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Rodríguez-Mondragón L, Moreno-Encinas A, Graell M, Román FJ, Sepúlveda AR. A case-control study to differentiate parents' personality traits on anorexia nervosa and affective disorders. FAMILY PROCESS 2024. [PMID: 38520285 DOI: 10.1111/famp.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Eating disorders (ED) and affective disorders (AD) in adolescent population and several investigations have pointed out that specific family dynamics play a major role in the onset, course, and maintenance of both disorders. The aim of this study was to extend the literature of this topic by exploring differences between parents' personality traits, coping strategies, and expressed emotion comparing groups of adolescents with different mental conditions (anorexia nervosa vs. affective disorder vs. control group) with a case-control study design. A total of 50 mothers and 50 fathers of 50 girls with anorexia nervosa (AN), 40 mothers and 40 fathers of 40 girls with affective disorder (AD), and 50 mothers and 50 fathers of 50 girls with no pathology that conformed the control group (CG) were measured with the Temperament and Character Inventory (TCI), the COPE Inventory, the Family Questionnaire (FQ), and psychopathology variables, anxiety, and depression. Both parents of girls with AN showed a significant difference in personality, coping strategies, and expressed emotion compared to both parents in the CG, while they presented more similarities to parents of girls in the AD group. Identifying personality traits, expressed emotion, coping strategies, and psychopathology of parents and their daughters will allow improvements in the interventions with the adolescents, parents, and families.
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Affiliation(s)
- L Rodríguez-Mondragón
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - A Moreno-Encinas
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - M Graell
- Section Head of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, Madrid, Spain
- CIBERSAM, Madrid, Spain
| | - F J Román
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - A R Sepúlveda
- Biological and Health Psychology Department, School of Psychology, Autonomous University of Madrid, Madrid, Spain
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Hill L. Temperament impact on eating disorder symptoms and habit formation: a novel model to inform treatment. J Eat Disord 2024; 12:40. [PMID: 38504375 PMCID: PMC10953227 DOI: 10.1186/s40337-024-00998-x] [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: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Temperament has long been described as the biological dimension of personality. Due to advancing brain-imaging technology, our understanding of temperament has deepened and transformed over the last 25 years. Temperament combines genetic, neurobiological and trait research. Temperament has been included peripherally in some eating disorder (ED) treatment approaches but has been ignored by most. Temperament fills a fundamental treatment gap by clarifying who is more vulnerable to develop ED and why some individuals are susceptible to specific ED symptoms while others are not. In addition, temperament targets possible treatment solutions. MAIN TEXT There is a need for a novel model that incorporates and explores the role of temperament in ED treatment intervention. This paper is a metaphoric temperament model to inform treatment intervention. It describes how temperament traits influences new decisions which impact new behavioural responses. In turn, it neurobiologically tracks how and why the brain efficiently transforms new decisions into new habits. This model integrates both temperament and habit research to explore (a) what temperament is; (b) how new decisions develop into habits neurobiologically; (c) that the brain wires destructive symptoms into habits in the same way that it wires healthy/productive behaviours into habits; (d) traits that trigger ED symptoms are the same traits that influence productive behaviours; and in regard to treatment implications (e) when treatment structure and intervention target client temperaments, the potential for new healthy "trait-syntonic" habits could develop. CONCLUSIONS This paper introduces a metaphoric model that synthesizes and integrates temperament neurobiological and trait findings with ED symptoms, habits, and client trait-based solutions. The model synthesizes and integrates different research domains to establish a brain-based foundation to inform treatment intervention. The model targets clients' temperament traits as central collections of innate self-expressions that could be utilized as tools to redirect client trait-syntonic ED responses into trait-syntonic productive outcomes. The brain bases of temperament and habit formation serve as a biological foundation for ED treatment intervention.
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Affiliation(s)
- Laura Hill
- Department of Psychiatry, University of California, San Diego, CA, USA.
