental Psychology and Didactics16718Universitat d'Alacant
| | | | | | - Carolina Gonzálvez
- Department of Developmental Psychology and Didactics16718Universitat d'Alacant
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Abstract
PURPOSE OF REVIEW Traits of autism spectrum disorder (ASD) are overrepresented among individuals with anorexia nervosa (AN) and may also moderate the behavioral manifestation of AN. This review aims to provide an overview of AN and comorbid ASD. RECENT FINDINGS Elevated ASD traits do not seem to precede AN among some individuals but are rather related to the illness stage. However, studies have suggested that there are ASD-specific mechanisms for developing AN in a subgroup of individuals with AN. Pronounced traits of ASD and diagnosed ASD are associated with illness prolongation and poorer outcomes in AN, and individuals with AN and elevated ASD traits may benefit less from many of the current treatments. Studies do not support a specific genetic relationship between ASD and AN. SUMMARY Recent research encourages the improved recognition of elevated ASD traits in individuals with AN and provides grounds for developing tailored treatments for those with this comorbidity.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki
| | - Marja Laasonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Kuopio
- Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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21
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Suttkus S, Schumann A, De la Cruz F, Bär KJ. Attenuated neuronal and autonomic responses during error processing in anorexia nervosa. Brain Behav 2021; 11:e2235. [PMID: 34318622 PMCID: PMC8413769 DOI: 10.1002/brb3.2235] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a severe psychiatric illness with alarming mortality rates. Nevertheless, despite former and recent research results, the etiology of AN is still poorly understood. Of particular interest is that, despite exaggerated response control and increased perfectionism scores, patients with AN seem not to perform better that those unaffected in tasks that require inhibitory control. One reason might be aberrant processing of errors. The objective of our study was thus to obtain further insight into the pathopsychology of AN. We were particularly interested in neuronal and autonomic responses during error processing and their association with behavior. METHODS We analyzed 16 acute patients suffering from restrictive type AN and 21 healthy controls using functional magnetic resonance imaging (fMRI) with simultaneous physiological recordings during a Go/Nogo response inhibition task. Data were corrected for noise due to cardiac and respiratory influence. RESULTS Patients and controls had similarly successful response inhibition in Nogo trials. However, in failed Nogo trials, controls had significantly greater skin conductance responses (SCR) than in correct Nogo trials. Patients did not exhibit elevated SCR to errors. Furthermore, we found significantly increased neuronal responses, especially in the amygdala and hippocampus, in controls compared to patients during error trials. We also found significant positive correlations in controls but not in patients between Nogo performance and activation in the salience network core regions after errors. CONCLUSION Acute restrictive type AN patients seem to lack neuronal and autonomic responses to errors that might impede a flexible behavior adaption.
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Affiliation(s)
- Stefanie Suttkus
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Andy Schumann
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Feliberto De la Cruz
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
| | - Karl-Jürgen Bär
- Lab for Autonomic Neuroscience, Imaging and Cognition (LANIC), Department of Psychosomatic Medicine and Psychotherapy, Jena University, Jena, Germany
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22
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Are orthorexia nervosa symptoms associated with deficits in inhibitory control? Eat Weight Disord 2021; 26:1553-1557. [PMID: 32767254 DOI: 10.1007/s40519-020-00979-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This study explored whether inhibitory control is associated with symptoms of orthorexia nervosa, a condition that involves substantial behavioral control in regard to healthy eating. METHOD Participants (50 women, 13 men) completed the Eating Habits Questionnaire as a measure of orthorexia symptomatology, along with computerized versions of the Go/No-Go Task, Flanker Task, and Stroop Task. RESULTS Orthorexia symptomatology did not correlate with either percent error or response time for any of the three tasks (all p's > 0.10). CONCLUSION These results suggest that orthorexia is not associated with deficits or other differences in inhibitory control. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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23
