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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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2
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Bhat RR, Vellekkat F, Goutama IL, Gill PS, Kakar G, Jabeen H, Gireesh K, Sanker V, Gupta U. A case of trichotillomania and bulimia nervosa in a patient with adult-onset attention-deficit/hyperactivity disorder (ADHD). Clin Case Rep 2023; 11:e7800. [PMID: 37601423 PMCID: PMC10432585 DOI: 10.1002/ccr3.7800] [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: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
Key Clinical Message Identifying any potential comorbidity such as bulimia nervosa (BN) and ADHD in trichotillomania patients is essential for a thorough treatment plan. Combining a multidisciplinary approach was found to be feasible and effective in the treatment. Abstract Trichotillomania is frequently considered an isolated disorder; nevertheless, emerging evidence suggests that other psychiatric conditions, including obsessive-compulsive disorder (OCD), eating disorders, and attention-deficit/hyperactivity disorder (ADHD), are often found to coexist. Several studies showed that eating disorders, such as bulimia nervosa, were found in chronic hair-pullers, while OCD was considered a factor in predicting the prevalence of eating disorders, as well as the severity of trichotillomania in the populations. While the relationship between trichotillomania and OCD has been quite well-documented, the evidence of its association with bulimia nervosa and ADHD remains limited. Here, we report a case of trichotillomania with comorbid bulimia nervosa, major depressive disorder, and ADHD.
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Affiliation(s)
- Rakshita Ramesh Bhat
- Bangalore Medical College and Research InstituteBangaloreIndia
- Team ErevnitesTrivandrumIndia
| | - Faheem Vellekkat
- Team ErevnitesTrivandrumIndia
- Indira Gandhi Medical College and Research InstitutePuducherryIndia
| | - Ivany Lestari Goutama
- Team ErevnitesTrivandrumIndia
- Faculty of MedicineTarumanagara UniversityJakartaIndonesia
| | | | - Gauri Kakar
- Team ErevnitesTrivandrumIndia
- Jawaharlal Nehru Medical CollegeWardhaIndia
| | - Hafsa Jabeen
- Team ErevnitesTrivandrumIndia
- Dow Medical CollegeKarachiPakistan
| | - Krishnan Gireesh
- Team ErevnitesTrivandrumIndia
- School of Behavioural SciencesTamil NaduIndia
| | - Vivek Sanker
- Team ErevnitesTrivandrumIndia
- Noorul Islam Institute of Medical SciencesTrivandrumIndia
| | - Umang Gupta
- Team ErevnitesTrivandrumIndia
- Nepalgunj Medical CollegeNepalgunjNepal
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Zhao X, Wang S, Hong X, Lu S, Tang S, Shen Y, Feng M, Guo P, Fang Y. A case of trichotillomania with binge eating disorder: combined with N-acetylcysteine synergistic therapy. Ann Gen Psychiatry 2021; 20:46. [PMID: 34563228 PMCID: PMC8467022 DOI: 10.1186/s12991-021-00369-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Obsessive-compulsive and related disorders (OCRDs) are a group of intractable and chronic mental disorders. Trichotillomania (TTM) is a common type of OCRDs characterized by repetitive hair pulling, driven by escalating tension before the action and during the attempts to resist it. Binge eating disorder (BED) is a common type of eating disorder characterized by recurrent compulsive episodes of binge eating. Both have common psychological processes (tension or impulsion) and pathological manifestations (out of control), but the pathological mechanisms are still unclear and the current clinical treatments are often unsatisfactory for these two disorders. CASE PRESENTATION A 25-year-old woman with TTM comorbid BED came to our hospital for treatment. She had accepted systematic cognitive behavioral therapy (CBT) and also monotherapy or multidrug therapy with sertraline, fluvoxamine, bupropion, risperidone in full dosage and duration for 2 years, but all of them did not work. We treated this case with N-acetylcysteine (NAC) as a synergist on the basis of recent treatment (fluvoxamine 150 mg/day and bupropion 300 mg/day). The pathological hair plucking behavior and binge eating symptoms were both significantly and rapidly improved, and the follow-up in next 14 weeks showed that the effect was still maintained. CONCLUSION To our knowledge, this may be the first case report of using NAC as a synergist to treat TTM comorbid BED successfully, which suggest that these two disorders may have a common pathophysiological mechanism. Moreover, NAC can be one choice as a synergistic treatment for OCRDs.