- Adjunct Associate Clinical Professor of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
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Trait anxiety is associated with amygdala expectation and caloric taste receipt response across eating disorders. Neuropsychopharmacology 2023; 48:380-390. [PMID: 36100656 PMCID: PMC9750993 DOI: 10.1038/s41386-022-01440-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/26/2022]
Abstract
Anxious traits are elevated in eating disorders (EDs), are considered risk factors for ED development, and trait anxiety has been linked to ED psychopathology. How trait anxiety relates to ED neurobiology is not well understood. In this study 197 individuals across the ED spectrum (anorexia nervosa n = 91; other specified EDs n = 34; bulimia nervosa n = 56; binge ED n = 16), and 120 healthy controls were assessed for anxious traits and learned to expect and receive caloric or neutral taste stimuli during brain imaging. Amygdala sucrose expectation response differed across groups (Wilk's lambda = 0.945, p = 0.023), and was higher on the left in anorexia nervosa compared to healthy controls (p = 0.002). Expected sucrose receipt response across taste reward regions was not different between groups. In the ED sample, trait anxiety negatively moderated the relationship between amygdala expectation and right dorsal (p = 0.0062) and ventral (p = 0.0046) anterior insula receipt response. A subgroup analysis showed similar results for anorexia nervosa, and partially in bulimia nervosa. Across EDs, appetitive motivation correlated positively with bilateral orbitofrontal cortex, caudate head, and ventral striatal sucrose receipt response (r = 0.215 to 0.179, p = 0.002 to 0.012). Across the study sample, trait anxiety showed an inverted-U-shaped relationship with right (r = 0.147, p = 0.034) and left (r = 0.162, p = 0.016) amygdala expectation response. Amygdala sucrose expectation response is elevated in anorexia nervosa, correlates with sucrose receipt response, and this relationship is negatively moderated by trait anxiety across EDs. Trait anxiety may have an important role in how expectation drives taste stimulus receipt brain response and perhaps food approach in individuals with EDs.
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Jérolon A, Perduca V, Delsedime N, Abbate-Daga G, Marzola E. Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa. Eat Weight Disord 2022; 27:2569-2581. [PMID: 35460450 PMCID: PMC9556361 DOI: 10.1007/s40519-022-01397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE V, cross-sectional study.
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Affiliation(s)
- Allan Jérolon
- CNRS, MAP5 UMR 8145, Université de Paris, F-75006 Paris, France
| | | | - Nadia Delsedime
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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Variability in cannabinoid receptor genes is associated with psychiatric comorbidities in anorexia nervosa. Eat Weight Disord 2021; 26:2597-2606. [PMID: 33575982 DOI: 10.1007/s40519-021-01106-7] [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: 10/30/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The endocannabinoid system plays a key role in eating behavior regulating appetite and reward mechanisms, but the impact of its genetic variability has been scarcely studied in Anorexia Nervosa (AN). We aimed to analyze the association of genetic variants in cannabinoid receptors with the risk for AN and with psychiatric comorbidities that are commonplace in these patients. METHODS We screened 221 AN patients and 396 controls for 14 tag-SNPs in the CNR1 and CNR2 genes, coding for cannabinoids receptors CB1 and CB2, respectively. Patients were diagnosed according to DSM-5 criteria and interviewed with the SCL-90R and the EDI-2 inventories to identify AN-coupled and general psychopathology. RESULTS None of the tag-SNPs was significantly related to AN risk. However, the rs806369-TT genotype and haplotype rs806368/rs1049353/rs806369 of CNR1 were respectively associated with lower weight (mean difference = - 4.92 kg, FDR-q = 0.044) and BMI (FDR-q = 0.042) in AN patients. CNR1 rs806374-TT and CNR2 rs3003335-AA and rs6658703-GG genotypes correlated with higher scores in the Positive Symptom Distress Index (PSDI, FDR-q = 0.011 and 0.009, respectively). These three genotypes were also linked to increased Hostility in the patients (FDR-q < 0.05). Remarkably, a proximal area of the CNR1 gene locus (positions 88,143,916-88,149,832) correlated with PSDI, Hostility, Asceticism and EDI-2 total scores after correcting by multiple testing (FDR-q < 0.05 in all instances). Finally, significant CNR1/CNR2 epistasis was observed in relation to Hostility (p < 0.01) and Maturity Fears (p < 0.001). CONCLUSION The CNR1 and CNR2 genes, coding for cannabinoid receptors, may constitute important loci regarding psychiatric comorbidities in AN patients. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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Marzola E, Fassino S, Migliaretti G, Abbate-Daga G, Kaye WH. Development and validation of the Premorbid Childhood Traits Questionnaire (PCT-Q) in eating disorders. Eat Weight Disord 2019; 24:815-823. [PMID: 31313252 DOI: 10.1007/s40519-019-00748-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/04/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Some features of eating disorders (EDs) are often present in childhood before the onset of the ED. We developed a novel questionnaire to retrospectively capture such childhood traits. METHODS Focus groups were conducted at the University of California-San Diego, USA, and at the University of Turin, Italy. Three focus groups were conducted at each site, interviewing patients and parents to identify those traits that most commonly characterize childhood of patients with EDs. A preliminary version of the Premorbid Childhood Traits Questionnaire (PCT-Q) derived from these focus groups was then administered to 94 consecutive inpatients with an ED and to 286 healthy controls (HCs) at the Turin site. Also, 208 participants' parents were enrolled as well; in fact, the PCT-Q was developed with both a proband and an informant version. RESULTS A 37-item final version of the PCT-Q was generated. Reliability analyses suggested acceptability for harm avoidance (HA), social phobia, alexithymia, interoceptive awareness (IA), and food obsessions. Inter-rater reliability ranged from fair to moderate. ED sufferers scored significantly higher than HCs on HA, social phobia, alexithymia, IA, and food obsessions. CONCLUSIONS These findings support the possibility that premorbid traits contribute to a risk to develop an ED in some individuals. LEVEL OF EVIDENCE III: case-control analytic study.
