1
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Wong VZ, Lowe MR. Is there a basis for a weight cut-off point? A large-scale investigation of atypical anorexia and anorexia nervosa subtypes among patients at a residential treatment centre. EUROPEAN EATING DISORDERS REVIEW 2024; 32:641-651. [PMID: 38383957 DOI: 10.1002/erv.3077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE There is debate surrounding how to differentiate between anorexia nervosa (AN) and atypical AN (atypAN) as diagnostic entities, and whether a distinction based on BMI is warranted. Better understanding eating disorder (ED) and emotional symptoms across atypAN and AN subtypes [AN-restricting (AN-R), AN-binge/purge (AN-BP)], with and without controlling for BMI, can elucidate how atypAN differs from AN subtypes and whether there is a basis for a BMI cut-off. METHODS 1810 female patients at an ED treatment centre completed intake surveys. ANCOVAs assessed differences across AN-R (n = 853), AN-BP (n = 726), and atypAN (n = 231) groups on ED, depressive, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness, with and without controlling for BMI. RESULTS Relative to AN-R, atypAN and AN-BP groups endorsed significantly higher ED and depressive symptoms, anxiety sensitivity, experiential avoidance, and significantly lower mindfulness (all p < 0.001), but atypAN and AN-BP groups did not differ from one another. When controlling for BMI, all previously significant differences between atypAN and AN-R did not remain significant. CONCLUSION Individuals with atypAN who have a higher BMI experience more pronounced ED and emotional symptoms, suggesting that relying solely on BMI as a marker of illness severity may be problematic.
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Affiliation(s)
- Valerie Z Wong
- Rutgers, The State University of New Jersey, Department of Psychology, Piscataway, New Jersey, USA
| | - Michael R Lowe
- Drexel University, Department of Psychological & Brain Sciences, Philadelphia, Pennsylvania, USA
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2
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Philippe FL, Carbonneau N, Fortin A, Guilbault V, Bouizegarene N, Antunes JM, Chua SN. Toward a memory perspective on eating psychopathology: An investigation of the types of childhood and adolescence memories that are associated with eating disorder symptoms. Appetite 2024; 198:107364. [PMID: 38642722 DOI: 10.1016/j.appet.2024.107364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
The cognitive mechanisms through which specific life events affect the development and maintenance of eating disorders (ED) have received limited attention in the scientific literature. The present research aims to address this gap by adopting a memory perspective to explore the type of life events associated with eating psychopathology and how these events are encoded and reconstructed as memories. Two studies (n = 208 and n = 193) were conducted to investigate the relationship between specific memories and eating disorder psychopathology. Study 1 focused on parent-related memories, while Study 2 examined childhood/adolescence memories. Results from both studies revealed that need thwarting and shame in memories were associated with eating disorder symptoms, but only when individuals drew symbolic connections between these memories and food or eating behavior. Moreover, need thwarting and shame in such memories were associated with other eating and body image outcomes, including uncontrolled eating and body esteem. These results also held after controlling for a host of known predictors of eating disorder psychopathology, such as BMI, perfectionism, or thin ideal internalization. Overall, the present findings suggest that the reprocessing of memories symbolically and idiosyncratically linked to food and eating behavior might be a fruitful clinical intervention.
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3
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Martinelli MK, Schreyer CC, Vanzhula IA, Guarda AS. Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program. Front Psychiatry 2024; 15:1325252. [PMID: 38832324 PMCID: PMC11145411 DOI: 10.3389/fpsyt.2024.1325252] [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: 10/20/2023] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited. Methods Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout. Results Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge. Conclusion Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.
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Affiliation(s)
- Mary K. Martinelli
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Soodla HL, Soidla K, Akkermann K. Reading tea leaves or tracking true constructs? An assessment of personality-based latent profiles in eating disorders. Front Psychiatry 2024; 15:1376565. [PMID: 38807687 PMCID: PMC11130490 DOI: 10.3389/fpsyt.2024.1376565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background Eating disorder (ED) subtyping studies have often extracted an undercontrolled, an overcontrolled and a resilient profile based on trait impulsivity and perfectionism. However, the extent to which methodological choices impact the coherence and distinctness of resulting subtypes remains unclear. Objective In this paper, we aimed to assess the robustness of these findings by extracting personality-based subtypes on a sample of ED patients (N = 221) under different analytic conditions. Methods We ran four latent profile analyses (LPA), varying the extent to which we constrained variances and covariances during model parametrization. We then performed a comparative analysis also including state ED symptom measures as indicators. Finally, we used cross-method validation via k-means clustering to further assess the robustness of our profiles. Results Our results demonstrated a four-profile model based on variances in impulsivity and perfectionism to fit the data well. Across model solutions, the profiles with the most and least state and trait disturbances were replicated most stably, while more nuanced variations in trait variables resulted in less consistent profiles. Inclusion of ED symptoms as indicator variables increased subtype differentiation and similarity across profiles. Validation cluster analyses aligned most with more restrictive LPA models. Conclusion These results suggest that ED subtypes track true constructs, since subtypes emerged method-independently. We found analytic methods to constrain the theoretical and practical conclusions that can be drawn. This underscores the importance of objective-driven analytic design and highlights its relevance in applying research findings in clinical practice.
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Affiliation(s)
- Helo Liis Soodla
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
| | - Kärol Soidla
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
| | - Kirsti Akkermann
- Institute of Psychology, University of Tartu, Tartu, Estonia
- Centre for Cognitive and Behavioural Therapy, Tartu, Estonia
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Kiser ET, Sinclair KL, Tullos EA, Ratcliff CG. Associations between disordered eating and body focused repetitive behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1184-1191. [PMID: 35549835 DOI: 10.1080/07448481.2022.2070713] [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: 05/26/2021] [Revised: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objective: College students with disordered eating (DE) are at increased risk of body focused repetitive behaviors (BFRBs). Both DE and BFRBs are described as impulsive and compulsive. However, the associations of impulsive DE with impulsive BFRBs and compulsive DE with compulsive BFRBs have not been examined. Methods: 191 college-aged students completed a survey of BFRBs and DE. Results: Participants who reported hair pulling were twice as likely to report clinically significant DE than those who denied hair pulling (p = .022). Participants who endorsed distressing hair pulling (p = .026), skin picking (p = .052), and nail biting (p = .094) were twice as likely to report clinically significant DE than those who were not distressed by these behaviors. Evidence did not support the association of BFRBs and DE along an impulsive/compulsive continuum. Conclusions: Results suggest that BFRBs and DE often co-occur, and the role of impulsivity and compulsivity in these behaviors is complex.
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Affiliation(s)
- Emalee T Kiser
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Kelsey L Sinclair
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
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6
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Bevione F, Martini M, Toppino F, Longo P, Abbate-Daga G, Brustolin A, Panero M. Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls. Nutrients 2024; 16:1156. [PMID: 38674849 PMCID: PMC11054498 DOI: 10.3390/nu16081156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.
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Affiliation(s)
| | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, via Cherasco 15, 10126 Turin, Italy; (F.B.); (M.M.); (F.T.); (P.L.); (A.B.); (M.P.)
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7
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Kirkpatrick RH, Breton E, Biorac A, Munoz DP, Booij L. Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis. Int J Eat Disord 2024; 57:223-248. [PMID: 38041221 DOI: 10.1002/eat.24088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis. METHOD Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot. RESULTS 79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies. DISCUSSION Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study. PUBLIC SIGNIFICANCE This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.
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Affiliation(s)
- Ryan H Kirkpatrick
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Edith Breton
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Aleksandar Biorac
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated Health and Social Services Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Quebec, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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8
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Mattavelli G, Gorrino I, Tornaghi D, Canessa N. Cognitive and motor impulsivity in the healthy brain, and implications for eating disorders and obesity: A coordinate-based meta-analysis and systematic review. Cortex 2024; 171:90-112. [PMID: 37984247 DOI: 10.1016/j.cortex.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/10/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
Alterations in the impulse-control balance, and in its neural bases, have been reported in obesity and eating disorders (EDs). Neuroimaging studies suggest a role of fronto-parietal networks in impulsive behaviour, with evaluation and anticipatory processes additionally recruiting meso-limbic regions. However, whether distinct facets of cognitive and motor impulsivity involve common vs. specific neural correlates remains unclear. We addressed this issue through Activation Likelihood Estimation (ALE) meta-analyses of fMRI studies on delay discounting (DD) and go/no-go (GNG) tasks, alongside conjunction and subtraction analyses. We also performed systematic reviews of neuroimaging studies using the same tasks in individuals with obesity or EDs. ALE results showed consistent activations in the striatum, anterior/posterior cingulate cortex, medial/left superior frontal gyrus and left supramarginal gyrus for impulsive choices in DD, while GNG tasks elicited mainly right-lateralized fronto-parietal activations. Conjunction and subtraction analyses showed: i) common bilateral responses in the caudate nucleus; ii) DD-specific responses in the ventral striatum, anterior/posterior cingulate cortex, left supramarginal and medial frontal gyri; iii) GNG-specific activations in the right inferior parietal cortex. Altered fronto-lateral responses to both tasks are suggestive of dysfunctional cortico-striatal balance in obesity and EDs, but these findings are controversial due to the limited number of studies directly comparing patients and controls. Overall, we found evidence for distinctive neural correlates of the motor and cognitive facets of impulsivity: the right inferior parietal lobe underpins action inhibition, whereas fronto-striatal regions and the left supramarginal gyrus are related to impulsive decision-making. While showing that further research on clinical samples is required to better characterize the neural bases of their behavioural changes, these findings help refining neurocognitive model of impulsivity and highlight potential translational implications for EDs and obesity treatment.
