1
|
Varela C, Hoyo Á, Tapia-Sanz ME, Jiménez-González AI, Moral BJ, Rodríguez-Fernández P, Vargas-Hernández Y, Ruiz-Sánchez LJ. An update on the underlying risk factors of eating disorders onset during adolescence: a systematic review. Front Psychol 2023; 14:1221679. [PMID: 38023032 PMCID: PMC10663237 DOI: 10.3389/fpsyg.2023.1221679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Eating disorders (EDs) are serious psychological problems that affect not only the individual, but also their entire environment. The prevalence rates of EDs are higher among the adolescent population. A better understanding of ED risk factors is essential to design effective prevention and intervention programs that focus beyond the areas of weight and appearance. Methods The main objective of this systematic review was to identify the risk factors of EDs and provide a comprehensive approach, analyzing the interplay between individuals, their inner circle, and the society characteristics. The Web of Science, Scopus, CENTRAL and PsycInfo databases were searched. Results The initial search produced 8,178 references. After removing duplicates and performing the selection process by three independent reviewers, 42 articles were included in the systematic review according to the pre-specified inclusion criteria. The results suggest the relevance of society and the inner circle on the development of EDs. Discussion The internalization of the thin ideal, promoted by the current society, and living in an unsupportive, unaffectionate, non-cohesive environment were associated with the onset of EDs symptomatology. Other associated variables with this ED indicator were poor-quality relationships and feeling judged about appearance. These aspects seem to be essential for the development of individual characteristics like self-esteem or adaptative coping during adolescence. This systematic review has shown the complex etiology of EDs and the relevance of the interplay between the different areas involved. Furthermore, this information could be relevant to improve the design of innovative and more effective prevention and intervention programs. Systematic review registration PROSPERO, identifier CRD42022320881.
Collapse
Affiliation(s)
- Carmen Varela
- Universitat de Barcelona, Barcelona, Spain
- Departamento de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad de Burgos, Burgos, Spain
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | - Ángela Hoyo
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | | | - Benito Javier Moral
- Área de Psicología, Facultad de Ciencias de la Salud, Universidad Isabel I, Burgos, Spain
| | | | | | | |
Collapse
|
2
|
Bills E, Greene D, Stackpole R, Egan SJ. Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis. Appetite 2023; 187:106586. [PMID: 37196843 DOI: 10.1016/j.appet.2023.106586] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/28/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023]
Abstract
There is a consistent link between perfectionism and eating disorders, however no meta-analysis to date has synthesized this literature in children and adolescents. We hypothesized that there would be significant, small pooled correlations between perfectionism dimensions and eating disorder symptoms in children and adolescents. Published, peer-reviewed articles with standardised measures of perfectionism and eating disorder symptoms were included. Articles were excluded if the age range was over 18 years. Overall, 39 studies were included (N = 13,954 participants, M age = 13.7 years). Total perfectionism (r = 0.25), perfectionistic strivings (r = 0.21), and perfectionistic concerns (r = 0.31) had significant positive associations with eating disorder symptoms. Most studies were rated as fair or good quality. Limitations included high heterogeneity, insufficient studies to investigate age as a moderator, the inclusion of only English articles, and predominately cross-sectional studies which precluded causal inference. Higher perfectionism was associated with greater eating disorder symptoms in children and adolescents. Future research should focus on longitudinal studies of eating disorder symptoms in children and adolescents.
Collapse
Affiliation(s)
- Elizabeth Bills
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Danyelle Greene
- Australian Institute for Business and Economics, Faculty of Business, Economics and Law, University of Queensland, Brisbane, Australia
| | - Rose Stackpole
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
| |
Collapse
|
3
|
Associations between pathological eating, relational attitudes and satisfaction in romantic relationships. Eat Weight Disord 2022; 27:1385-1393. [PMID: 34342845 DOI: 10.1007/s40519-021-01283-5] [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: 02/25/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Women with disordered eating report low satisfaction from romantic relationships. We wished to examine whether this may be explained in part by a restricted or inflated sense of relational entitlement, pathological concern and low authenticity levels. METHOD A community sample of 170 women aged 18-60 (M = 24.89 + 6.22), who had experienced a meaningful romantic relationship, completed questionnaires online. These included measures of disordered eating (EDE-Q), sense of relational entitlement (SRE-R), pathological concern (PCQ), relational authenticity (AIRS) and basic relational needs satisfaction (BNSRS). Structural equation model (SEM) was employed to assess the mediating effect of the SRE-R, PCQ and AIRS on the association between ED symptoms and BNSRS. RESULTS Participants with high EDE-Q scores tended to score high on inflated and restricted SRE-R, PCQ, AIRS and BNSRS. SRE-R, PCQ and AIRS scores mediated the negative association between EDE-Q and BNSRS scores. CONCLUSIONS An imbalanced sense of relational entitlement, pathological concern and inauthenticity seem to underlie the dissatisfaction that women with disordered eating experience from romantic relationships. Since these relational characteristics seem to take a high toll on the intimate relationships, it is important to encourage healthy eating attitudes and assertiveness within romantic relationships, in life and in therapy. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies.