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Affiliation(s)
- Xudong Zhao
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Shikai Wang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China.
| | - Xiujuan Hong
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Shaojia Lu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sufang Tang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Yue Shen
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Ming Feng
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Ping Guo
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
| | - Yu Fang
- Department of Psychiatry, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, 2088 Tiaoxi Road, Huzhou, 313000, Zhejiang, China
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Houazene S, Leclerc J, O’Connor K, Aardema F. “Shame on you”: The impact of shame in body-focused repetitive behaviors and binge eating. Behav Res Ther 2021; 138:103804. [DOI: 10.1016/j.brat.2021.103804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/08/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
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Devoe DJ, Anderson A, Bahji A, Singh M, Patten SB, Soumbasis A, Ramirez Pineda A, Flanagan J, Richardson C, Lange T, Dimitropoulos G, Paslakis G. The Prevalence of Impulse Control Disorders and Behavioral Addictions in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:724034. [PMID: 35069274 PMCID: PMC8770943 DOI: 10.3389/fpsyt.2021.724034] [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: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: Individuals with eating disorders (EDs) may present with impulse control disorders (ICDs) and behavioral addictions (BAs), which may result in additional suffering and treatment resistance. However, the prevalence of ICDs and BAs in EDs has not been systematically examined. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of ICDs and BAs in ED samples. Methods: A comprehensive electronic database search of the peer-reviewed literature was conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from their inception to May 2021. We restricted review eligibility to research studies reporting prevalence for ICDs or BAs in individuals with diagnosed EDs. The outcome for this review was the prevalence of ICDs or BAs in individuals with EDs. A series of random-effects meta-analyses were performed on eligible studies to estimate the pooled proportions and 95% confidence intervals (CIs). Results: Thirty-five studies met the inclusion criteria, including a total of 9,646 individuals identified as having an ED, 18 of these studies specifically examined ICDs/BAs in AN, BN, and BED. Random-effects pooled estimates demonstrated that the comorbid prevalence of any ICD was 22%. The prevalence of comorbid pathological/compulsive buying was highest (19%), followed by kleptomania (18%), pathological internet use (12%), intermittent explosive disorder (4%), trichotillomania (3%), and gambling disorder (2%). In addition, the prevalence of stealing/shoplifting behaviors was 30% in those with EDs. Conclusion: This is the first meta-analysis on the comorbid prevalence of EDs and ICDs/BAs. We found a moderate prevalence for these comorbid conditions, with approximately one out of five individuals with an ED also displaying a comorbid ICD/BA. Although causal inferences cannot be drawn, the numbers strongly suggest that clinical screening/monitoring of ICDs/BAs should be part of the clinical routine in cohorts with EDs. ED settings need either the capacity to manage these disorders or adequate access to relevant services. Further investigations are needed to reveal common underlying pathomechanisms. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202044.
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Affiliation(s)
- Daniel J Devoe
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alida Anderson
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anees Bahji
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Manya Singh
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Andrea Soumbasis
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Ana Ramirez Pineda
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jordyn Flanagan
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Tom Lange
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Lübbecke, Germany
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Hielscher E, DeVylder JE, Saha S, Connell M, Scott JG. Why are psychotic experiences associated with self-injurious thoughts and behaviours? A systematic review and critical appraisal of potential confounding and mediating factors. Psychol Med 2018; 48:1410-1426. [PMID: 28929996 DOI: 10.1017/s0033291717002677] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Psychotic experiences (PEs), including hallucination- and delusion-like experiences, are robustly associated with self-injurious thoughts and behaviours (SITB) in the general population. However, it remains unclear as to why there is an association. The purpose of this systematic review was to elucidate the role of other factors that influence the association between PEs and SITB and, in doing so, highlight potential mechanisms underlying the relationship. A search of electronic international databases was undertaken, including PubMed, PsycINFO and EMBASE, and eligible studies were grouped according to seven confounder categories: sociodemographics, mental disorders, alcohol and substance use, environmental, psychological, intervention and family history/genetic factors. The systematic search strategy identified 41 publications reporting on 1 39 427 participants from 16 different countries. In the majority of studies, where adjustment for other variables occurred, the association between PEs and SITB persisted, suggesting PEs have an independent role. Common mental disorders, psychological distress and negative environmental exposures explained a substantial amount of the variance and therefore need to be considered as potential underlying mechanisms. There was high variability in the variables adjusted for in these studies, and so the question still remains as to whether the association between PEs and self-harm/suicidality can be attributed (fully or in part) to confounding and mediating factors or directly causal mechanisms. Regardless of causality, the now extensive literature reporting an association between these two clinical phenomena supports the broad usefulness of PEs as an indicator of risk for SITB.