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Affiliation(s)
- Giulia Mattavelli
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy; Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
| | - Irene Gorrino
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
| | - Diana Tornaghi
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
| | - Nicola Canessa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy; Cognitive Neuroscience Laboratory of Pavia Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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9
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Reivan Ortiz GG, Campoverde X, Vinañzaca J, Estrada J, Yanza R, Granero R. Factors increasing the risk for food addiction in Ecuadorian students. Front Psychiatry 2024; 14:1214266. [PMID: 38234363 PMCID: PMC10792013 DOI: 10.3389/fpsyt.2023.1214266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/06/2023] [Indexed: 01/19/2024] Open
Abstract
Background Food addiction (FA) is a construct that has gained interest in recent years, but its relevance in the Ecuadorian population has not yet been explored. The aims of this study were to explore the differences in the psychological profile (including FA) between university students from Ecuador and to identify the underlying structure of the relationships of the FA severity level through a mediational model. Methods The sample consisted of 972 university students, women and men (mean age: 20.1 years old, SD = 2.6), recruited from four Ecuadorian regions. The assessment tools included a unidimensional scale of FA, eating-related measures, emotion regulation state, impulsivity, and psychopathology state. Path analysis modeled the direct and indirect effects explaining the FA severity level. Results The results indicated that higher psychopathological levels were associated with FA. Similarly, no differences in FA were observed between the Ecuadorian regions. The path analysis suggested that older age, female sex, and higher difficulties in emotional regulation, impulsivity, negative mood, and anxiety trigger disordered eating; subsequently, more impaired eating behavior impacted the FA level. Conclusion FA is a complex clinical entity that includes multiple components related to eating disorders (EDs) and other mental health problems. The results of this study provide empirical knowledge for designing evidence-based prevention and treatment strategies.
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Affiliation(s)
- Geovanny Genaro Reivan Ortiz
- Laboratory of Basic Psychology, Behavioral Analysis, and Programmatic Development (PAD-LAB), Catholic University of Cuenca, Cuenca, Ecuador
| | | | - Juan Vinañzaca
- Laboratory of Basic Psychology, Behavioral Analysis, and Programmatic Development (PAD-LAB), Catholic University of Cuenca, Cuenca, Ecuador
| | - Johanna Estrada
- Laboratory of Basic Psychology, Behavioral Analysis, and Programmatic Development (PAD-LAB), Catholic University of Cuenca, Cuenca, Ecuador
| | - Rafael Yanza
- Catholic University of Cuenca, Cuenca, Azuay, Ecuador
| | - Roser Granero
- Autonomous University of Barcelona, Barcelona, Spain
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Riva A, Bizzi F, Borgatti R, Mensi M, Charpentier Mora S, Di Guardo S, Nacinovich R. Family functioning of adolescents with restrictive eating disorders with or without nonsuicidal self-injury. Clin Psychol Psychother 2024; 31:e2955. [PMID: 38356195 DOI: 10.1002/cpp.2955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
Family influence is a crucial factor in the onset and maintenance of eating disorders. Nonsuicidal self-injury (NSSI) and restrictive eating disorders (REDs) co-occur in a significant percentage of subjects but family functioning of these families remains underexplored. This study examines the family functioning perceptions of 80 families with adolescents experiencing RED, comparing those with and without NSSI, alongside a control group, utilising the FACES-IV assessment. The study also aims to compare the triadic (adolescent-mother-father) perception of family functioning in the three groups. The results reveal distinct family dynamics in adolescents with both RED and NSSI, marked by problematic functioning perceptions from all family members and low parental agreement. A further understanding of the family functioning of adolescents with RED with NSSI can help clinicians in defining the treatment setting.
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Affiliation(s)
- Anna Riva
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Mensi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation, Pavia, Italy
| | | | - Simona Di Guardo
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Cooke JT, Schmidt AT, Garos S, Littlefield AK. The Relations Between an Inventory-Based Measure of Executive Function and Impulsivity Factors in Alcohol- and Cannabis-Relevant Outcomes. Arch Clin Neuropsychol 2023; 38:1068-1081. [PMID: 37001549 DOI: 10.1093/arclin/acad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE While the lack of relation between performance- and inventory-based executive function (EF) measures is well documented, there remains ambiguity between self-report EFs and closely related constructs (e.g., impulsivity) assessed via the same method. The degree of convergence between purported EF measures with similar yet distinct constructs contain important theoretical implications for available EF assessment strategies and their construct validity. A newer measure of EF, the Behavior Regulation Inventory of Executive Functions-Adult (BRIEF-A), allows for more direct comparisons to self-reported measures of impulsivity, such as the commonly used Urgency, Planning, Perseverance, Sensation Seeking-Positive Urgency (UPPS-P) assessment. METHOD The present study used factor analysis and hierarchical regression to explore the associations between the BRIEF-A and UPPS-P, using alcohol and cannabis consumption across various outcomes (i.e., quantity-frequency and consequences) as an external criterion. Participants were 339 undergraduate students (Mage = 19.35; Female = 63%) from a large southwestern university. RESULTS The BRIEF-A and UPPS-P demonstrated strong correlations at both higher- and lower order facets. While the BRIEF-A was a significant correlate to many substance use outcomes, these relations were generally weaker than those seen with the UPPS-P. Hierarchical regression suggested limited contributions of the BRIEF-A over and above the UPPS-P. CONCLUSIONS Overall, this study suggested substantial overlap between impulsigenic factors and EFs when measured by self-report, and limited utility of EF measures to account for unique variance with substance use outcomes in this sample.
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Affiliation(s)
- Jeffrey T Cooke
- Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, Texas 79409, USA
| | - Adam T Schmidt
- Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, Texas 79409, USA
| | - Sheila Garos
- Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, Texas 79409, USA
| | - Andrew K Littlefield
- Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, Texas 79409, USA
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Schaefer LM, Forester G, Dvorak RD, Steinglass J, Wonderlich SA. Integrating aspects of affect, reward, and cognition to develop more comprehensive models of binge-eating pathology. Int J Eat Disord 2023; 56:1502-1510. [PMID: 37084184 PMCID: PMC10681362 DOI: 10.1002/eat.23971] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/28/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Abstract
Reward-related processes are an increasing focus of eating disorders research. Although evidence suggests that numerous distinct reward processes may contribute to eating pathology (e.g., reward learning and delay discounting), existing etiological models of reward dysfunction tend to focus on only a limited number of reward processes, and frequently lack specificity when identifying the individual reward processes hypothesized to contribute to dysregulated eating behavior. Moreover, existing theories have been limited in their integration of reward-related processes with other demonstrated risk and maintenance factors for eating disorders (e.g., affect and cognition), potentially contributing to underdeveloped models of eating pathology. In this article, we highlight five distinct reward processes with theorized or demonstrated relevance to eating disorders involving binge-eating, followed by a review of two well-established risk/maintenance factors for binge-eating pathology. We then introduce two novel models of binge eating onset and maintenance that integrate these factors (i.e., the Affect, Reward, Cognition models), and discuss methods for testing each of the models in future research. Ultimately, we hope that the proposed models provide a springboard for the continued evolution of more precise and comprehensive theories of reward dysfunction in the eating disorders, as well as the development of novel intervention approaches. PUBLIC SIGNIFICANCE STATEMENT: Eating disorders are associated with abnormalities in multiple domains of reward functioning. However, models of reward dysfunction within the eating disorders have not been well-integrated with prominent models of affect and cognition. This article presents two novel models of onset and maintenance for binge-eating pathology, which attempt to integrate observed reward abnormalities with other affective and cognitive processes implicated in binge-type eating disorders.
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Affiliation(s)
- Lauren M. Schaefer
- Center for Biobehavioral Research, Sanford Research, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, North Dakota, USA
| | - Glen Forester
- Center for Biobehavioral Research, Sanford Research, North Dakota, USA
| | - Robert D. Dvorak
- Center for Biobehavioral Research, Sanford Research, North Dakota, USA
- Department of Psychology, University of Central Florida, Orlando, Florida, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Medical Center, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Stephen A. Wonderlich
- Center for Biobehavioral Research, Sanford Research, North Dakota, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, North Dakota, USA
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Boswell RG, Gueorguieva R, Grilo CM. Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder. Psychol Med 2023; 53:2789-2797. [PMID: 34812713 PMCID: PMC9124732 DOI: 10.1017/s003329172100475x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. METHODS In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. RESULTS Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. CONCLUSIONS Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.