Collapse
|
4
|
Bachner-Melman R, Watermann Y, Lev-Ari L, Zohar AH. Associations of self-repression with disordered eating and symptoms of other psychopathologies for men and women. J Eat Disord 2022; 10:41. [PMID: 35313987 PMCID: PMC8935791 DOI: 10.1186/s40337-022-00569-y] [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: 10/28/2021] [Accepted: 03/11/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Disordered eating has been found to be associated with constructs involving self-repression, such as selflessness (the tendency to relinquish one's needs for others'), and concern for appropriateness (an alertness to information about social comparison and tendency to vary one's behavior in different social situations). This study aimed to examine associations between these self-repression variables and symptoms of general psychopathology for women and men in a community sample. METHODS Two hundred and thirty-six participants (92 men) aged 18-76 (M = 29.11 ± 10.10) volunteered to complete online measures of disordered eating, concern for appropriateness (cross-situational variability and attention to social comparison information), selflessness, and symptoms of depression, anxiety and somatization. Structural equation models were built to assess pathways between the study variables for men and women separately. RESULTS A MANOVA 2*7 design showed that women scored significantly higher than men on measures of selflessness, disordered eating and depression. For men, selflessness scores were positively and significantly associated only with depression scores. Cross-situational variability scores were positively associated with depression, somatization and anxiety scores. For women, selflessness scores were positively and significantly associated with depression, disordered eating, somatization and anxiety scores. Cross-situational variability scores were positively and significantly associated with depression, anxiety and somatization scores but not with disordered eating scores. Attention to Social Comparison Information scores were positively and significantly associated only with disordered eating scores. CONCLUSIONS Self-repression is more closely linked to psychopathology in women than in men. For men, self-suppression seems to be associated with symptoms of internalizing disorders, but not disordered eating. Even for women, it appears that self-repression is not connected exclusively with disordered eating, but with symptoms of psychopathology in general. Future research should explore why self-suppression plays such a central role in women's psychopathology.
Collapse
Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Watermann
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
| | - Lilac Lev-Ari
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H. Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
5
|
Moberg LT, Solvang B, Sæle RG, Myrvang AD. Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission. J Eat Disord 2021; 9:74. [PMID: 34174942 PMCID: PMC8235811 DOI: 10.1186/s40337-021-00430-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/09/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design. METHOD Reports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design. RESULTS The remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies. CONCLUSIONS CBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.
Collapse
Affiliation(s)
- Leif Tore Moberg
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
| | - Birgitte Solvang
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
| | - Rannveig Grøm Sæle
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway.
| | - Anna Dahl Myrvang
- Department of Psychology, UiT The Arctic University of Norway, Huginbakken 32, N-9037, Tromsø, Norway
| |
Collapse
|
6
|
Vacca M, Ballesio A, Lombardo C. The relationship between perfectionism and eating-related symptoms in adolescents: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2020; 29:32-51. [PMID: 32975870 DOI: 10.1002/erv.2793] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 12/26/2022]
Abstract
The clinical significance of two major aspects of perfectionism, perfectionistic strivings (PS) and perfectionistic concerns (PC), in eating disorders (EDs) symptoms was well-established among adults. However, no systematic review has assessed evidence examining associations between both unidimensional and multidimensional perfectionism and EDs in early and middle adolescence. For this aim, three online databases (PsycINFO, Medline and PsycArticle) were searched for articles published until January 2019, and observational studies were considered. Study quality was systematically appraised, and results were summarized using a narrative synthesis approach. Fifty-one cross-sectional and 28 longitudinal studies were included. Most studies supported the relationship between perfectionism and EDs, with the majority adopting a unidimensional approach for assessing perfectionism. Among studies that employed multidimensional measures of perfectionism, the majority (n = 11) of evidence supported the relationship between eating symptoms and PC, while fewer (n = 5) studies provided significant unique associations with PS. These findings are consistent with the body of research suggesting the strength of the relationship between PC and EDs was greater than between PS and EDs. It was recommended that preventive interventions should be primarily focused on reducing self-critical perfectionism, since it resulted to be the most relevant perfectionistic dimension in the development of eating symptoms in adolescents.