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Cholet J, Rousselet M, Donnio Y, Burlot M, Pere M, Lambert S, Rocher B, Chirio-Espitalier M, Eyzop E, Grall-Bronnec M. Evaluation of cognitive impairment in a French sample of patients with restrictive anorexia nervosa: two distinct profiles emerged with differences in impaired functions and psychopathological symptoms. Eat Weight Disord 2021; 26:1559-1570. [PMID: 32767255 PMCID: PMC8128741 DOI: 10.1007/s40519-020-00981-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/31/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The cognitive profiles of patients suffering from anorexia nervosa (AN) are currently explored as potential facilitating and/or maintenance factors. Specific data in restrictive AN (AN-R) remain contradictory. This study focused on women with AN-R to evaluate their cognitive functions to develop a more specific cognitive remediation program. METHODS Female patients older than 15 years who were suffering from AN-R were recruited in a specialized unit for eating disorder management. Female healthy control (HC) participants were recruited who were matched with AN patients on age. All participants completed a cognitive evaluation (premorbid intelligence quotient (IQ), planning, information processing speed, cognitive flexibility) and a clinical evaluation (impulsivity, anxiety, depression). RESULTS A total of 122 participants were included. Patients suffering from AN-R had significant impairment in information processing speed and planning. Patients exhibited significantly better cognitive flexibility than did the HC group when adjustments were made for other cognitive functions and impulsivity. Two distinct subgroups of patients were identified. The first subgroup had more marked cognitive impairment and fewer psychopathological symptoms than did the second subgroup of patients and the HC group. CONCLUSION Our results highlight cognitive impairment in patients with AN who had normal premorbid IQ. Two distinct profiles emerge. In clinical practice, these results open up perspectives for the development of more specific cognitive remediation programs (one specific program for cold cognitions and another specific program targeting emotions and hot cognitions). These results warrant confirmation by larger studies with a more specific evaluation of the impact of emotional status. Trial registration NTC02381639, Date of registration. March 6, 2015.
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Affiliation(s)
- J Cholet
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Rousselet
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France. .,U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", INSERM, University of Nantes and Tours, 22 Boulevard Benoni-Goullin, 44200, Nantes, France.
| | - Y Donnio
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Burlot
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Pere
- Biostatistics Unit, Research Board, Nantes University Hospital, 5 Allées de l'île Gloriette, 44093, Nantes Cedex 1, France
| | - S Lambert
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - B Rocher
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Chirio-Espitalier
- Reference Centre for Therapeutic Education and Cognitive Remediation Care (CReSERC), Psychiatry and Mental Health Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - E Eyzop
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France
| | - M Grall-Bronnec
- Clinical Investigation Unit BALANCED "BehaviorAL AddictioNs and ComplEx Mood Disorders", Addictology and Psychiatry Department, University Hospital of Nantes, 85 Rue Saint Jacques, 44093, Nantes Cedex 1, France.,U1246 SPHERE "methodS in Patient-Centered Outcomes and HEalth ResEarch", INSERM, University of Nantes and Tours, 22 Boulevard Benoni-Goullin, 44200, Nantes, France
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24
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Osorio Acuña LC, Franco Zuluaga A. Behavioural and Emotional Symptoms of Adolescents Consulting a Specialised Eating Disorders Programme. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(21)00044-5. [PMID: 33962787 DOI: 10.1016/j.rcp.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.
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Affiliation(s)
- Lucia Carolina Osorio Acuña
- Especialista en psiquiatría infantil y del adolescente, Docente del Departamento de Psiquiatría, Universidad ICESI, Fundación Valle del Lili, Cali, Colombia.