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Affiliation(s)
- Rebecca G Boswell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Princeton Center for Eating Disorders, Penn Medicine, Princeton, NJ, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Zheng A, Chen X, Li Q, Ling Y, Liu X, Li W, Liu Y, Chen H. Neural correlates of Type A personality: Type A personality mediates the association of resting-state brain activity and connectivity with eating disorder symptoms. J Affect Disord 2023; 333:331-341. [PMID: 37086800 DOI: 10.1016/j.jad.2023.04.063] [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: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Type A personality (TAP) was characterized by impatience, competitiveness, aggressiveness, and hostility. Higher TAP was proved to be associated with more eating disorder symptoms (EDS). While little is known about the underlying neural substrates of TAP and how TAP is linked to EDS at the neural level. METHODS To investigate the neural basis of TAP, we adopted fractional amplitude of low-frequency fluctuations (fALFF) and resting-state functional connectivity (RSFC) via resting-state functional magnetic resonance imaging (rs-fMRI) (N = 1620). Mediation models were examined to explore the relationship between TAP, EDS, and brain activity. RESULTS TAP was associated with decreased fALFF in the left middle frontal gyrus (MFG) and increased fALFF in the left precentral gyrus (PreCG). Furthermore, TAP was positively correlated to RSFC between the left MFG and left inferior temporal gyrus (ITG) and between the left PreCG and right middle temporal gyrus (MTG). Mediation analysis showed TAP fully mediated the association of the left MFG activity, MFG-ITG connectivity, and PreCG-MTG connectivity with EDS. LIMITATIONS The cross-sectional design of this study precludes us from specifying the causal relationship in the associations we observed. CONCLUSIONS Our results suggested spontaneous activity in the left MFG and PreCG is associated with TAP, and even in general sample, people with higher TAP showed more EDS. The present study is the first to investigate the neurobiological underpinnings of TAP in a large sample and further offered new insights into the relation between TAP and EDS from a neural basis perspective.
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Affiliation(s)
- Anqi Zheng
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Ximei Chen
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Qingqing Li
- School of Psychology, Central China Normal University, China
| | - Ying Ling
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Xinyuan Liu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Wei Li
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (SWU), Ministry of Education, Chongqing 400715, China; Faculty of Psychology, Southwest University, Chongqing 400715, China; Research Center of Psychology and Social Development, Chongqing 400715, China.
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15
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Arnold S, Correll CU, Jaite C. Frequency and correlates of lifetime suicidal ideation and suicide attempts among consecutively hospitalized youth with anorexia nervosa and bulimia nervosa: results from a retrospective chart review. Borderline Personal Disord Emot Dysregul 2023; 10:10. [PMID: 36998054 PMCID: PMC10064676 DOI: 10.1186/s40479-023-00216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/25/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Youth with eating disorders (EDs) face an increased risk of a premature suicide death. Precursors of completed suicide are suicidal ideation and suicide attempts, which need to be well understood to prevent suicide. However, epidemiological data on the lifetime prevalence and clinical correlates of suicidal ideation and suicide attempts (i.e., "suicidality") are lacking for the vulnerable group of inpatient ED youth. METHODS This retrospective chart review was conducted at a psychiatric child and adolescent inpatient department, covering a 25-year period. Consecutively hospitalized youth with an ICD-10 diagnosis of anorexia nervosa (AN), restricting type (AN-R), binge-purging type (AN-BP), and bulimia nervosa (BN) were included. Data extraction and coding were standardized with trained raters extracting information from patient records according to a procedural manual and using a piloted data extraction template. The lifetime prevalence of suicidal ideation and suicide attempts was calculated for each ED subgroup, and clinical correlates of suicidality were analyzed via multivariable regression analyses. RESULTS In the sample of 382 inpatients aged 9-18 years (median age = 15.6, females = 97.1%; AN-R: n = 242, BN: n = 84, AN-BP: n = 56), 30.6% of patients had lifetime suicidal ideation (BN:52.4% ≈ AN-BP:44.6% > AN-R:19.8%, χ2(2,382) = 37.2, p < 0.001, Φ = 0.31), and 3.4% of patients reported a history of suicide attempts (AN-BP:8.9% ≈ BN:4.8% > AN-R:1.7%, χ2(2,382) = 7.9, p = 0.019, Φ = 0.14). Independent clinical correlates of suicidality were i) for AN-R a higher number of psychiatric comorbidities (OR = 3.02 [1.90, 4.81], p < 0.001), and body weight < 1st BMI percentile at hospital admission (OR = 1.25 [1.07,1.47], p = 0.005) (r2 = 0.20); ii) for AN-BP patients a higher number of psychiatric comorbidities (OR = 3.68 [1.50, 9.04], p = 0.004) and history of childhood abuse (OR = 0.16 [0.03, 0.96], p = 0.045) (r2 = 0.36), and iii) for BN patients a higher prevalence of non-suicidal self-injury (NSSI)(OR = 3.06 [1.37, 6.83], p = 0.006) (r2 = 0.13). CONCLUSIONS About half of youth inpatients with AN-BP and BN had lifetime suicidal ideation, and one-tenth of patients with AN-BP had attempted suicide. Treatment programs need to address specific clinical correlates of suicidality, namely, low body weight, psychiatric comorbidities, history of childhood abuse, and NSSI. TRIAL REGISTRATION This study was not a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants; however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of intervention in participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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16
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Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, Maguire S. Risk factors for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:8. [PMID: 36650572 PMCID: PMC9847054 DOI: 10.1186/s40337-022-00717-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/04/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Risk factors represent a range of complex variables associated with the onset, development, and course of eating disorders. Understanding these risk factors is vital for the refinement of aetiological models, which may inform the development of targeted, evidence-based prevention, early intervention, and treatment programs. This Rapid Review aimed to identify and summarise research studies conducted within the last 12 years, focusing on risk factors associated with eating disorders. METHODS The current review forms part of a series of Rapid Reviews to be published in a special issue in the Journal of Eating Disorders, funded by the Australian Government to inform the development of the National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2021, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, or population studies). Data pertaining to risk factors for eating disorders were synthesised and outlined in the current paper. RESULTS A total of 284 studies were included. The findings were divided into nine main categories: (1) genetics, (2) gastrointestinal microbiota and autoimmune reactions, (3) childhood and early adolescent exposures, (4) personality traits and comorbid mental health conditions, (5) gender, (6) socio-economic status, (7) ethnic minority, (8) body image and social influence, and (9) elite sports. A substantial amount of research exists supporting the role of inherited genetic risk in the development of eating disorders, with biological risk factors, such as the role of gut microbiota in dysregulation of appetite, an area of emerging evidence. Abuse, trauma and childhood obesity are strongly linked to eating disorders, however less conclusive evidence exists regarding developmental factors such as role of in-utero exposure to hormones. Comorbidities between eating disorders and mental health disorders, including personality and mood disorders, have been found to increase the severity of eating disorder symptomatology. Higher education attainment, body image-related factors, and use of appearance-focused social media are also associated with increased risk of eating disorder symptoms. CONCLUSION Eating disorders are associated with multiple risk factors. An extensive amount of research has been conducted in the field; however, further studies are required to assess the causal nature of the risk factors identified in the current review. This will assist in understanding the sequelae of eating disorder development and in turn allow for enhancement of existing interventions and ultimately improved outcomes for individuals.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia. .,Faculty of Medicine and Health, Charles Perkins Centre (D17), InsideOut Institute, University of Sydney, Level 2, Sydney, NSW, 2006, Australia.
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | | | - Stephen Touyz
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Sydney, Australia
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17
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Criscuolo M, Marchetto C, Buzzonetti A, Castiglioni MC, Cereser L, Salvo P, Zanna V. Parental Emotional Availability and Family Functioning in Adolescent Anorexia Nervosa Subtypes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:68. [PMID: 36612388 PMCID: PMC9819780 DOI: 10.3390/ijerph20010068] [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: 09/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Emotional availability (EA) is a complex construct describing the emotional bond between parents and child, and it refers to support, sensitivity, warmth and closeness. Few studies have investigated the perception of parental EA and its association with dysfunctional eating pattern. The aim of the study is to explore the perception of mothers' and fathers' EA of adolescents with anorexia nervosa (AN) and any differences between the two subtypes of binge-purge (B/P) or restrictive (R) AN. Furthermore, it investigates the association of parental EA with AN symptomatology and with patients' perception of family functioning, which is identified as a maintenance factor for AN. A total of 60 adolescents between 12 and 18 years and their parents (n = 120) were recruited in two eating disorder (ED) specialized care centers. Patients completed the LEAP and the FACES IV questionnaires evaluating parental EA and family functioning, respectively. Results showed no difference between AN subtypes, but a greater perception of mother when compared to father EA was found. Moreover, the EA construct was found not to be associated with ED symptomatology but with a greater positive family functioning. Our study is the first that explores EA in AN, and results suggest the importance of considering parents' emotional engagement as part of the treatment core, together with the eating symptomatology management.