Collapse
Affiliation(s)
| | - Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy.,Department of Human Sciences, University of Rome "G. Marconi"-Telematic, Rome, Italy
| | | |
Collapse
|
7
|
Collins M, Quinton S. The inter-relationship between diet, selflessness, and disordered eating in Australian women. Brain Behav 2020; 10:e01774. [PMID: 32767655 PMCID: PMC7507084 DOI: 10.1002/brb3.1774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 05/04/2020] [Indexed: 12/23/2022] Open
Abstract
Personality traits and diet can be used to predict if a person is predisposed to disordered eating. Results of this study demonstrate a strong significant relationship between the personality trait of selflessness, diet group, and disordered eating. Vegans were most likely to display selflessness tendencies associated with disordered eating; however when selflessness was controlled for, vegans displayed substantially less disordered eating pathology than non-vegetarians. OBJECTIVE To explore the relationship between diet group (non-vegetarian, semi-vegetarian, true-vegetarian, and vegan) and disordered eating while investigating to what extent personality trait of selflessness mediates the relationship between diet group and disordered eating. METHOD Cross-sectional data from 634 Australian nonclinical women who completed a series of online questionnaires including measures of diet group, disordered eating, and selflessness were used to examine associations between diet, personality (selflessness), and disordered eating. RESULTS Selflessness was found to be a significant positive predictor of disordered eating. Results confirm that selflessness played a suppressing role in the relationship between the vegan diet group and disordered eating, when compared to non-vegetarians. Surprisingly, vegans displayed significantly less disordered eating than non-vegetarians and semi-vegetarians. DISCUSSION Results of the current study imply that the role of selflessness on disordered eating, when broken down across diet group, may be more complex than first thought. If replicated, these results suggest that targeted treatment of selflessness in different diet groups may improve treatment outcomes for disordered eating. Further research should explore why diet groups differ in terms of selflessness and how this impacts disordered eating.
Collapse
|
8
|
Reshef P, Israelashvili M. Between Selflessness and Differentiation in Postnatal Adjustment: Exploration of a Combined Model. JOURNAL OF ADULT DEVELOPMENT 2020. [DOI: 10.1007/s10804-020-09355-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
9
|
Bachner-Melman R, Zohar AH. Potential Risk and Protective Factors for Eating Disorders in Haredi (ultra-Orthodox) Jewish Women. JOURNAL OF RELIGION AND HEALTH 2019; 58:2161-2174. [PMID: 31175539 DOI: 10.1007/s10943-019-00854-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Little is known scientifically about eating disorders (EDs) in the Haredi (Jewish ultra-Orthodox) community. This paper aims to describe Haredi culture, review available peer-reviewed research on EDs in the Haredi community and discuss possible risk and protective factors for these disorders in a culturally informed way. A literature search for 2009-2019 yielded 180 references of which only nine were studies on ED in the Haredi community. We describe these and use them as a basis for discussion of possible risk and protective factors for ED in Haredi women. Risk factors may include the centrality of food, poverty, rigid dress codes, the importance of thinness for dating and marriage, high demands from women, selflessness and early marriage and high expectations from women. Protective factors may include faith, Jewish laws governing eating and food that encourage gratitude and mindful eating, and body covering as part of modesty laws that discourage objectification. Ways of overcoming the current barriers to research in the Haredi community should be sought to advance ED prevention and treatment in this population.
Collapse
Affiliation(s)
- Rachel Bachner-Melman
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel.