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Affiliation(s)
- Enrica Marzola
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy.
| | - Secondo Fassino
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Giuseppe Migliaretti
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
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Latzer Y, Stein D. Introduction: Novel perspectives on the psychology and psychotherapy of eating disorders. J Clin Psychol 2019; 75:1369-1379. [PMID: 30995356 DOI: 10.1002/jclp.22786] [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: 11/10/2022]
Abstract
The aim of this introduction to this issue is to review and summarize significant new psychological perspectives and psychotherapeutic interventions in the treatment of eating disorder (EDs). In this issue, five novel therapeutic strategies for the treatment of EDs are presented. These include a combination of psychodynamic psychotherapy and neuropsychology, two recent modifications of cognitive behavioral therapy (the MANTRA, and the conceptualization of change in patients with ED in terms of sense of agency), a specific group movement therapy, and an innovative rehabilitation treatment. In addition, one article offers an historic review of the development of psychotherapy of EDs, and two articles highlight specific considerations related to the treatment of EDs: compulsory treatment, and culturally sensitive treatment.
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Affiliation(s)
- Yael Latzer
- Faculty of Social welfare and Health Science, Haifa University, Haifa, Israel.,Eating Disorders Institution, Rambam Medical Center, Haifa, Israel
| | - Daniel Stein
- Medical School, Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lee SJ, Park SH, Cloninger CR, Chae H. Behavior problems and personality in Korean high school students. PeerJ 2018; 6:e6106. [PMID: 30581682 PMCID: PMC6292374 DOI: 10.7717/peerj.6106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/14/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction Extant studies have examined the effect of psychological characteristics on clinical features that define behavior problems. The purpose of this study was to analyze the effects of temperament and character as both individual factors and complex profiles on behavior problems in a community sample of adolescents. Methods Behavior problems and personality of 670 Korean high school students were measured with the Youth Self-Report (YSR) and Junior version of the Temperament and Character Inventory (JTCI). Stepwise regression analysis analyzed the effects of JTCI character and temperament traits on YSR Total, Internalizing and Externalizing subscale scores, and Profile Analysis examined differences of JTCI personality profiles among three latent YSR subscale profiles acquired from Latent Profile Analysis. Results Seven subscales of the JTCI explained 38% of the YSR total degree of behavior problems, and JTCI Novelty-Seeking and Harm-Avoidance were found to account for vulnerability while JTCI Reward-Dependence and Self-Directedness explained resilience to behavior problems. There were three distinct latent YSR profile groups based on nine YSR subscales, and low behavior problem group showed a resilient personality profile characterized by low Novelty-Seeking and Harm-Avoidance and high Reward-Dependence, Persistence, Self-Directedness and Cooperativeness while high behavior problem group exhibited a vulnerable personality profile of the opposite tendency. Discussion Temperament and character explained behavior problems of Korean high school students as both individual personality traits and a complex personality profile. The results and implications of this study were examined in regard to mental health of adolescents, and the importance of education in the development of mature personality are discussed.