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Affiliation(s)
- Michela Criscuolo
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Childrens’ Hospital IRCCS, 00165 Rome, Italy
| | - Chiara Marchetto
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Childrens’ Hospital IRCCS, 00165 Rome, Italy
| | - Alessandra Buzzonetti
- Center for Pediatric Palliative Care, Bambino Gesù Childrens’ Hospital IRCCS, 00165 Rome, Italy
| | - Maria Chiara Castiglioni
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Childrens’ Hospital IRCCS, 00165 Rome, Italy
| | - Lucia Cereser
- Center for Eating Disorders and Weight, 30026 Portogruaro, Italy
| | - Pierandrea Salvo
- Center for Eating Disorders and Weight, 30026 Portogruaro, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Childrens’ Hospital IRCCS, 00165 Rome, Italy
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18
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Turner D, Briken P, Grubbs J, Malandain L, Mestre-Bach G, Potenza MN, Thibaut F. The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2022; 24:10-69. [PMID: 37522807 PMCID: PMC10408697 DOI: 10.1080/19585969.2022.2134739] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/18/2022] [Accepted: 10/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. METHODS An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. RESULTS Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. CONCLUSIONS An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.
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Affiliation(s)
- Daniel Turner
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joshua Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Leo Malandain
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
| | - Gemma Mestre-Bach
- Facultad de Ciencias de la Salud, Universidad Internacional de La Rioja, La Rioja, Spain
| | - Marc N. Potenza
- Departments of Psychiatry and Neuroscience and Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Connecticut Mental Health Center, New Haven, CT, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, USA
- Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Florence Thibaut
- Department of Psychiatry and Addictive Disorders, University Hospital Cochin (site Tarnier) AP-HP, Paris, France
- INSERM U1266, Institute of Psychiatry and Neurosciences, University of Paris Cité, Paris, France
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19
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Blake K, Portingale J, Giles S, Griffiths S, Krug I. Dating app usage and motivations for dating app usage are associated with increased disordered eating. J Eat Disord 2022; 10:186. [PMID: 36443873 PMCID: PMC9706906 DOI: 10.1186/s40337-022-00693-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/23/2022] [Indexed: 11/30/2022] Open
Abstract
The centrality of physical appearance in dating app environments may constitute an appearance-related pressure that increases the likelihood of body dissatisfaction (BD) and disordered eating (DE), thus exacerbating the relationship between DE-predictive traits and DE itself. Although dating app use has been linked to BD and DE, prior research has also neglected the role of individuals' dating app use motivations and relevant traits in eating pathology. To address these gaps, the current study investigated whether dating app usage moderated the effects of appearance-based rejection sensitivity, fear of negative evaluation, emotion dysregulation, and perceived social rank on DE. We also examined the unique effects of individuals' dating app use motivations on DE. Participants (N = 690) completed baseline measures of demographic and trait variables including dating app usage. DE was positively associated with female gender, higher body mass index, a history of eating disorder (ED) diagnosis, appearance-based rejection sensitivity, and emotion dysregulation. There was a small, positive association between dating app usage and DE, indicating that dating app users were more likely to report DE symptoms, appearance-based rejection sensitivity, and emotion dysregulation. No investigated predictor was moderated by dating app usage, but four of the six measured motivations for using dating apps (love, self-worth, ease of communication, and thrill of excitement motivations) were associated with DE among the dating app user sample (casual sex and trendiness motivations were not). Given that DE behaviours can lead to EDs, the present findings suggest that lifetime dating app usage may increase socio-cultural appearance pressures that confer risk for DE.
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Affiliation(s)
- K Blake
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia.,School of Biological, Earth, and Environmental Sciences, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - J Portingale
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - S Giles
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - S Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - I Krug
- Melbourne School of Psychological Sciences, University of Melbourne, Redomond Barry Builiding, Level 7, Room 707, Melbourne, VIC, 3010, Australia.
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20
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Clinical correlates and prognostic impact of binge-eating symptoms in major depressive disorder. Int Clin Psychopharmacol 2022; 37:247-254. [PMID: 35815954 PMCID: PMC9521583 DOI: 10.1097/yic.0000000000000422] [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] [Indexed: 02/04/2023]
Abstract
Binge-eating (BE) symptoms are relatively common in major depressive disorder (MDD), but their prognostic role is not fully understood. This study compared two groups of patients with MDD experiencing or not BE symptoms to ascertain differences in terms of clinical manifestations, presence of bipolar features, and antidepressant treatment outcomes. The study involved 482 outpatients collected within the Combining Medications to Enhance Depression Outcomes (CO-MED) trial, who were assessed with scales for depressive and hypomanic symptomatology, suicidality, comorbid mental disorders, and childhood traumas. BE symptoms were reported in 95 patients (20%). Patients with MDD experiencing BE symptoms were characterized by higher scores of negative self-outlook ( P = 0.0018), negative outlook of future ( P = 0.0014), irritability ( P = 0.0043), comorbid anxiety disorders (generalized anxiety disorder: P = 0.0006; panic disorder: P < 0.0001; social phobia: P < 0.0001), obsessive-compulsive disorder ( P = 0.0053), hypomanic symptoms (increased talkativeness: P = 0.0029; reduced need for sleep: P = 0.0171), and suicidality (suicidal propensity: P = 0.0013; suicidal risk: P = 0.0148; lifetime suicidal behavior: P = 0.0052). BE symptoms (OR = 2.02; 95% CI = 1.06-3.84) and depression severity (OR = 1.04; 95% CI = 1.00-1.08) were independently associated with lifetime attempted suicide. The presence of BE symptoms might indicate higher severity of depressive disorder. Suicidal risk is a major issue in these patients, whereas the association between BE and bipolar features needs further research.
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21
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Valenciano-Mendoza E, Fernández-Aranda F, Granero R, Vintró-Alcaraz C, Mora-Maltas B, Valero-Solís S, Sánchez I, Toro JJD, Gómez-Peña M, Moragas L, Jiménez-Murcia S. Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder. J Behav Addict 2022; 11:963-978. [PMID: 36287739 PMCID: PMC9881661 DOI: 10.1556/2006.2022.00072] [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: 11/18/2021] [Revised: 05/23/2022] [Accepted: 09/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD. METHODS A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated. RESULTS The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD. DISCUSSION Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder. CONCLUSIONS Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.
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Affiliation(s)
- Eduardo Valenciano-Mendoza
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Valero-Solís
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Jessica Jimenez-de Toro
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
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22
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Castellini G, Cassioli E, Rossi E, Mancini M, Ricca V, Stanghellini G. Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eat Weight Disord 2022; 27:2273-2289. [PMID: 35179727 PMCID: PMC9556383 DOI: 10.1007/s40519-022-01379-6] [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: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 10/29/2022] Open
Abstract
Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for "objective" (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons' lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive-behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since "being anorexic" becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Stanghellini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy.,Centro de Estudios de Fenomenología y Psiquiatría, Diego Portales' University, Santiago, Chile
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23
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Martin E, Dourish CT, Hook R, Chamberlain SR, Higgs S. Associations between inattention and impulsivity ADHD symptoms and disordered eating risk in a community sample of young adults. Psychol Med 2022; 52:2622-2631. [PMID: 33272332 PMCID: PMC7613803 DOI: 10.1017/s0033291720004638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/25/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms. METHODS We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, Mage = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator. RESULTS Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R2 = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R2 = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores. CONCLUSIONS These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.
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Affiliation(s)
- E. Martin
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - R. Hook
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - S. R. Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
- Department of Psychiatry, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - S. Higgs
- School of Psychology, University of Birmingham, Birmingham, UK
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24
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Nazmus Sakib M, Best JR, Ramezan R, Thompson ME, Hall PA. Bidirectional Associations Between Adiposity and Cognitive Function: A Prospective Analysis of the Canadian Longitudinal Study on Aging (CLSA). J Gerontol A Biol Sci Med Sci 2022; 78:314-325. [PMID: 35640256 PMCID: PMC9951058 DOI: 10.1093/gerona/glac115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Theoretical perspectives suggest that adiposity and cognitive function may be bidirectionally associated, but this has not been examined in a large-scale data set. The current investigation aims to fill this gap using a large, representative sample of middle-aged and older adults. METHODS Using data from the Canadian Longitudinal Study on Aging (N = 25 854), the bidirectional hypothesis was examined with 3 indicators of cognitive function (ie, executive function, processing speed, and verbal fluency) and adiposity (ie, waist circumference [WC], body mass index [BMI], and total fat mass). We used multivariate multivariable regression and structural equation modeling to assess the prospective associations between adiposity and cognitive indicators. RESULTS Analyses revealed that higher baseline WC was associated with higher Stroop interference at follow-up for both middle-aged (standardized estimate, β = 0.08, 95% confidence interval [CI] 0.06, 0.10) and older adults (β = 0.07, 95% CI 0.04, 0.09). Similarly, higher baseline Stroop interference was also associated with higher follow-up WC in middle-aged (β = 0.08, 95% CI 0.06, 0.10) and older adults (β = 0.03, 95% CI 0.01, 0.06). Effects involving semantic fluency and processing speed were less consistent. The earlier effects were similar to those observed using other adiposity indicators (eg, BMI and total fat mass) and were robust to adjustment for demographics and other cofounders, and when using latent variable modeling of the adiposity variable. CONCLUSION Evidence for a bidirectional relationship between adiposity and cognitive function exists, though the associations are most reliable for executive function and primarily evident at midlife.