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, 12 Hagedud Haivri Street, 9234506, Jerusalem, Israel.
| | - Ada H Zohar
- Clinical Psychology Graduate Program, Ruppin Academic Center, Emek Hefer, Israel
| |
Collapse
|
10
|
Rothschild-Yakar L, Stein D, Goshen D, Shoval G, Yacobi A, Eger G, Kartin B, Gur E. Mentalizing Self and Other and Affect Regulation Patterns in Anorexia and Depression. Front Psychol 2019; 10:2223. [PMID: 31681070 PMCID: PMC6803447 DOI: 10.3389/fpsyg.2019.02223] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/17/2019] [Indexed: 11/13/2022] Open
Abstract
The study aimed to examine two constructs: general mentalizing processes and the specific component of affective mentalizing regarding self and others alongside the construct of affect regulation patterns in female adolescent and young adult inpatients with anorexia nervosa (AN; n = 41), depression (n = 20) and controls (n = 53). We further examined the predictive ability of affect regulation to eating-disorder (ED) symptoms beyond that of the mentalizing variables, and their potential role in mediating between mentalizing, depression and ED symptoms. We used tools assessing reflective functioning (RF), complex emotion recognition and theory of mind (ToM), alexithymia, affect regulation, depression, and ED symptoms. The AN and depression groups exhibited lower general mentalizing and higher alexithymia, emotional reactivity, and emotional cutoff patterns than controls, but showed no greater disturbance in ToM. The two clinical groups did not differ on any of these variables. Elevated mentalizing and adequate affect regulation patterns separately predicted lower severity of ED symptoms. Nonetheless, affect regulation did not add to the predictive value of mentalizing variables. Specifically, elevated alexithymia, and depressive symptomatology, but not RF, predicted greater ED symptomatology. Moreover, alexithymia directly accounted for elevated ED symptoms and also indirectly connected with ED symptoms via emotional hyperactivation and elevated depressive symptoms. These findings suggest that deficiencies in mentalization and affect regulation are not unique to AN, but may rather associated with psychopathology in general. Nonetheless, alexithymia and depression may increase ED-related symptomatology. Affect regulation deficiencies are mainly related with depressive symptoms and emotional hyperactivation is indirectly related with AN via the depressive symptoms.
Collapse
Affiliation(s)
- Lily Rothschild-Yakar
- School of Psychology, The Herta and Paul Amir Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - Daniel Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Dor Goshen
- School of Psychology, The Herta and Paul Amir Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - Gal Shoval
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Assaf Yacobi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Gilad Eger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Bar Kartin
- School of Psychology, The Herta and Paul Amir Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - Eitan Gur
- Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
11
|
Pinus U, Canetti L, Bonne O, Bachar E. Selflessness as a predictor of remission from an eating disorder: 1-4 year outcomes from an adolescent day-care unit. Eat Weight Disord 2019; 24:777-786. [PMID: 29022234 DOI: 10.1007/s40519-017-0444-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 09/16/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the potential role of selflessness in predicting remission from an eating disorder (ED) following discharge from an adolescent day-care unit. METHOD Participants were 95 female patients (aged 13-19 years) with an ED diagnosis across the spectrum admitted to an adolescent day-care unit for EDs between 2008 and 2012. Forty-one of these participants completed the follow-up assessment, between 12 and 46 months following discharge. No significant differences were found in Time 1 variables between patients who participated in Time 2 and those who did not. At both time points, ED and psychiatric comorbidity diagnoses were made using standard structured interviews. Patients were also administered the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), The Eating Attitude Test (EAT-26), The Eating Disorder Inventory (EDI-2) and the Selflessness Scale (SS)*. RESULTS Only baseline Selflessness Scale was significant in predicting the continuous variable of ED symptomatology level in follow-up. When dividing EDI total score into its subscales at baseline, one of those, maturity fears, was found, together with the SS, significant in the prediction. In predicting remission (this time as a dichotomized variable) in follow-up, only the SS, maturity fears, EDI total, and EAT-26, at baseline, predicted remission at follow-up, but the strength of selflessness was the greatest. CONCLUSIONS Psychological features are not the main target of the important search for predictors of remission from ED. The findings of the present study add the psychological feature of selflessness to this search. Psychotherapy can be enriched by identifying psychological features such as selflessness as one of its foci. The present findings might also renew interest in maturity fears as an additional focus in psychotherapy. LEVEL OF EVIDENCE Level III, cohort study.