| | - Alvaro Franco Zuluaga
- Especialista en psiquiatría infantil y del adolescente, Docente de psiquiatría de la Universidad El Bosque, Bogotá, Colombia
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25
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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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26
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Hayatbini N, Knauft K, Kalia V. Cognitive reappraisal moderates the relationship between perfectionism and cognitive flexibility. J Clin Psychol 2021; 77:1685-1699. [PMID: 33608882 DOI: 10.1002/jclp.23124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Characterized by setting high standards for performance, perfectionism is a transdiagnostic process implicated in the development and maintenance of psychopathology. In contrast, cognitive flexibility is associated with enhanced mental health. Yet, the relationship between perfectionism and cognitive flexibility is understudied. We examined the relationship between perfectionism and cognitive flexibility, and whether emotion regulation strategies moderated the association between them. METHOD Adult participants (N = 486) were recruited online and completed questionnaires on perfectionism, emotion regulation and cognitive flexibility. RESULTS Perfectionism negatively correlated with one of the two aspects of cognitive flexibility assessed. Reappraisal, but not suppression, moderated the relationship between perfectionism and flexibility. CONCLUSIONS Results indicate that perfectionism is associated with inflexible appraisal of everyday challenges. Additionally, cognitive reappraisal attenuates the negative relationship between perfectionism and cognitive flexibility; except in individuals with high narcissistic perfectionism for whom the debilitating relationship between the two variables is enhanced by reappraisal.
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Affiliation(s)
| | | | - Vrinda Kalia
- Psychology Department, Miami University, Oxford, Ohio
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27
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Miles S, Gnatt I, Phillipou A, Nedeljkovic M. Cognitive flexibility in acute anorexia nervosa and after recovery: A systematic review. Clin Psychol Rev 2020; 81:101905. [PMID: 32891022 DOI: 10.1016/j.cpr.2020.101905] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
Difficulties in cognitive flexibility-the ability to adapt effectively to changes in the environment and/or changing task demands-have been reported in anorexia nervosa (AN). However, findings are inconsistent across studies and it remains unclear which specific aspects of cognitive flexibility patients with AN may struggle with. This systematic review aimed to synthesise existing research on cognitive flexibility in AN and clarify differences between patients with acute AN, patients who are weight-restored and patients who are fully recovered from AN. Electronic databases were searched through to January 2020. 3,310 papers were screened and 70 papers were included in the final review. Although adults with acute AN performed worse in perceptual flexibility tasks and self-report measures compared to HCs, they did not exhibit deficits across all domains of cognitive flexibility. Adolescents with acute AN did not differ to HCs in performance on neurocognitive tasks despite self-reporting poorer cognitive flexibility. Overall, significant differences in cognitive flexibility between acute and recovered participants was not evident, though, the findings are limited by a modest number of studies. Recovered participants performed poorer than HCs in some neurocognitive measures, however, results were inconsistent across studies. These results have implications for the assessment of cognitive flexibility in AN and targeted treatment approaches.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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28
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Neuser MP, Kühnel A, Svaldi J, Kroemer NB. Beyond the average: The role of variable reward sensitivity in eating disorders. Physiol Behav 2020; 223:112971. [DOI: 10.1016/j.physbeh.2020.112971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 01/13/2023]
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29
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Saure E, Laasonen M, Lepistö-Paisley T, Mikkola K, Ålgars M, Raevuori A. Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:1056-1079. [PMID: 32181530 DOI: 10.1002/eat.23259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Laasonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Katri Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Monica Ålgars
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Åbo Akademi University, Department of Psychology, Åbo Akademi Fakulteten för humaniora psykologi och teologi, Turku, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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30
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Di Lodovico L, Gorwood P. The relationship between moderate to vigorous physical activity and cognitive rigidity in anorexia nervosa. Psychiatry Res 2020; 284:112703. [PMID: 31813596 DOI: 10.1016/j.psychres.2019.112703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