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Affiliation(s)
- Mohammad Nazmus Sakib
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - John R Best
- Gerontology Research Centre, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reza Ramezan
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter A Hall
- Address correspondence to: Peter A. Hall, PhD, School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1. E-mail:
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25
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French EN, Eneva K, Arlt JM, Yiu A, Chen EY. Negative mood induction effects on problem-solving task in women with eating disorders: a multi-method examination. J Eat Disord 2022; 10:73. [PMID: 35598002 PMCID: PMC9123706 DOI: 10.1186/s40337-022-00591-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The effects of negative affect on problem-solving and its psychophysiological correlates are poorly understood in eating disorder populations. METHODS This study examined respiratory sinus arrhythmia (RSA) and skin conductance responses of women with Binge Eating Disorder (BED: n = 56), Anorexia Nervosa (AN: n = 12), Bulimia Nervosa (BN: n = 32), and 24 healthy controls (HCs) at baseline, and then during: a negative mood induction task, an adapted Means Ends Problem-Solving (MEPS) task, and recovery. The MEPS task included four interpersonal scenarios: (1) binge-eating as a solution to stress, (2) job loss, (3) rejection by friends, and (4) by a significant other. RESULTS We found that individuals with eating disorders reported less positive mood than HCs and individuals with BN and BED reported more negative mood and greater urges to binge than HCs. After a negative mood induction, women with BED provided significantly less effective problem-solving strategies compared to HCs and women with BN for the binge-eating MEPS scenario. Relative to baseline and the negative mood induction, all participants exhibited significantly higher skin conductance measures throughout the MEPS scenarios and recovery. BED showed significantly lower respiratory sinus arrhythmia (RSA) levels than individuals with BN and HCs throughout the protocol. CONCLUSIONS The multimethod findings suggest individuals with BED are likely to have disorder-specific problem-solving difficulties after a negative mood induction.
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Affiliation(s)
- Elan N French
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Kalina Eneva
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Jean M Arlt
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Angelina Yiu
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Eunice Y Chen
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
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26
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Caso JR, MacDowell KS, Soto M, Ruiz-Guerrero F, Carrasco-Díaz Á, Leza JC, Carrasco JL, Díaz-Marsá M. Dysfunction of Inflammatory Pathways and Their Relationship With Psychological Factors in Adult Female Patients With Eating Disorders. Front Pharmacol 2022; 13:846172. [PMID: 35517819 PMCID: PMC9062031 DOI: 10.3389/fphar.2022.846172] [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: 12/30/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022] Open
Abstract
The attempts to clarify the origin of eating disorders (ED) have not been completely successful and their etiopathogenesis remains unknown. Current research shows an activation of the immune response in neuropsychiatric diseases, including ED. We aimed to investigate immune response parameters in patients with ED and to identify psychological factors influencing the inflammatory response. The relationship between inflammation markers and impulsivity and affective symptomatology was explored as well. Thirty-four adult female patients with current diagnosis of ED, none of them under psychopharmacological treatment (excluding benzodiazepines), were included in this study. Patients were compared with a healthy control group of fifteen adult females. The levels of inflammatory markers and indicators of oxidative/nitrosative stress were evaluated in plasma and/or in peripheral blood mononuclear cells (PBMCs). Subjects were assessed by means of different ED evaluation tools. Additionally, the Barratt Impulsiveness Scale, the Montgomery-Asberg Depression Rating Scale and the Hamilton Anxiety Rating Scale were also employed. Patients with ED shown increased plasma levels of the pro-inflammatory nuclear factor kappa B (NFκB) and the cytokine tumor necrosis factor-alpha (TNF-α), among other factors and an increment in the oxidative/nitrosative stress as well as increased glucocorticoid receptor (GR) expression levels in their PBMCs. Moreover, the inflammatory prostaglandin E2 (PGE2) correlated with impulsiveness and the anti-inflammatory prostaglandin J2 (15d-PGJ2) correlated with depressive symptomatology. Our results point towards a relationship between the immune response and impulsiveness and between the immune response and depressive symptomatology in female adult patients with ED.
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Affiliation(s)
- Javier R Caso
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Instituto Universitario de Investigación en Neuroquímica UCM, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Karina S MacDowell
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Instituto Universitario de Investigación en Neuroquímica UCM, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marta Soto
- Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Álvaro Carrasco-Díaz
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Madrid, Spain
| | - Juan C Leza
- Departamento de Farmacología y Toxicología, Facultad de Medicina, Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), Instituto Universitario de Investigación en Neuroquímica UCM, Universidad Complutense de Madrid, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - José L Carrasco
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain
| | - Marina Díaz-Marsá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Departamento de Medicina Legal, Psiquiatría y Patología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, Madrid, Spain
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27
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Presseller EK, Wilkinson ML, Trainor C, Lampe EW, Juarascio AS. Self-regulation deficits moderate treatment outcomes in a clinical trial evaluating just-in-time adaptive interventions as an augmentation to cognitive-behavioral therapy for bulimia-spectrum eating disorders. Int J Eat Disord 2022; 55:709-716. [PMID: 35212017 PMCID: PMC9106913 DOI: 10.1002/eat.23695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: Just-in-time adaptive interventions (JITAIs), momentary interventions delivered at identified times of risk, may improve skill utilization during cognitive-behavioral therapy (CBT-E) for bulimia-spectrum eating disorders (BN-EDs). JITAIs may be especially helpful for individuals with self-regulation deficits, including emotion regulation deficits and elevated impulsivity. METHOD: Participants (N = 55 with BN-EDs) received 16 sessions of CBT-E with electronic self-monitoring and were randomized to receive JITAIs (JITAIs-On) or not receive JITAIs (JITAIs-Off). Baseline Difficulties in Emotion Regulation Scale (DERS) and UPPS-P Impulsive Behavior Scale (UPPS-P) total scores were examined as moderators of baseline to post-treatment change in binge episodes, compensatory behaviors, and Eating Disorder Examination (EDE) global score using repeated measures ANOVAs. RESULTS: Emotion regulation difficulties significantly moderated compensatory behavior change (F[1, 51] = 4.31, p = .04, ηp2 = 0.08) such that individuals with emotion regulation deficits demonstrated greater improvements in the JITAIs-On condition. Impulsivity moderated change in binge episodes (F[1, 51] = 8.94, p = .004, ηp2 = 0.15) and compensatory behaviors (F[1, 51] = 7.83, p = .007, ηp2 = 0.13), such that individuals with high impulsivity showed greater improvement in the JITAIs-On condition. Neither DERS nor UPPS-P scores moderated EDE global score change. DISCUSSION: JITAIs appear particularly beneficial for facilitating skill use during treatment for BN-EDs for individuals with self-regulation deficits, yielding improved treatment outcomes. PUBLIC SIGNIFICANCE STATEMENT: Reminders to use therapy skills that are delivered via smartphone as an individual goes about their daily life may improve treatment response among individuals with bulimia nervosa who have difficulty coping with emotions or who tend to act impulsively. Results from this study indicate that individuals with these difficulties benefitted more from cognitive-behavioral therapy when it was accompanied by in-the-moment reminders to use therapeutic skills, which may facilitate long-term recovery. CLINICAL TRIALS.GOV REGISTRATION NUMBER: NCT03673540.
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Affiliation(s)
- Emily K. Presseller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Megan L. Wilkinson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Claire Trainor
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth W. Lampe
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S. Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
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28
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Portingale J, Fuller-Tyszkiewicz M, Liu S, Eddy S, Liu X, Giles S, Krug I. Love me Tinder: The effects of women's lifetime dating app use on daily body dissatisfaction, disordered eating urges, and negative mood. Body Image 2022; 40:310-321. [PMID: 35121567 DOI: 10.1016/j.bodyim.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/31/2023]
Abstract
Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique effects of women's dating app partner preferences (i.e., seeking idealised versus non-idealised physical characteristics) on the aforementioned outcomes, and whether appearance-based rejection sensitivity (appearance-RS) moderated the effects of dating app use. Participants (N = 296; 100% women) first completed a baseline survey assessing lifetime dating app usage (i.e., current or former usage), partner preferences, and appearance-RS, followed by a 7-day smartphone-facilitated ecological investigation into momentary experiences of BD, DE urges (i.e., binge-eating/purging, dietary restraint, and exercise), and negative mood. Ninety-four women (32%) reported lifetime dating app usage, which, relative to non-use, predicted greater daily urges for binge-eating/purging and negative mood. However, appearance-RS failed to moderate these effects. Among dating app users, partner preferences were not a significant predictor of the central outcomes. These findings extend previous research by examining the unique effects of dating app use on everyday BD, DE urges, and negative mood. Replication and extension are encouraged.