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Affiliation(s)
- Soo Jin Lee
- Department of Psychology, Kyungsung University, Busan, South Korea
| | - Soo Hyun Park
- Department of Psychology, Yonsei University, Seoul, South Korea
| | - C Robert Cloninger
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America
| | - Han Chae
- School of Korean Medicine, Pusan National University, Busan, South Korea
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Wierenga CE, Hill L, Knatz Peck S, McCray J, Greathouse L, Peterson D, Scott A, Eisler I, Kaye WH. The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa. Int J Eat Disord 2018; 51:863-869. [PMID: 29722047 DOI: 10.1002/eat.22876] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Novel treatments for adults with anorexia nervosa (AN) are lacking. Recent scientific advances have identified neurobiologically-driven temperament contributors to AN symptoms that may guide development of more effective treatments. This preliminary study evaluates the acceptability, feasibility and possible benefits of a multicenter open trial of an intensive 5-day neurobiologically-informed multifamily treatment for adults with AN and their supports (SU). The temperament-focused treatment combines psychoeducation of AN neurobiology and SU involvement to develop skills to manage traits contributing to disease chronicity. METHOD Fifty-four adults with AN and at least one SU (n = 73) received the 5-day treatment. Acceptability, feasibility, and attrition were measured post-treatment. Clinical outcome (BMI, eating disorder psychopathology, family function) was assessed post-treatment and at >3-month follow-up. RESULTS The treatment had low attrition, with only one drop-out. Patients and SU rated the intervention as highly acceptable, and clinicians reported good feasibility. At post-treatment, patients demonstrated significantly increased BMI, reduced eating disorder psychopathology, and improved family function. Benefits were maintained in the 39 patients who completed follow-up assessment, with 62% reporting full or partial remission. DISCUSSION Preliminary results are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary.
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Affiliation(s)
- Christina E Wierenga
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Laura Hill
- The Center for Balanced Living, Columbus, Ohio
| | - Stephanie Knatz Peck
- Department of Psychiatry, University of California San Diego, San Diego, California
| | | | - Laura Greathouse
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Danika Peterson
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Amber Scott
- The Center for Balanced Living, Columbus, Ohio
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California
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De Cuyper K, Hermans D, Pieters G, Claes L, Vansteelandt K. Indirect and direct measures of striving for perfection moderate body mass index curves in the intensive treatment of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2018; 27:86-96. [PMID: 30009415 DOI: 10.1002/erv.2625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/11/2018] [Accepted: 06/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Kathleen De Cuyper
- University Psychiatric Center KU Leuven, Leuven, Belgium.,KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Dirk Hermans
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Guido Pieters
- KU Leuven Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Laurence Claes
- KU Leuven Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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Buzzichelli S, Marzola E, Amianto F, Fassino S, Abbate-Daga G. Perfectionism and cognitive rigidity in anorexia nervosa: Is there an association? EUROPEAN EATING DISORDERS REVIEW 2018; 26:360-366. [DOI: 10.1002/erv.2591] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Sara Buzzichelli
- Eating Disorder Center, Department of Neuroscience; University of Turin; Turin Italy
| | - Enrica Marzola
- Eating Disorder Center, Department of Neuroscience; University of Turin; Turin Italy
| | - Federico Amianto
- Eating Disorder Center, Department of Neuroscience; University of Turin; Turin Italy
| | - Secondo Fassino
- Eating Disorder Center, Department of Neuroscience; University of Turin; Turin Italy
| | - Giovanni Abbate-Daga
- Eating Disorder Center, Department of Neuroscience; University of Turin; Turin Italy
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Marzola E, Fassino S, Amianto F, Abbate-Daga G. Affective temperaments in anorexia nervosa: The relevance of depressive and anxious traits. J Affect Disord 2017; 218:23-29. [PMID: 28456073 DOI: 10.1016/j.jad.2017.04.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/09/2017] [Accepted: 04/24/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Affective temperaments have been so far understudied in anorexia nervosa (AN) despite the relevance of personality and both affective and anxious comorbidity with regard to vulnerability, course, and outcome of this deadly disorder. METHODS Ninety-eight female inpatients diagnosed with AN and 131 healthy controls (HCs) were enrolled in this study and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in addition to assessments of eating psychopathology, depression, and anxiety. RESULTS AN patients and HCs differed in all affective temperaments. The diagnostic subtypes of AN differed as well with binge-purging individuals being more cyclothymic and anxious than those with restricting-type AN. TEMPS-A scores correlated with body mass index and eating psychopathology but not with duration of illness. Concerning comorbidity, grater scores on the depressive and lower scores on the hyperthymic temperaments were found in depressed patients. Those who had either an anxious or irritable temperament were significantly more diagnosed with an anxious disorder than those who did not show this temperament. When logistic regression was performed, high depressive/low hyperthymic and high irritable/anxious traits resulted to be associated with depressive and anxious comorbidity, respectively, independently of confounding factors. LIMITATIONS Cross-sectional design, some patients on medications, few baseline clinical differences between diagnostic subtypes, no other personality assessments. CONCLUSIONS An affective continuum strongly associated with mood and anxious comorbidity emerged in AN. Such an evaluation could have several research and clinical implications given the need of improving treatment individualization and early interventions for such a complex disorder.
