Core beliefs and social anxiety in the eating disorders

Early maladaptive schemas and COVID-19 anxiety: The mediational role of mistrustfulness and vulnerability to harm and illness

BACKGROUND

Early maladaptive schemas (EMS), as lifelong psychological structures, tend to be associated with psychopathological symptomatology. Previous research has suggested that schemas act as psychological vulnerabilities to stressful life situations, such as the present worldwide COVID-19 pandemic. In this context, anxiety and psychological distress have been documented as two of the main psychological symptoms associated with the COVID-19 pandemic. However, the associations between specific EMS and COVID-19 anxiety remain unexplored. Therefore, this study aims to explore the relationships between EMS, COVID-19 anxiety as well as other mental health variables such as psychological well-being, distress and life satisfaction.

METHODS

In a cross-sectional design, 249 individuals (M = 34.2, SD = 12.0) completed several self-report measures.

RESULTS

EMS from different schematic domains were positively associated with COVID-19 anxiety and psychological distress and negatively associated with psychological well-being and life satisfaction. An EMS hierarchical regression model predicted COVID-19 anxiety. Mistrustfulness and vulnerability to harm and illness mediated the relationships between COVID-19 anxiety, psychological distress and life satisfaction.

CONCLUSIONS

According to these results, mistrustfulness and vulnerability to harm and illness can act as underlying variables for the decrease in mental health associated with the COVID-19 pandemic.

Examining the relationship between shame and social anxiety disorder: A systematic review

This paper is the first systematic review of the literature on the relationship between shame and social anxiety (SA). We reviewed a total of 60 peer-reviewed empirical articles that met criteria for inclusion. We begin by summarizing literature investigating the empirical association between shame and SA and review literature on whether this association is impacted by cultural or diagnostic differences. Next, we briefly describe the updated version of Rapee and Heimberg's (1997) cognitive-behavioral model of social anxiety disorder (SAD; Heimberg, Brozovich, & Rapee, 2014) and propose how shame may interact with five processes described therein: environmental experiences, observations/images of the self, perceived negative evaluation by others, post-event cognitive processes, and behavioral manifestations of SA. We review the current literature on shame and SA as it relates to each of these domains. Thereafter, we discuss existing research on the role of shame in the treatment of SAD and the implications of the research discussed in this review. Finally, we conclude with a discussion of some key limitations in the existing literature and areas for future research.

A glance into psychiatric comorbidity in adolescents with anorexia nervosa

BACKGROUND

Eating disorders display several psychiatric comorbidities. The aim of this study was to describe these comorbidities in a group of adolescent patients with anorexia nervosa or OSFED (Other Specified Feedind or Eating Disorder). We have evaluated the comorbidity both with a clinical interview (categorical comorbidities) and with a self-report interview (dimensional comorbidities) in order to compare the two profiles.

METHODS

The study was carried out at the Division of Child and Adolescent Psychiatry (eating disorder service for developmental age) of the Luigi Vanvitelli University of Campania (ex Second University of Naples). Data were collected retrospectively from chart review, routinely gathered during the clinical assessment.

RESULTS

Seventy-two subjects constituted the sample, 62 (86.1%) were female and 10 (13.9%) male. The most frequent categorical comorbidities were social anxiety disorder (SS: 38; 52.8%), Depression disorder (SS: 30; 41.7%) and generalized anxiety disorder (SS: 14; 19.4%). The mean scores at dimensional questionnaires were 15.5 (SD: 10.7) for the depression (Children Depression Inventory) and 34.8 (SD: 28.3) for social anxiety (Liebowitz Social Anxiety Scale).

CONCLUSIONS

Data analysis showed that social anxiety and depression were the most common categorical comorbidities in young patients with eating disorders. However, comparing the data from the clinical interview with those of the self-interviews revealed that patients well recognize social anxiety symptoms, but tend to deny depressive ones.

Clients' perceptions of the therapeutic relationship in the treatment of anorexia nervosa: qualitative findings from an online questionnaire

The therapeutic relationship plays a unique and pivotal role in the treatment and recovery of individuals with mental illness. The aim of the questionnaire was to understand clients’ perceptions of the factors affecting the formation of the therapeutic relationship during treatment or recovery from self-reported anorexia nervosa. Former or current individuals diagnosed with anorexia nervosa, 18 years and over, were invited to participate in an online questionnaire developed by the researchers. Eating disorder organisations in Australia and the United Kingdom advertised the study and provided the link to the online questionnaire. The questionnaire collected both quantitative and qualitative data, with quantitative data analysed using descriptive statistics and qualitative data using conventional content analysis. Findings revealed only 25% of participants (n=33) believed treatment providers listened and understood (to a great extent) their concerns during treatment and 30.08% (n=40) did not have sufficient trust or confidence in providers. The four qualitative themes identifying factors affecting therapeutic relationships are described. Healthcare providers working in acute and primary health settings should persevere with the development and maintenance of the therapeutic relationship in adults with anorexia nervosa. An investment in this relationship will be the catalyst driving motivation to change.

Social anxiety in the eating disorders: a systematic review and meta-analysis

Social anxiety disorder is one of the most common comorbid conditions in eating disorders (EDs). The aim of the current review and meta-analysis is to provide a qualitative summary of what is known about social anxiety (SA) in EDs, as well as to compare levels of SA in those with EDs and healthy controls. Electronic databases were systematically searched for studies using self-report measures of SA in ED populations. In total, 38 studies were identified, 12 of which were included in the meta-analyses. For both anorexia nervosa (AN) and bulimia nervosa, there were significant differences between ED groups and HCs, with medium to large effect sizes. Findings from the qualitative review indicate that levels of SA are similar across the ED diagnoses, and SA improves with treatment in AN. In addition, high levels of SA are associated with more severe ED psychopathology, but not body mass index. These findings add to the wider literature on socio-emotional functioning in EDs, and may have implications for treatment strategies.

Beliefs about exercise: relationship to eating psychopathology and core beliefs among young female exercisers

OBJECTIVE

This study had two objectives. First, to determine links between levels of eating psychopathology and beliefs about exercise among young women. Second, to determine the predictive effects of unhealthy core beliefs on exercise beliefs.

METHOD

A convenience sample of 185 young female exercisers completed the Eating Disorders Inventory (EDI), the Exercise Beliefs Questionnaire (EBQ) and the Young Schema Questionnaire (YSQ).

RESULTS

The participants' mean scores on the EDI were as follows: drive for thinness=0.69 (SD=0.82); body dissatisfaction=1.30 (SD=0.86); and bulimia=0.33 (SD=0.42). There were significant, positive correlations of all three EDI scales with EBQ social and EBQ appearance subscales. In addition, YSQ Defectiveness/Shame beliefs predicted EBQ social scores, while YSQ Unrelenting Standards predicted EBQ appearance scores.

DISCUSSION

Those women with relatively unhealthy eating attitudes are likely to believe that exercise will prevent negative social consequences, and are likely to be motivated to exercise in order to preserve or enhance their physical appearance. These same types of exercise belief (regarding social consequences and appearance) are predicted by feelings of defectiveness and shame and by unrelenting high personal standards.