A drive for physical activity despite underweight is a core feature of anorexia nervosa. This pilot study detects which aspect of physical activity, if any, could be related to cognitive rigidity in anorexia nervosa. Twenty-eight outpatients with anorexia nervosa and 24 healthy participants were assessed for cognitive flexibility with the Trail Making Test (TMT) and for multiple dimensions of physical activity by subjective and objective assessments. Correlation analysis was conducted to disentangle the relationship between cognitive rigidity and the different aspects of physical activity, then, the moderating effect of anorexia nervosa on this relationship was assessed. A principal component analysis was performed to incorporate all variables of physical activity in (a) global factor(s) reflecting the multidimensional nature of this construct. Cognitive rigidity (TMT b - a score) was significantly correlated to the amount of objectively assessed physical activity estimated, only in the sample of patients with anorexia nervosa. The principal component analysis confirms the correlation between a single construct of "physical activity" and cognitive rigidity in anorexia nervosa only. This pilot study suggests a relationship between cognitive rigidity and physical activity that could help explain the persistence of the latter despite ongoing malnutrition in patients with anorexia nervosa.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
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31
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Calati R, Nemeroff CB, Lopez-Castroman J, Cohen LJ, Galynker I. Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper. Int J Neuropsychopharmacol 2019; 23:192-205. [PMID: 31781761 PMCID: PMC7171927 DOI: 10.1093/ijnp/pyz063] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There has been increasing interest in both suicide-specific diagnoses within the psychiatric nomenclature and related biomarkers. Because the Suicide Crisis Syndrome-an emotional crescendo of several interrelated symptoms-seems to be promising for the identification of individuals at risk of suicide, the aim of the present paper is to review the putative biological underpinnings of the Suicide Crisis Syndrome symptoms (entrapment, affective disturbance, loss of cognitive control, hyperarousal, social withdrawal). METHODS A PubMed literature search was performed to identify studies reporting a link between each of the 5 Suicide Crisis Syndrome symptoms and biomarkers previously reported to be associated with suicidal outcomes. RESULTS Disturbances in the hypothalamic-pituitary-adrenal axis, with dysregulated corticotropin-releasing hormone and cortisol levels, may be linked to a sense of entrapment. Affective disturbance is likely mediated by alterations in dopaminergic circuits involved in reward and antireward systems as well as endogenous opioids. Loss of cognitive control is linked to altered neurocognitive function in the areas of executive function, attention, and decision-making. Hyperarousal is linked to autonomic dysregulation, which may be characterized by a reduction in both heart rate variability and electrodermal activity. Social withdrawal has been associated with oxytocin availability. There is also evidence that inflammatory processes may contribute to individual Suicide Crisis Syndrome symptoms. CONCLUSION The Suicide Crisis Syndrome is a complex syndrome that is likely the consequence of distinct changes in interconnected neural, neuroendocrine, and autonomic systems. Available clinical and research data allow for development of empirically testable hypotheses and experimental paradigms to scrutinize the biological substrates of the Suicide Crisis Syndrome.
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Affiliation(s)
- Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychology, University of Milan-Bicocca, Milan, Italy,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,Correspondence: Raffaella Calati, PsyD, PhD, Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, Italy ()
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas Dell Medical School, Austin, Texas
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
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32
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Dumb or smart asses? Donkey's (Equus asinus) cognitive capabilities share the heritability and variation patterns of human's (Homo sapiens) cognitive capabilities. J Vet Behav 2019. [DOI: 10.1016/j.jveb.2019.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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33
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Hayatbini N, Oberle CD. Are orthorexia nervosa symptoms associated with cognitive Inflexibility? Psychiatry Res 2019; 271:464-468. [PMID: 30544072 DOI: 10.1016/j.psychres.2018.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
This study investigated whether symptoms of orthorexia nervosa, a conjectured disorder characterized by obsessive thoughts and compulsive behaviors regarding healthy eating, are associated with cognitive inflexibility. Participants (25 in the orthorexia symptoms group, 25 in the control group) completed the Eating Habits Questionnaire and computerized versions of the Wisconsin Card Sorting Test and the Trail Making Test. Of the 11 variable measurements from these cognitive tests, only one significantly differed between the groups, with the orthorexia symptoms group making more errors than the control group on the first part of the Trail Making Test that does not actually require any set shifting. These results suggest that although orthorexia is associated with inflexible thoughts and behaviors specific to healthy eating, the condition does not seem to be associated with cognitive inflexibility as an executive function deficit.
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Affiliation(s)
- Niki Hayatbini
- Department of Psychology, Texas State University, 601 University Drive, San Marcos, TX, USA
| | - Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Drive, San Marcos, TX, USA.
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