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Affiliation(s)
- E Hielscher
- Centre for Clinical Research,Faculty of Medicine,The University of Queensland,Brisbane, QLD,Australia
| | - J E DeVylder
- Graduate School of Social Service,Fordham University,New York, NY,USA
| | - S Saha
- Queensland Centre for Mental Health Research (QCMHR),The Park Centre for Mental Health,Brisbane, QLD,Australia
| | - M Connell
- Centre for Clinical Research,Faculty of Medicine,The University of Queensland,Brisbane, QLD,Australia
| | - J G Scott
- Centre for Clinical Research,Faculty of Medicine,The University of Queensland,Brisbane, QLD,Australia
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7
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Greenberg E, Grant JE, Curley EE, Lochner C, Woods DW, Tung ES, Stein DJ, Redden SA, Scharf JM, Keuthen NJ. Predictors of comorbid eating disorders and association with other obsessive-compulsive spectrum disorders in trichotillomania. Compr Psychiatry 2017; 78:1-8. [PMID: 28667830 DOI: 10.1016/j.comppsych.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/07/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022] Open
Abstract
Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18-65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. 7.2% (N=40) of our TTM subjects met criteria for an ED in their lifetime. In univariable regression analysis, obsessive-compulsive disorder (OCD), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) worst-ever compulsion and total scores, certain obsessive-compulsive spectrum disorders, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and substance disorder all met the pre-specified criteria for inclusion in the multivariable analysis. In the final multivariable model, diagnosis of OCD (OR: 5.68, 95% CI: 2.2-15.0) and diagnosis of an additional body-focused repetitive behavior disorder (BFRB) (OR: 2.69, 95% CI: 1.1-6.8) were both associated with increased risk of ED in TTM. Overall, our results provide further support of the relatedness between ED and TTM. This finding highlights the importance of assessing for comorbid OCD and additional BFRBs in those with TTM. Future research is needed to identify additional predictors of comorbid disorders and to better understand the complex relationships between BFRBs, OCD and EDs.
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Affiliation(s)
- Erica Greenberg
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
| | - Erin E Curley
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Christine Lochner
- SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa.
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA.
| | - Esther S Tung
- Department of Psychology, Boston University, Boston, MA, USA.
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Anxiety & Stress Disorders, University of Cape Town, Cape Town, South Africa.
| | - Sarah A Redden
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
| | - Jeremiah M Scharf
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Psychiatric & Neurodevelopmental Genetics Unit, Center for Human Genetics Research, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
| | - Nancy J Keuthen
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
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Pedrolli C, Sacchi MC, Togni M, Cereda E. A case of hyperemesis in bulimia nervosa. Int J Eat Disord 2015; 48:446-8. [PMID: 24902945 DOI: 10.1002/eat.22315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/06/2014] [Accepted: 05/25/2014] [Indexed: 11/06/2022]
Abstract
Bulimia nervosa is an eating disorder defined by recurrent episodes of binge eating followed by compensatory behaviors, primarily self-induced vomiting. Most common complications are due to purge behaviors and are frequently responsible for hospitalization. These include electrolyte disturbances, dehydration, hypovolemia, stomatitis, esophageal diseases, and functional impairment of the colon. However, an obstruction-like syndrome has never been reported. We report the case of a middle-age woman suffering from bulimia nervosa and referring at the emergency department with a 7-day story of hyperemesis responsible for an acute renal failure. During hospitalization, after the most important and common medical causes of hyperemesis were excluded, an upper gastrointestinal endoscopy was performed. The endoscopist reported the presence of an impressive bezoar, which underwent to mechanical fragmentation and biopsy sampling, revealing it was made up exclusively of liquorice wheels. An endoscopy performed few days after showed the complete dissolution of the bezoar, and the patient was discharged without any further gastrointestinal complaint.
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Affiliation(s)
- Carlo Pedrolli
- Dietetic and Clinical Nutrition Unit, "Santa Chiara" Hospital, APSS Trento, Trento, Italy
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