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Affiliation(s)
- Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
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Temperament and stress coping styles in bronchial asthma patients. Postepy Dermatol Alergol 2016; 33:469-474. [PMID: 28035226 PMCID: PMC5183786 DOI: 10.5114/ada.2016.63886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/24/2015] [Indexed: 01/15/2023] Open
Abstract
Introduction Temperament, defined as the formal characteristics of behavior, is a personality trait which can influence the clinical presentation and course of bronchial asthma. It determines susceptibility to stress as well as stress coping styles. Aim The aim of the study was to assess whether healthy subjects differ from bronchial asthma patients with regard to temperamental variables and stress coping styles, and whether these factors may also differentiate patients with severe asthma from those with the milder form. The study also assesses whether the results of flow volume curve analysis correlate with temperamental traits and stress coping styles. Material and methods The study was conducted in a group of 65 asthma patients and 62 healthy controls. All underwent flow volume curve examination and psychological tests: Formal Characteristics of Behavior – Temperament Inventory (FCB-TI) and Coping in Stress Situations (CISS) questionnaire. Results Bronchial asthma patients were characterized by a lower level of briskness (“agility”) than healthy subjects (13.35 ±4.48 vs. 14.97 ±3.98, p = 0.031). The remaining temperamental traits and stress coping styles did not differ between the groups. Additionally, the forced expiratory volume in 1 s (FEV1) value was found to correlate negatively with the intensity of the emotion-oriented stress coping style, whereas FEV1 and forced vital capacity (FVC) were found to positively correlate with briskness, emotional reactivity and endurance, while a negative correlation was found with activity. Conclusions Briskness differentiates healthy subjects from bronchial asthma patients. The values obtained in FEV1 and FVC pulmonary function tests were also found to correlate with some temperamental variables.
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Knatz S, Wierenga CE, Murray SB, Hill L, Kaye WH. Neurobiologically informed treatment for adults with anorexia nervosa: a novel approach to a chronic disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246796 PMCID: PMC4518705 DOI: 10.31887/dcns.2015.17.2/sknatz] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anorexia nervosa (AN) is a severe and debilitating disorder with significant medical and psychological sequelae. To date, there are no effective treatments for adults, resulting in high rates of chronicity, morbidity, and mortality. Recent advances in brain imaging research have led to an improved understanding of etiology and specific neurobiological mechanisms underlying symptoms. Despite this, there are no treatments focused on targeting symptoms using this empirically supported mechanistic understanding of the illness. Updated treatment approaches focused on targeting neurobiological mechanisms underlying core AN symptomatology are necessary to improve treatment out-comes for this population. Neurobiologically Enhanced With Family Eating Disorder Trait Response Treatment (NEW FED TR) is a neurobiologically informed treatment targeting key temperament constructs associated with the illness through the delivery of psychoeducation and skills training to patients and nominated carers.
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Affiliation(s)
- Stephanie Knatz
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Christina E Wierenga
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Stuart B Murray
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Laura Hill
- Ohio State University, Department of Psychiatry, Columbus, Ohio, USA
| | - Walter H Kaye
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
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Lee-Winn AE, Townsend L, Reinblatt SP, Mendelson T. Associations of Neuroticism and Impulsivity with Binge Eating in a Nationally Representative Sample of Adolescents in the United States. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016; 90:66-72. [PMID: 26705374 DOI: 10.1016/j.paid.2015.10.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Binge eating behavior is a public health concern with serious physical and mental health consequences. Certain personality traits have been found to contribute to the development of eating disorders in clinical samples of youth, but little is known about associations between personality traits and binge eating in the general adolescent population. We examined the associations of neuroticism and impulsivity-both independently and in combination-with lifetime prevalence of binge eating, using nationally representative, cross-sectional data from the National Comorbidity Survey: Adolescent Supplement (n=437). Neuroticism and impulsivity were each significantly associated with lifetime prevalence of binge eating (adjusted prevalence ratio [aPR]=1.11, confidence interval [CI]=1.07, 1.15, p<0.001; aPR=1.06, CI=1.04, 1.09, p<0.001, respectively). The combination of high neuroticism and high impulsivity was associated with higher lifetime binge eating than the combination of low neuroticism and low impulsivity (aPR=3.72, CI=2.45, 5.65, p<0.001), and this association was stronger for female than male adolescents (females: aPR=5.37, CI=3.24, 8.91, p<0.001 vs. males: aPR=2.45, CI=1.43, 4.22, p=0.002). Our findings have implications for informing theories of etiology and interventions to target binge eating behaviors.