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Affiliation(s)
- Jade Portingale
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia; Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Shanshan Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Eddy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Xinyue Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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29
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Tabri N, Wohl MJA. Explaining reinforcement and erroneous beliefs in pathological exercise: A commentary and expansion on Coniglio et al. (in press) using the pathways model of disordered gambling. Int J Eat Disord 2022; 55:180-183. [PMID: 34846749 DOI: 10.1002/eat.23646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022]
Abstract
Coniglio, Cooper, and Selby proposed that behavioral reinforcement may be critical for understanding the etiology and maintenance of pathological exercise among people living with anorexia nervosa. They presented three competing hypotheses about why exercise can become problematic: (a) positive reinforcement via biological and behavioral rewards, (b) negative reinforcement via avoidance of aversive states, or (c) a synergistic interplay between positive and negative reinforcement. Herein, we extend Coniglio and colleagues' framework by drawing on theory and research from the field of disordered gambling-a behavior in which reinforcement is an etiological and maintaining mechanism. We applied the pathways model of disordered gambling to the study of pathological exercise and made the following two proposals. First, pathological exercise may be driven by positive reinforcement, negative reinforcement, or both (they are not mutually exclusive), depending on the presence or absence of specific co-occurring psychopathologies. Second, erroneous beliefs about the safety and efficacy of maladaptive exercise for weight control may help maintain pathological exercise regardless of the type of reinforcement. We conclude by calling for research that assesses Coniglio and colleagues' novel hypotheses and our supposition that the pathways model can help provide a framework for those hypotheses.
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Affiliation(s)
- Nassim Tabri
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada.,Mental Health and Well-being Research and Training Hub, Carleton University, Ottawa, Ontario, Canada
| | - Michael J A Wohl
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada.,Mental Health and Well-being Research and Training Hub, Carleton University, Ottawa, Ontario, Canada
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30
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Volume and Connectivity Differences in Brain Networks Associated with Cognitive Constructs of Binge Eating. eNeuro 2022; 9:ENEURO.0080-21.2021. [PMID: 35064023 PMCID: PMC8856709 DOI: 10.1523/eneuro.0080-21.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/14/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022] Open
Abstract
Bulimia nervosa (BN) and binge eating disorder (BED) are characterized by episodes of eating large amounts of food while experiencing a loss of control. Recent studies suggest that the underlying causes of BN/BED consist of a complex system of environmental cues, atypical processing of food stimuli, altered behavioral responding, and structural/functional brain differences compared with healthy controls (HC). In this narrative review, we provide an integrative account of the brain networks associated with the three cognitive constructs most integral to BN and BED, namely increased reward sensitivity, decreased cognitive control, and altered negative affect and stress responding. We show altered activity in BED/BN within several brain networks, specifically in the striatum, insula, prefrontal cortex (PFC) and orbitofrontal cortex (OFC), and cingulate gyrus. Numerous key nodes in these networks also differ in volume and connectivity compared with HC. We provide suggestions for how this integration may guide future research into these brain networks and cognitive constructs.
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31
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Lanoye A, Adams E, Fuemmeler BF. Obesity and Attention-Deficit Hyperactivity Disorder. Curr Top Behav Neurosci 2022; 57:221-241. [PMID: 35505058 DOI: 10.1007/7854_2022_337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An association between ADHD and obesity has been established throughout the past 20 years via animal model experiments and both correlational and longitudinal studies in humans. However, much remains to be determined regarding causality, developmental course, and effective treatments targeting both conditions. This chapter provides an overview and update on the current state of the science on the relationship between obesity and ADHD; expands the scope of the connection between obesity and ADHD to include behavioral components important to weight regulation - i.e., physical activity, eating behaviors, and sleep; and presents applications of these findings to treatment approaches and future directions.
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Affiliation(s)
- Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Elizabeth Adams
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
- Research Center for Child Well-Being, University of South Carolina, Columbia, SC, USA
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
- Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA.
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32
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Awad E, Salameh P, Sacre H, Malaeb D, Hallit S, Obeid S. Association between impulsivity and orthorexia nervosa / healthy orthorexia: any mediating effect of depression, anxiety, and stress? BMC Psychiatry 2021; 21:604. [PMID: 34861836 PMCID: PMC8640965 DOI: 10.1186/s12888-021-03594-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a lack of studies investigating the possible mediating role of psychological factors, such as depression, anxiety and stress on orthorexic eating behaviors. Given that personality attributes might affect the manifestation of psychological disorders, it was hypothesized that depression, anxiety and stress mediate the relationship between impulsivity-related traits and orthorexic eating, noting that previous research had evaluated the role of depression as a mediator between impulsivity and other pathological eating behaviors. The study objectives were to explore the mediating effect of depression, anxiety, and stress, on impulsivity and orthorexia nervosa, and healthy orthorexia. METHODS This cross-sectional study conducted between July and December 2019 recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. RESULTS Our results showed that depression and anxiety were positively correlated with ON. We also found a notable gender difference in findings: higher anxiety and female gender were significantly associated with higher TOS healthy orthorexia, while higher stress was associated with lower TOS healthy orthorexia. Finally, higher urgency was associated with lower TOS healthy orthorexia, while higher perseverance was significantly associated with higher TOS healthy orthorexia. Depression and anxiety partially mediated the association between perseverance and ON while anxiety and stress partially mediated the association between urgency and healthy orthorexia. CONCLUSION Our study suggests that depression, anxiety and stress play a mediating role between impulsivity and orthorexia nervosa/healthy orthorexia. Our findings provide a ground for future investigations of impulsive behaviors, psychopathology, and orthorexia in different populations.
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Affiliation(s)
- Emmanuelle Awad
- grid.4514.40000 0001 0930 2361Faculty of Social Sciences, Psychology Department, Lund University, Lund, Sweden
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon ,grid.411324.10000 0001 2324 3572Faculty of Pharmacy, Lebanese University, Hadat, Lebanon ,grid.413056.50000 0004 0383 4764University of Nicosia Medical School, Nicosia, Cyprus
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon
| | - Diana Malaeb
- grid.444421.30000 0004 0417 6142School of Pharmacy, Lebanese International University, Beirut, Lebanon ,grid.466400.0Life Sciences and Health Department, Paris-Est University, Paris, France
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon. .,Psychology Department, Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
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Castellini G, Rossi E, Ricca V. Are There Common Pathways for Eating Disorders and Female Sexual Dysfunction? J Sex Med 2021; 19:8-11. [PMID: 34848138 DOI: 10.1016/j.jsxm.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Michael ML, Juarascio A. Elevated cognitive dietary restraint mediates the relationship between greater impulsivity and more frequent binge eating in individuals with binge-spectrum eating disorders. Eat Weight Disord 2021; 26:2795-2800. [PMID: 33660165 DOI: 10.1007/s40519-021-01153-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The current study aimed to examine the relationships between impulsivity, dietary restraint, and binge eating frequency in individuals with binge-spectrum eating disorders. METHODS Secondary data analysis was conducted on baseline data from three ongoing or recently completed clinical trials. 148 participants diagnosed with a DSM-5 eating disorder characterized by binge eating were administered a clinical interview to assess dietary restraint and binge eating frequency and completed a self-report measure of trait impulsivity. RESULTS Mediation analyses found that increased dietary restraint mediated the relationship between higher impulsivity, particularly greater positive urgency and sensation-seeking, and more frequent binge eating episodes. CONCLUSION While more research using momentary assessment methods is necessary to confirm our findings, results from the current study call attention to the potential role of dietary restraint in the impulsivity-binge eating relationship for individuals with binge-spectrum eating disorders. LEVEL OF EVIDENCE Level V descriptive study.
