The role of self-monitoring metacognition sub-function and negative urgency related to binge severity

Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study

Background

Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA).

Method

A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles.

Results

A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment.

Conclusion

This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.

Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review

Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.

Impaired Metacognitive Differentiation, High Difficulty in Controlling Impulses and Non-acceptance of Emotions are Associated With the Severity of Gambling Disorder

The role of metacognition in gambling disorder (GD) is underexplored. To date, only two studies have investigated the role of metacognitive functioning, but among the adolescent population. The first aim of the current research was to assess and compare adult male gamblers with healthy controls (HCs) in relation to metacognition, impulsivity and emotional dysregulation. The second aim was to identify the variables among metacognition, impulsivity and emotional dysregulation associated with the severity of GD by means of linear regression.A total of 116 adult males (58 with GD and 58 HCs) completed self-report questionnaires on gambling severity, metacognition, emotional dysregulation and impulsivity. A linear regression analysis was run to assess the variables associated with gambling severity.Patients with GD exhibited more impaired scores than HCs in all the psychopathological dimensions investigated. More interestingly, gambling severity was significantly associated with metacognitive differentiation/decentration, difficulty in controlling impulses and non-acceptance of negative emotions.According to our results, the severity of gambling is associated with impaired metacognitive differentiation, high difficulty in controlling impulses and non-acceptance of negative emotions, and these findings can lead to new treatment implications. Interventions focused on metacognition and emotion regulation could help patients with GD to avoid maladaptive strategies such as behavioural addictions and, more specifically, to manage their own emotions. This type of treatment could help gamblers to become more aware of their internal state and learn strategies for adaptively managing emotions through functional metacognitive differentiation.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Exploring Correlates of Loss of Control Eating in a Nonclinical Sample

OBJECTIVE

Loss of control (LOC) eating has been directly related to the core aspects of the psychopathology of eating disorders and to different dimensions of emotion and behavior regulation and self-criticism. This study investigates a model representing the interplay between these dimensions to understand LOC eating among a nonclinical sample.

METHODS

A total of 341 participants, recruited in a college campus (mean age 23.21, SD = 6.02), completed a set of self-report measures assessing LOC eating, weight suppression, psychopathology of eating disorders, depression, negative urgency, emotion regulation difficulties, and self-criticism. Path analysis modeling tested a hypothesized model with 3 paths for LOC eating as follows: (1) psychopathology of eating disorders; (2) emotion and behavior regulation; and (3) interplay between these paths.

RESULTS

We found goodness-of-fit indexes to our data: χ2 = 17.11, df = 10, Comparative Fit Index (CFI) = 0.99, Tucker-Lewis index (TLI) = 0.98, Root Mean Square Error Approximation (RMSEA) = 0.045, Standardized Root Mean Square Residual (SRMR) = 0.041, suggesting that: (1) participants with higher weight suppression showed higher degrees of the psychopathology of eating disorders, which was linked to higher levels of LOC eating; (2) self-criticism was a mediator between emotion regulation and depression/negative urgency; (3) self-criticism was a mediator between emotion regulation and disorder eating, which was significantly associated with LOC eating via increased negative urgency.

CONCLUSION

Our model shows that LOC eating occurs for individuals with the psychopathology of higher eating disorders who experience depressive symptoms and act rashly under distress for their inability to cope adequately with negative feelings of self-devaluation. These findings point to the importance of negative self-evaluations and feelings of inadequacy or worthlessness to understand LOC eating among college students.

Association Between Parental Educational Attainment and Children's Negative Urgency: Sex Differences

Background and aims

Negative urgency reflects a specific facet of impulsivity and correlates with a wide range of health-related risk behaviors, including, but not limited to, problematic substance use. Negative urgency is also shaped by family socioeconomic position (SEP), such as parental educational attainment (PEA). This study aimed to explore sex differences regarding protective effects of PEA on children's negative urgency in the US.

Methods

This cross-sectional study used the Adolescent Brain Cognitive Development (ABCD) study data. Baseline ABCD data included 10,535 American children in the age range of 9-10 years old. The independent variable was PEA, treated as a 5-level categorical variable. The primary outcome was negative urgency measured by the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). Mixed-effects regression models were applied for data analysis.