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Affiliation(s)
- Angela E Lee-Winn
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 782 Baltimore, MD 21205, USA
| | - Lisa Townsend
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 898 Baltimore, MD 21205, USA,
| | - Shauna P Reinblatt
- The Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, 5300 Alpha Commons Drive 4th Floor Baltimore, MD 21224 USA,
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Hampton House, Room 853 Baltimore, MD 21205, USA,
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Lloyd S, Schmidt U, Simic M, Tchanturia K. Self-reported and performance based perfectionism in mothers of individuals with Anorexia Nervosa: a pilot study. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2015; 29:192-9. [PMID: 26399933 DOI: 10.1007/s40211-015-0161-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perfectionism is implicated in the development and maintenance of Anorexia Nervosa and there is some evidence that perfectionism may be elevated in family members. However to date there are no studies investigating behavioural aspects of perfectionism in unaffected mothers. METHODS Forty-one participants took part in this pilot study: 21 unaffected mothers of individuals with Anorexia Nervosa and 20 healthy control mothers. Participants completed two performance based tasks assessing perfectionism-a text replication task and a bead sorting task-along with self-report measures of perfectionism. RESULTS No group differences were found between unaffected AN mothers and HC mothers on performance measures of perfectionism. DISCUSSION The findings are discussed in relation to existing studies and clinical implications explored.
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Affiliation(s)
- Samantha Lloyd
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, UK. .,Illia State University, Tbilisi, Georgia.
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17
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Lee SJ, Cloninger CR, Chae H. Cloninger's temperament and character traits in medical students of Korea with problem eating behaviors. Compr Psychiatry 2015; 59:98-106. [PMID: 25732413 DOI: 10.1016/j.comppsych.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/02/2015] [Accepted: 02/06/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The personality profiles of patients with eating disorder have been extensively investigated, but those of people in the general population with eating behavior problems need to be evaluated to assess the relationship between personality, health behavior and level of overall well-being in non-clinical samples. DESIGN Temperament and character traits, reasons for over-eating, and the negative influence of functional dyspepsia on quality of life were measured by the Temperament and Character Inventory (TCI), Dutch Eating Behavior Questionnaire (DEBQ), and Functional Dyspepsia Quality of Life (FDQOL) inventory, respectively, in 199 Korean medical students. The associations among TCI, FDQOL, DEBQ and body mass index (BMI) were examined by correlational analysis. Multiple regression analysis was carried out to measure how well personality (TCI) accounted for patterns of overeating (DEBQ) and impaired quality of life from functional dyspepsia (FDQOL). RESULTS Individual differences in personality (especially harm-avoidance, self-transcendence, and self-directedness) were weakly associated with overeating and impaired quality of life from functional dyspepsia. Gender, social desirability and body mass index also played important roles in predicting eating behavior problems in the nonclinical population. DISCUSSION AND CONCLUSION We found that the personality traits observed in clinical patients with eating disorders are also found in people with eating behavior problems in the nonclinical population of Korea. The ways that personality traits affect eating behaviors were discussed along with recommendations for future studies in light of the limitations of available data.
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Affiliation(s)
- Soo Jin Lee
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, MO 63110, USA; Department of Psychotherapy, School of Nursing and Public Health, Kyungil University, Daegu, 712-701, South Korea
| | - C Robert Cloninger
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, MO 63110, USA
| | - Han Chae
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, MO 63110, USA; Division of Longevity and Biofunctional Medicine, School of Korean Medicine, Pusan National University, Busan, 609-735, South Korea.