Collapse
Affiliation(s)
- Uri Pinus
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
- School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Laura Canetti
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omer Bonne
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel
| | - Eytan Bachar
- Department of Psychiatry, Hadassah University Medical Center, Jerusalem, Israel.
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
12
|
Quilliot D, Brunaud L, Mathieu J, Quenot C, Sirveaux MA, Kahn JP, Ziegler O, Witkowski P. Links between traumatic experiences in childhood or early adulthood and lifetime binge eating disorder. Psychiatry Res 2019; 276:134-141. [PMID: 31082748 DOI: 10.1016/j.psychres.2019.05.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the association between childhood or early adulthood traumatic experiences and adulthood binge eating disorder (BED) in 326 male and 1158 female patients. A structured clinical interview for the DSM-IV (SCID-I/P)-adapted to lifetime exploration for the diagnosis of BED and for DSM-IV Childhood Disorders was conducted by the psychiatrist. RESULTS Emotional neglect was the most frequent event experienced (77.8% of females vs. 63.5% of males, p < 0.0001), ahead of physical abuse (23.3%), witnessed domestic violence (17.7%) and sexual abuse (11.8% of females vs. 2.8% of males (p < 0.0001)). The prevalence rate for BED in the whole population was 34.9%. The independent predictors for BED were emotional neglect in male obese patients (OR = 3.49; IC95% (1.94-6.29); p < 0.0001) and physical abuse (OR = 1.56; IC95% (1.14-2.12); p = 0.0047), emotional neglect (OR = 1.83; IC95% (1.37-2.44); p < 0.0001), and sexual abuse (OR = 1.80; IC95% (1.22-2.65); p = 0.0029) in female patients. With a cut-off value of 17, the sensitivity of the Binge Eating Scale for BED during lifetime was 50.8% with 74.7% specificity. CONCLUSIONS This study shows that early psychological events are independent predictors of BED in obese female and male adults. The BES questionnaire is a poor predictor of BED during lifetime and a structured clinical interview should be recommended.
Collapse
Affiliation(s)
- Didier Quilliot
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France.
| | - Laurent Brunaud
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France
| | - Joris Mathieu
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France
| | - Christelle Quenot
- Service de Psychiatrie et de Psychologie Clinique, CHRU de Nancy, France
| | - Marie-Aude Sirveaux
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France
| | - Jean-Pierre Kahn
- Service de Psychiatrie et de Psychologie Clinique, CHRU de Nancy, France
| | - Olivier Ziegler
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France
| | - Pierrette Witkowski
- Unité Multidisciplinaire de Chirurgie de l'Obésité, CHRU de Nancy, Rue du Morvan, 54511 Vandoeuvre les Nancy Cedex, France; Service de Psychiatrie et de Psychologie Clinique, CHRU de Nancy, France
| |
Collapse
|
13
|
Bardone-Cone AM, Thompson KA, Miller AJ. The self and eating disorders. J Pers 2018; 88:59-75. [PMID: 30506587 DOI: 10.1111/jopy.12448] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022]
Abstract
In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.
Collapse
Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine A Thompson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Mentalizing in self vs. parent representations and working models of parents as risk and protective factors from distress and eating disorders. J Nerv Ment Dis 2013; 201:510-8. [PMID: 23686159 DOI: 10.1097/nmd.0b013e3182948316] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study examined whether low developmental level of mentalization and symbolization, manifested as low ability to represent and reflect on mental states of the self and parents as well as malevolent working models of parents, may be risk factors in the genesis of eating disorders (EDs). We examined 71 female adolescent inpatients with ED and 45 controls without ED using the Object Representation Inventory and self-report measures assessing emotional distress and ED symptoms. The results indicated that the patients with ED presented with a significantly lower level of mentalization and symbolization and with more malevolent working models of their parents in comparison with the controls without ED. A more benevolent parental representation, specifically with the father, combined with better mentalization abilities, was found to indirectly predict lower ED symptoms, via the reduction of distress levels. These findings suggest that adequate mentalization and benevolent working models of parents may serve as a protective factor reducing the level of ED symptoms.