Results

In sex-stratified regression models, high PEA was predictive of lower levels of negative urgency in female but not male children. In the overall sample, sex showed a statistically significant interaction with PEA on children's negative urgency, indicating a stronger protective effect of high PEA for female compared to male children.

Conclusion

PEA was a more salient determinant of negative urgency in female children than male ones. Our results also showed that American boys tend to have high levels of negative urgency, which is a risk factor of drug use, at all parental education levels.

The neural correlates of delay discounting in obesity and binge eating disorder

BACKGROUND AND AIMS

Increased delay discounting is associated with obesity and binge eating disorder (BED). Although BED and obesity frequently co-occur, the neural mechanisms underlying delay discounting in these conditions remain poorly understood.

METHODS

Thirtyfive women with obesity, including 10 participants with obesity and BED and 31 controls completed a monetary delay discounting task during functional magnetic resonance imaging.

RESULTS

We identified that increased discounting rates were associated with decreased activity in the left anterior insula in participants with obesity compared to controls when choosing immediate rewards over delayed rewards (PFWE < 0.05). An exploratory analysis comparing the BED subsample to the other groups did not detect significant differences.

DISCUSSION AND CONCLUSIONS

Our findings suggest decreased activity in the anterior insula may underlie heightened delay discounting in individuals with obesity, contributing the probability of choosing immediate rewards over delayed rewards based on emotional states. Future studies including larger, more diverse samples are required to confirm these effects.

Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study

BACKGROUND

This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions.

METHODS

A total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index.

RESULTS

Impaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network.

CONCLUSIONS

According to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.

Racial Variation in the Association between Positive Urgency and Body Mass Index among American Children

Background

Positive urgency reflects a specific facet of impulsivity and correlates with several health-related risk behaviors such as obesity, food addiction, and substance use. However, less is known about whether positive urgency is similarly or differently associated with high body mass index (BMI) across diverse racial groups.

Aim

The aim of this study was to investigate racial differences in the associations between positive urgency and BMI in 9-10-year-old children in the US.

Materials and Methods

This cross-sectional study used the Adolescent Brain Cognitive Development (ABCD) study data. Participants were 11590 American children between ages 9 and 10 years old. The independent variable was positive urgency measured by the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). The primary outcome was BMI. Race was the moderator. Demographic variables (age and sex) were covariates. Mixed-effects regression models were used for data analysis to adjust for the nested nature of the ABCD data. We also used weights (propensity score) to generate nationally representative results.

Results

In the pooled sample, race showed a statistically significant interaction with positive urgency on children's BMI, indicating a stronger effect of positive urgency on BMI for White children, compared to African American children.

Conclusion

The association between positive urgency and BMI seems to be weaker in African American children than in White American children. The role of individual-level risk factors such as impulsive traits may be smaller for African American than White American children. Future research should study the role of obesogenic environments and other area -level indicators in altering the effects of individual-level risk factors on BMI and obesity.

Racial Variation in the Association between Suicidal History and Positive and Negative Urgency among American Children

BACKGROUND

Positive and negative urgency reflect specific facets of impulsivity and correlate with several health-related risk behaviors such as aggression, substance use, and suicide. Less is known about how positive and negative urgency are associated with suicidal behaviors of diverse racial groups.

AIM

To investigate racial differences in the positive associations between positive and negative urgency and suicide in children in US.

MATERIALS AND METHODS

This longitudinal study used the Adolescent Brain Cognitive Development (ABCD) study. Participants were 10535 American children between ages 9 and 10 years old who were followed for up to one year. The independent variable was suicide history. The primary outcomes were the positive and negative urgency measured by the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior Scale (UPPS-SS). Mixed-effects regression models were used for data analysis.

RESULTS

In the overall sample, suicidality was associated with positive and negative urgency in children. Race showed a statistically significant interaction with suicidality on children's positive and negative urgency, indicating stronger effects of suicidality on positive and negative urgency for White, compared to Black and Other/Mixed race children respectively.

CONCLUSION

The effects of positive and negative urgency for suicidality of American children depend on race. White American children show the strongest links between positive and negative urgency and risk of suicide, while the effects of positive and negative urgency on children suicide are weaker for Black and Other/Mixed race children.