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18
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Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Clinical investigation of set-shifting subtypes in anorexia nervosa. Psychiatry Res 2014; 219:592-7. [PMID: 25017616 DOI: 10.1016/j.psychres.2014.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022]
Abstract
While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Kaye WH, Wierenga CE, Knatz S, Liang J, Boutelle K, Hill L, Eisler I. Temperament-based treatment for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:12-8. [PMID: 25377622 DOI: 10.1002/erv.2330] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/19/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022]
Abstract
Anorexia nervosa (AN) tends to be a chronic and deadly disorder with no proven treatments that reverse core symptoms in adults. New insight into neurobiological mechanisms that contribute to symptoms may support development of more effective interventions. We describe the development of a temperament-based treatment for AN on the basis of empirically supported models. It uses a systemized approach and takes into consideration an understanding of how neurobiological mechanisms are expressed through behaviour and personality and contribute to specific AN symptomatology. This model integrates the development of AN-focused constructive coping strategies with carer-focused strategies to manage temperament traits that contribute to AN symptomatology. This intervention is consistent with the recent Novel Interventions for Mental Disorders initiative mandating that treatment trials follow an experimental medicine approach by identifying underlying mechanisms that are directly targeted by the intervention to influence symptoms.
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Affiliation(s)
- Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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20
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Kachani AT, Barroso LP, Brasiliano S, Hochgraf PB, Cordás TA. Body checking and obsessive-compulsive symptoms in Brazilian outpatients with eating disorders. Eat Weight Disord 2014; 19:177-82. [PMID: 24639070 DOI: 10.1007/s40519-014-0111-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 02/20/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Compare obsessive-compulsive symptoms in patients with anorexia nervosa (AN) and bulimia nervosa (BN), and assess the association of these symptoms and body checking in each of these groups of patients. METHODS Eighty-five female outpatients with eating disorders (ED) completed body checking and obsessive-compulsive questionnaires. RESULTS Body checking was more prevalent in the BN group. Among patients with AN, the highest mean body-checking scores were found in patients with somatic obsessions related to body areas and eating rituals (p = 0.003 and 0.018, respectively). DISCUSSION Patients with eating disorders are believed to be included in the obsessive-compulsive spectrum, and may experience intrusive thoughts about behavior. The results of our work suggest that obsessive symptoms and body checking should be further investigated and properly managed in patients with ED.
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Affiliation(s)
- Adriana Trejger Kachani
- Women Drug Dependent Treatment Center, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil,
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21
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Is the relationship between binge eating episodes and personality attributable to genetic factors? Twin Res Hum Genet 2014; 17:65-71. [PMID: 24423627 DOI: 10.1017/thg.2013.92] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aspects of disordered eating and personality traits, such as neuroticism, are correlated and individually heritable. We examined the phenotypic correlation between binge eating episodes and indices of personality (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness, and control/impulsivity). For correlations ≥|0.20|, we estimated the extent to which genetic and environmental factors contributed to this correlation. Participants included 3,446 European American same-sex female twins from the Missouri Adolescent Female Twin Study (median age = 22 years). Binge eating episode was assessed via interview questions. Personality traits were assessed by self-report questionnaires. There was a significant moderate phenotypic correlation between binge eating episode and neuroticism (r = 0.33) as well as conscientiousness (r = -0.21), while other correlations were significant but smaller (r ranging from -0.14 to 0.14). Individual differences in binge eating episodes, neuroticism, and conscientiousness were attributed to additive genetic influences (38% [95% CI: 21-53%], 45% [95% CI: 38-52%], and 44% [95% CI: 0.33-0.55%] respectively), with the remaining variance attributed to individual-specific environmental influences. Covariance was attributable to genetic (neuroticism r g = 0.37; conscientiousness r g = -0.22) and individual-specific environmental (neuroticism r e = 0.28; conscientiousness r e = -0.19) influences. Personality traits may be an early indicator of genetic vulnerability to a variety of pathological behaviors, including binge eating episode. Furthermore, prior research documenting phenotypic correlations between eating disorder diagnoses and personality may have stemmed from etiological overlap between these personality traits and aspects of disordered eating, such as binge eating episode.
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Bueno B, Krug I, Bulik CM, Jiménez-Murcia S, Granero R, Thornton L, Penelo E, Menchón JM, Sánchez I, Tinahones FJ, Fernández-Aranda F. Late onset eating disorders in Spain: clinical characteristics and therapeutic implications. J Clin Psychol 2013; 70:1-17. [PMID: 23801539 DOI: 10.1002/jclp.22006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). METHOD All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. ASSESSMENT Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. RESULTS LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. CONCLUSION LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.