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Affiliation(s)
- Megan L Michael
- Department of Psychology, Drexel University, 3201 Chestnut Street, Stratton Hall 119, Philadelphia, PA, 19104, USA.
| | - Adrienne Juarascio
- Department of Psychology, Drexel University, 3201 Chestnut Street, Stratton Hall 119, Philadelphia, PA, 19104, USA
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Boswell RG, Lydecker JA. Double trouble? Associations of parental substance use and eating behaviors with pediatric disordered eating. Addict Behav 2021; 123:107089. [PMID: 34450350 PMCID: PMC8506907 DOI: 10.1016/j.addbeh.2021.107089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/19/2021] [Accepted: 08/15/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Comorbidity between substance use disorders and eating disorders is common and related to severity of psychopathology. Parents' eating disorder or substance use disorder have been examined independently and appear to be related to psychopathology in their children. However, no prior work has examined whether co-occurring substance use and eating disorder behaviors in parents relate to eating-disorder psychopathology and weight in their children. METHOD Participants (N = 435) were parents who completed an online cross-sectional survey. Parents reported their personal substance use and eating-disorder behaviors. Relationships between parental substance use (SUD), parental binge eating (ED), and co-occurring parental substance use and binge eating (SUDxED) with child eating-disorder psychopathology and weight were examined using linear regression. Parent age and sex, child age and sex, parent impulsivity and parent depression scores were included as covariates in analyses. RESULTS Greater severity of co-occurring parental SUDxED behavior was associated with greater child eating-related psychopathology, including child binge eating and child purging. Additionally, greater parental binge eating (ED) alone was associated with greater child binge eating and overeating. Parental SUD and/or ED behavior were not related to child weight. Child age did not moderate relationships between parent SUDxED behaviors and child binge eating or overeating. DISCUSSION Overall, parents with greater co-occurring substance use and eating disorder behaviors had children with more severe eating-disorder psychopathology. Clinicians working with families, and those seeking to prevent pediatric eating-related problems, should consider assessing and addressing parents' psychopathology to improve prevention and treatment efforts.
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Affiliation(s)
- Rebecca G Boswell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Princeton Center for Eating Disorders, Penn Medicine, Princeton, NJ, USA.
| | - Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Suzuki T, Yamamiya Y, Yazawa M. Relationship Between Impulsivity and Binge Eating in Japanese Adult Women: Using a Japanese Version of
S‐UPPS‐P
Impulsive Behavior Scale. JAPANESE PSYCHOLOGICAL RESEARCH 2021. [DOI: 10.1111/jpr.12392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6: n-3 ratio and impulsivity. Br J Nutr 2021; 126:1431-1440. [PMID: 33441196 DOI: 10.1017/s0007114521000118] [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: 11/07/2022]
Abstract
Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.
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Piñar-Gutiérrez A, Dios-Fuentes E, Remón-Ruiz P, Del Can-Sánchez D, Vázquez-Morejón A, López-Narbona M, Dastis-Rodríguez de Guzmán J, Venegas-Moreno E, Soto-Moreno A. Description of characteristics and outcomes of a cohort of patients with severe and enduring eating disorders (SE-ED). J Eat Disord 2021; 9:135. [PMID: 34670625 PMCID: PMC8529819 DOI: 10.1186/s40337-021-00492-8] [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: 07/08/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (> 7 years evolution despite evidence-based conventional treatment). METHODS A descriptive observational study was conducted. Patients with a diagnosis of SE-ED (anorexia nervosa and bulimia nervosa) treated in the Endocrinology and Nutrition service of the Virgen del Rocío University Hospital between 2014 and 2019 were included. RESULTS 67 patients were contacted and accepted to participate in the study. 95.5% were women. 67.2% were diagnosed with AN (anorexia nervosa) and 32.8% with BN (bulimia nervosa). Their median ages (years) at the onset of symptoms, beginning of follow-up and at present were 17, 32 and 42.5 respectively. Their median time of follow-up was 9 years. 73.1% had mental comorbitidy and AN patients had more osteoporosis (48.9% vs 22.7%, p = 0.04) and hypogonadotropic hypogonadism (31.1% vs. 4.5%, p = 0.014). DISCUSSION The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. This emphasizes the importance of an early diagnosis in eating disorders. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis and hypogonadotropic hypogonadism than patients with BN. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies. At present, the criteria for severe and enduring eating disorders (SE-ED) are not sufficiently clearly defined. It has been calculated that approximately 20% of patients with anorexia nervosa (AN) and 10% of patients with bulimia nervosa (BN) suffer a chronification. We evaluated the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (which was made based on an evolution greater than 7 years despite conventional treatment). The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis (health condition that weakens bones, making them fragile and more likely to break) and hypogonadotropic hypogonadism (illness in which testes or ovaries produce little or no sex hormones due to a problem in the pituitary gland) than patients with BN.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain. .,Centro de Diagnóstico Y Tratamiento, Planta Baja: Endocrinología Y Nutrición, Av Manuel Siurot sn, CP 41013, Sevilla, Andalucía, Spain.
| | - Elena Dios-Fuentes
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Pablo Remón-Ruiz
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Diego Del Can-Sánchez
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Marta López-Narbona
- Mental Health Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Eva Venegas-Moreno
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Alfonso Soto-Moreno
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
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Kaczkurkin AN, Mu W, Gallagher T, Lieblich S, Tyler J, Foa EB. The Association of Obsessive-Compulsive Disorder, Anxiety Disorders, and Posttraumatic Stress Disorder with Impairment Related to Eating Pathology. J Obsessive Compuls Relat Disord 2021; 31:100685. [PMID: 34660185 PMCID: PMC8513719 DOI: 10.1016/j.jocrd.2021.100685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prior work has shown a number of similarities between obsessive-compulsive disorder (OCD) and eating disorders such as perfectionism and depressive symptoms. However, distress and impairment due to eating pathology are also highly comorbid with other disorders, which brings into question whether the relationship with eating pathology is unique to OCD. The aims of the current study were 1) to test perfectionism and depression as mediators of the relationship between OCD and eating pathology, and 2) to determine whether OCD is related to greater distress/impairment regarding eating habits, exercising, or feelings about eating, shape, or weight above and beyond other disorders. Symptoms were assessed in 329 treatment-seeking patients in a secondary analysis of a clinical battery. The results showed that depressive symptoms and perfectionism were found to mediate the relationship between OCD and eating pathology. Additionally, a regression analysis showed that OCD, social anxiety disorder, and panic disorder symptoms were associated with eating pathology to a greater extent than other disorders. These results suggest that distress and impairment related to eating habits, exercising, or feelings about eating, shape, or weight are not unique to OCD and that depression and perfectionism may, in part, explain the association between OCD and eating pathology.
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Affiliation(s)
- Antonia N Kaczkurkin
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
- Vanderbilt University, Department of Psychology, 2301 Vanderbilt Place, Nashville, TN, USA 37240
| | - Wenting Mu
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
| | - Thea Gallagher
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
| | - Shari Lieblich
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
| | - Jeremy Tyler
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
| | - Edna B Foa
- University of Pennsylvania, Department of Psychiatry, Center for the Treatment and Study of Anxiety, 3535 Market St, Suite 600 North, Philadelphia, PA, USA 19104
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Abstract
BACKGROUND The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity. METHOD A total of 343 consecutive treatment-seeking patients with BED were categorized as having BED with general impulsivity (GI+; N = 73) or BED without general impulsivity (GI-: N = 270) based on structured diagnostic and clinical interviews. The groups were compared on demographic, developmental, and psychological features, and on rates of psychiatric and personality comorbidity. RESULTS Individuals with BED and general impulsivity (GI+) reported greater severity of eating-disorder psychopathology, greater depressive symptoms, and greater rates of comorbidity than those without general impulsivity (GI-). CONCLUSIONS A subtype of individuals with BED and general impulsivity may signal a more severe presentation of BED characterized by heightened and broader psychopathology. Future work should investigate whether these impulse-control difficulties relate to treatment outcomes.
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Biberdzic M, Tang J, Tan J. Beyond difficulties in self-regulation: the role of identity integration and personality functioning in young women with disordered eating behaviours. J Eat Disord 2021; 9:93. [PMID: 34332636 PMCID: PMC8325868 DOI: 10.1186/s40337-021-00398-5] [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: 12/16/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Past research has established individual relationships between disordered eating behaviours (DEB) and both self-regulation difficulties and identity disturbance. However, no research has looked at the shared influence of these constructs on DEB nor at personality functioning in individuals with DEB. METHODS In the present study, self-regulation was explored in terms of effortful control, impulsivity and emotion regulation while identity integration was measured in terms of impairments in self-functioning using a sample of 247 undergraduate students. RESULTS Significant associations were found between all components of self-regulation and DEB, with the exception of impulsivity. Identity instability was also associated with self-regulation difficulties and DEB. Structural Equation Modelling analyses indicated that identity instability partially mediated the relationship between self-regulation and DEB. Lastly, disordered eating was associated with difficulties in personality functioning, with young women presenting with DEB reporting significantly greater difficulties in both self and interpersonal personality functioning. CONCLUSION Behavioural eating anomalies should be considered as epiphenomena secondary to a possible deeper issue that reflects difficulties related to identity integration and potential personality functioning. The clinical implications of these findings are discussed.