Collapse
|
15
|
Boone L, Braet C, Vandereycken W, Claes L. Are maladaptive schema domains and perfectionism related to body image concerns in eating disorder patients? EUROPEAN EATING DISORDERS REVIEW 2012; 21:45-51. [PMID: 22556040 DOI: 10.1002/erv.2175] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Both maladaptive schemas (MS) and perfectionism have been associated with eating pathology. However, previous research has not examined these variables simultaneously and has not studied possible mediating relationships between MS and multidimensional perfectionism for body image concerns in eating disorder (ED) patients. Eighty-eight female ED patients completed the Young Schema Questionnaire, the Frost Multidimensional Perfectionism Scale, and the Body Attitude Test. Body image concerns were found to be positively related to Personal Standards (PS) and Evaluative Concerns (EC) perfectionism and all five schema domains. PS Perfectionism was positively associated with Disconnection, Other-directedness, and Overvigilance. EC Perfectionism was positively related to Disconnection, Impaired Autonomy, Other-directedness, and Overvigilance. Moreover, EC perfectionism was found to be a significant mediator in the relationship between the schema domains Impaired Autonomy and Overvigilance and body image concerns. These findings denote the importance to address both core beliefs and perfectionism in ED treatment.
Collapse
|
16
|
Villarejo C, Fernández-Aranda F, Jiménez-Murcia S, Peñas-Lledó E, Granero R, Penelo E, Tinahones FJ, Sancho C, Vilarrasa N, Montserrat-Gil de Bernabé M, Casanueva FF, Fernández-Real JM, Frühbeck G, De la Torre R, Treasure J, Botella C, Menchón JM. Lifetime obesity in patients with eating disorders: increasing prevalence, clinical and personality correlates. EUROPEAN EATING DISORDERS REVIEW 2012; 20:250-4. [PMID: 22383308 PMCID: PMC3510304 DOI: 10.1002/erv.2166] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. METHODS Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90-Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory-Revised. RESULTS The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. CONCLUSIONS Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis.
Collapse
Affiliation(s)
- Cynthia Villarejo
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Clinical Sciences Department, University of BarcelonaSpain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Clinical Sciences Department, University of BarcelonaSpain
| | | | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaSpain
| | - Eva Penelo
- Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de BarcelonaSpain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de VictoriaMálaga, Spain
| | - Carolina Sancho
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
| | - Nuria Vilarrasa
- Endocrinology and Nutrition Department, Bellvitge Universitary Hospital—IDIBELLBarcelona, Spain
| | | | - Felipe F Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Division of Endocrinology, Complejo Hospitalario Universitario de Santiago de CompostelaSpain
| | - Jose Manuel Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Diabetes, Endocrinology and Nutrition, Institut d'Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep TruetaGirona, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Department of Endocrinology and Nutrition, University of NavarraPamplona, Spain
| | - Rafael De la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM—Hospital del Mar Research InstituteBarcelona, Spain
| | - Janet Treasure
- Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, King's College LondonLondon, UK
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos IIISpain
- University Jaume ICastellón, Spain
| | - José Manuel Menchón
- Department of Psychiatry, University Hospital of Bellvitge—IDIBELLBarcelona, Spain
- Clinical Sciences Department, University of BarcelonaSpain
- CIBER, Salud Mental (CIBERSAM), Instituto Carlos IIISpain
| |
Collapse
|
17
|
Abstract
Perfectionism and drive for thinness have both been described as predictors of eating disorders, but the relationship between these two constructs over time requires further investigation, as does the an understanding of what components of perfectionism are important in this relationship. Using a longitudinal design, a population of 175 young adults was followed up over a 4 month period. Structural equation modelling indicated a unidirectional relationship between evaluative concerns and drive for thinness, with evaluative concerns, measured at Time 1 predicting an increase in drive for thinness at Time 2. This finding has potential implications for understanding psychological symptoms that precede eating disorder symptoms, and may help build models about prevention and treatment. As a first study to prospectively examine this relationship, further research is needed to assess the generalisability of the findings, and to explore additional variables that may mediate the relationship between evaluative concerns and drive for thinness.
Collapse
Affiliation(s)
- Liza Dickie
- School of Psychology, Victoria University of Wellington, Easterfield Building, Kelburn Parade, Wellington 6140, New Zealand.
| | | | | | | |
Collapse
|