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Affiliation(s)
- B Bueno
- Department of Psychiatry, University Hospital of Bellvitge; CIBER Salud Mental (CIBERSAM), ISCIII
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Pollack LO, Forbush KT. Why do eating disorders and obsessive-compulsive disorder co-occur? Eat Behav 2013; 14:211-5. [PMID: 23557823 PMCID: PMC3618658 DOI: 10.1016/j.eatbeh.2013.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 11/01/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to use an alternative, dimensionally based approach to understanding the reasons for comorbidity between eating disorders and obsessive-compulsive disorder. Participants from a representative community sample (N=407; 47% female) completed self-report measures of eating pathology, obsessive-compulsive symptoms, perfectionism, and neuroticism. Hierarchical multiple regression indicated that neuroticism and perfectionism completely mediated associations between most obsessive-compulsive and eating disorder symptoms. However, body dissatisfaction shared unique associations with checking, cleaning, and obsessive rituals that could not be explained by these personality traits. Results suggest that shared personality traits play a key role in the comorbidity between eating disorders characterized by binge eating and dietary restraint and obsessive-compulsive disorder. Future studies are needed to examine whether similar underlying neurocognitive processes that give rise to compulsive checking, cleaning, and obsessive rituals may also contribute to the development and maintenance of body checking in individuals diagnosed with eating disorders.
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Affiliation(s)
- Lauren O. Pollack
- University of Missouri-Kansas City, Department of Psychology, 5030 Cherry Hall, Kansas City, MO, USA, 64110
| | - Kelsie T. Forbush
- Purdue University, Department of Psychological Sciences, 703 Third Street, West Lafayette, IN, USA, 47907-2081
,Corresponding Author: Purdue University, Department of Psychological Sciences, 703 Third Street, West Lafayette, IN, USA, 47907-2081, Office telephone: 765-494-6977,
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Nagata T, Yamada H, Teo AR, Yoshimura C, Kodama Y, van Vliet I. Using the mood disorder questionnaire and bipolar spectrum diagnostic scale to detect bipolar disorder and borderline personality disorder among eating disorder patients. BMC Psychiatry 2013; 13:69. [PMID: 23443034 PMCID: PMC3599106 DOI: 10.1186/1471-244x-13-69] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/14/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. METHODS Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. All participants completed the mood and eating disorder sections of the SCID-I/P and the borderline personality disorder section of the SCID-II, in addition to the MDQ and BSDS. Predictive validity of the MDQ and BSDS was evaluated by Receiver Operating Characteristic analysis of the Area Under the Curve (AUC). RESULTS Fifteen (19%) and twelve (15%) patients fulfilled criteria for bipolar II disorder and borderline personality disorder, respectively. The AUCs for bipolar II disorder were 0.78 (MDQ) and 0.78 (BDSD), and the AUCs for borderline personality disorder were 0.75 (MDQ) and 0.79 (BSDS). CONCLUSIONS Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.
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Affiliation(s)
- Toshihiko Nagata
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Alan R Teo
- Department of Internal Medicine and Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Chiho Yoshimura
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuya Kodama
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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DeSocio JE. The Neurobiology of Risk and Pre-Emptive Interventions for Anorexia Nervosa. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2012; 26:16-22. [DOI: 10.1111/jcap.12018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Effectiveness of cognitive remediation therapy (CRT) in anorexia nervosa: A case series. J Clin Exp Neuropsychol 2012; 34:1009-15. [DOI: 10.1080/13803395.2012.704900] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eating disorders and major depression: role of anger and personality. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:194732. [PMID: 21977317 PMCID: PMC3184501 DOI: 10.1155/2011/194732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/04/2011] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate comorbidity for MD in a large ED sample and both personality and anger as clinical characteristics of patients with ED and MD. We assessed 838 ED patients with psychiatric evaluations and psychometric questionnaires: Temperament and Character Inventory, Eating Disorder Inventory-2, Beck Depression Inventory, and State-Trait Anger Expression Inventory. 19.5% of ED patients were found to suffer from comorbid MD and 48.7% reported clinically significant depressive symptomatology: patients with Anorexia Binge-Purging and Bulimia Nervosa were more likely to be diagnosed with MD. Irritable mood was found in the 73% of patients with MD. High Harm Avoidance (HA) and low Self-Directedness (SD) predicted MD independently of severity of the ED symptomatology, several clinical variables, and ED diagnosis. Assessing both personality and depressive symptoms could be useful to provide effective treatments. Longitudinal studies are needed to investigate the pathogenetic role of HA and SD for ED and MD.
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