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Affiliation(s)
- Marko Biberdzic
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Josephine Tang
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Junhao Tan
- School of Psychology, University of Wollongong, Wollongong, NSW, 2522, Australia
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Munguía L, Lucas I, Jiménez-Murcia S, Mora-Maltas B, Granero R, Miranda-Olivos R, Sánchez I, Testa G, Lozano-Madrid M, Turton R, Menchon JM, Fernández-Aranda F. Executive functions in binge spectrum eating disorders with comorbid compulsive buying. EUROPEAN EATING DISORDERS REVIEW 2021; 29:854-867. [PMID: 34322952 DOI: 10.1002/erv.2855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims were to explore if bulimic spectrum disorders (BSD) patients, who also present comorbid compulsive buying (CB), could represent a specific subtype considering its neuropsychological performance; to present a descriptive analysis of different clinical features; and to explore how these variables could influence treatment outcome. It was hypothesised that the comorbid group will present worse neuropsychological performance that will lead to a worse treatment outcome. METHOD The study has a longitudinal design. Women (N = 75) diagnosed with BSD, BSD + CB and Healthy Controls (HC); completed an evaluation of: cognitive flexibility, decision making, eating disorder (ED) symptomatology, psychopathological state and personality traits. RESULTS BSD + CB was the group with the most severe clinical profile, worst treatment outcome and higher neuropsychological impairment, than other groups. Path-analysis evidenced that deficits in decision making were associated with bad treatment outcome, while deficits in flexibility with the presence of the comorbidity. Self-directedness and novelty seeking were associated with the neuropsychological performance and the comorbidity. CONCLUSION BSD + CB exhibit a worse clinical and neuropsychological profile that seems to be related with the treatment outcome, which should be taken into account for the establishment of specific treatment approaches.
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Affiliation(s)
- Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Ignacio Lucas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Roser Granero
- Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Romina Miranda-Olivos
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Giulia Testa
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - María Lozano-Madrid
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Robert Turton
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jose M Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Salud Mental (CIBERsam), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Physiopathology, Obesity and Nutrition (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
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Awad E, Salameh P, Sacre H, Malaeb D, Hallit S, Obeid S. Association between impulsivity and healthy orthorexia: any moderating role of personality traits? PSYCHOL HEALTH MED 2021; 27:1832-1841. [PMID: 34256660 DOI: 10.1080/13548506.2021.1954673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study objectives were to investigate correlates of healthy orthorexia (HeOr), its relation with impulsivity, and the moderating role of adaptive personality traits among a Lebanese adult sample. The sample was recruited from seven community pharmacies, from the five districts in Lebanon, chosen from a list provided by the Lebanese Order of Pharmacists in a convenient way. The questionnaire included the Teruel Orthorexia Scale (TOS) to measure HeOr, Big Five Inventory (BFI) to assess adaptive personality traits, and the I-8 scale for impulsivity. Higher extraversion (B = -4.31) was significantly associated with lower healthy orthorexia. The interaction perseverance by extraversion was associated with higher healthy orthorexia; in those with higher perseverance, higher extraversion was associated with more healthy orthorexia. Our study presents findings that could be of significant clinical relevance in the future, especially with the interest increase in Orthorexia Nervosa prevalence, which subsequently prompts more research and intrigue about HeOr. Furthermore, it places healthy eating and consistent commitment to a healthy diet within a clearly defined scientific frame, on which further investigation can be based.
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Affiliation(s)
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d'Epidémiologie Clinique et de Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Hala Sacre
- INSPECT-LB: Institut National de Santé Publique, d'Epidémiologie Clinique et de Toxicologie, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Life Sciences and Health Department, Paris-Est University, Paris, France
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d'Epidémiologie Clinique et de Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- INSPECT-LB: Institut National de Santé Publique, d'Epidémiologie Clinique et de Toxicologie, Beirut, Lebanon.,Departments of Research and Psychology, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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Romero-Mesa J, Peláez-Fernández MA, Extremera N. Emotional intelligence and eating disorders: a systematic review. Eat Weight Disord 2021; 26:1287-1301. [PMID: 32734465 DOI: 10.1007/s40519-020-00968-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/17/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology, varies across lifespan development. However, while the findings suggest promising results for the development of potential effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and ED due to the diversity of theoretical approaches and variety of EI and ED measures. OBJECTIVE Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and clinical populations and across different developmental stages. METHODS The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. RESULTS All the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted. CONCLUSION The systematic review suggests promising but challenging preliminary evidence of the associations between EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and limitations are discussed. LEVEL OF EVIDENCE I Systematic review.
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Affiliation(s)
- Juana Romero-Mesa
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
| | - María Angeles Peláez-Fernández
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain.
| | - Natalio Extremera
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
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Todisco P, Meneguzzo P, Garolla A, Antoniades A, Vogazianos P, Tozzi F. Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study. Eat Weight Disord 2021; 26:869-877. [PMID: 32430886 DOI: 10.1007/s40519-020-00916-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/02/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs). METHODS 320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient. RESULTS Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037). DISCUSSION Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings. LEVEL OF EVIDENCE III, cohort or case-control analytic studies.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | - Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy. .,Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University Cyprus, Engomi, Cyprus
| | - Federica Tozzi
- Research and Development, Stremble Ventures, Limassol, Cyprus
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İnce B, Schlatter J, Max S, Plewnia C, Zipfel S, Giel KE, Schag K. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review. J Eat Disord 2021; 9:38. [PMID: 33736708 PMCID: PMC7977597 DOI: 10.1186/s40337-021-00384-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others. METHOD A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed. RESULTS Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful. CONCLUSION Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.
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Affiliation(s)
- Başak İnce
- Department of Psychology, Haliç University, Istanbul, Turkey
| | - Johanna Schlatter
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Sebastian Max
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany. .,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany.
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Atomoxetine Reduced Binge/Purge Symptoms in a Case of Anorexia Nervosa Binge/Purge Type. Clin Neuropharmacol 2021; 44:68-70. [PMID: 33538518 DOI: 10.1097/wnf.0000000000000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Psychopharmacologic treatments for eating disorders (EDs) remain unclear, particularly for anorexia nervosa. As in attention-deficit hyperactivity disorder, a dopaminergic mechanism has been implicated in EDs, prompting our use of atomoxetine in an 18-year-old woman with anorexia nervosa, binge/purge type. Atomoxetine is a highly selective norepinephrine reuptake inhibitor with nonaddictive properties and limited effects of appetite suppression. Doses followed those used in a previous trial of atomoxetine in the treatment of binge ED, and response was assessed over 4 months, with significant improvement in ED behaviors and mood. Larger-scale, randomized studies that assess the efficacy of atomoxetine in the treatment of anorexia nervosa, binge/purge type are warranted.
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Larsen JK, Hollands GJ. Targeting automatic processes to reduce unhealthy behaviours: a process framework. Health Psychol Rev 2021; 16:204-219. [PMID: 33491571 DOI: 10.1080/17437199.2021.1876572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
While previous frameworks to address health behaviours through targeting underlying automatic processes have stimulated an improved understanding of related interventions, deciding between intervention strategies often remains essentially arbitrary and atheoretical. Making considered decisions has likely been hampered by the lack of a framework that guides the selection of different intervention strategies targeting automatic processes to reduce unhealthy behaviours. We propose a process framework to fulfil this need, building upon the process model of emotion regulation. This framework differentiates types of intervention strategies along the timeline of the unfolding automatic response, distinguishing between three broad classes of intervention strategies - direct antecedent, indirect antecedent, and response-focused. Antecedent-focused strategies aim to prevent the exposure to or activation of automatic responses directly through the avoidance of unwanted stimulus-response associations (i.e., situation modification or situation-specific response selection), or indirectly through automatising self-control (i.e., attentional deployment or cognitive change). Response-focused strategies aim to directly downregulate automatic unwanted responses (i.e., response modulation). Three main working hypotheses derived from this process framework provide practical guidance for selecting interventions, but await direct testing in future studies.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Gareth J Hollands
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Legg NK, Turner BJ. Personality correlates of eating pathology severity and subtypes in The National Comorbidity Survey Adolescent Supplement. J Clin Psychol 2021; 77:189-210. [PMID: 32627202 PMCID: PMC7725846 DOI: 10.1002/jclp.23021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/30/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We examined how personality traits are associated with eating pathology (EP) across a range of severities and symptom subtypes. METHOD The National Comorbidity Survey Adolescent Supplement (N = 10,148) was used to compare personality across severities (i.e., clinical Eating Disorders [EDs], subclinical disordered eating, preclinical weight concerns, or no weight/EP [no W/EP]), subclinical subtypes (i.e., Binge Eating Only, Binge-Purge, Binge-Restrict, Restrict-Purge, or no W/EP), and clinical subtypes (i.e., Anorexia Nervosa [AN]), Bulimia Nervosa [BN], Binge Eating Disorder [BED], internalizing disorders, or no ED or internalizing disorder) of EP. RESULTS More severe EP was associated with more extreme personality trait endorsements. Impulsivity-related traits did not consistently distinguish binge eating/purging from restricting subtypes, although behavioral disinhibition differentiated adolescents with BN or BED from AN. CONCLUSION Personality traits related to affectivity and impulsivity were more consistently associated with severity rather than subtype of EP.
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Affiliation(s)
- Nicole K Legg
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - Brianna J Turner
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
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Stapleton P, Whitehead M. Dysfunctional Eating in an Australian Community Sample: The Role of Emotion Regulation, Impulsivity, and Reward and Punishment Sensitivity. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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