The integration of primary anorexia nervosa and obsessive-compulsive disorder

Exposure with response prevention (ERP) for body dissatisfaction in a group therapy format: an exploratory study

PURPOSE

The aim of this exploratory study was to examine patient satisfaction and outcomes from exposure with response prevention (ERP) delivered in a group therapy format. The group was aimed at addressing eating disorder symptoms associated with body dissatisfaction in the later stages of outpatient treatment.

METHODS

33 adults with a DSM-5 diagnosis of an eating disorder participated in the ERP group. Participants completed pre- and post-ERP group measures of depression, anxiety, self-evaluation based on body image, restraint, eating concern, weight concern, shape concern, upward and downward appearance comparisons, and patient satisfaction.

RESULTS

Involvement in the ERP group was associated with significant decreases in self-evaluation based on body image, restraint, eating concern, weight concern, shape concern, and upward physical appearance comparisons post-group treatment. This adjunct treatment group was well received and viewed as being helpful by participants.

CONCLUSIONS

ERP in a group therapy format for addressing body dissatisfaction may represent a complimentary approach to current evidence-based treatments for an eating disorder, and warrant further investigation.

Cognitive behavioral therapy in pharmacoresistant obsessive-compulsive disorder

BACKGROUND

The aim of the study was to determine whether patients with obsessive-compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline.

METHODS

Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale-Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale-Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period.

RESULTS

During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder.

Body checking and obsessive-compulsive symptoms in Brazilian outpatients with eating disorders

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.

Multidimensional self reports as a measure of characteristics in people with eating disorders

This study used multidimensional self report assessments to measure perfectionism, impulsivity and obsessive compulsive characteristics in females with anorexia nervosa (AN), bulimia nervosa (BN) and in matched healthy controls (HC). The Frost Multidimensional Perfectionism Scale (FMPS), Barrett Impulsivity Scale (BIS) and Obsessive Compulsive Inventory-Revised (OCI-R) scale were completed by 107 participants (AN=30, BN=26, HC=51), in parallel with clinical measures. Results show that people with AN have the highest scores on the dimensions of the FMPS as well as on the overall score; the AN and BN groups have the highest scores on the dimensions and on the overall score of the OCI-R; on the BIS, the AN and BN groups have the highest scores on the attention subscale, but there are no group differences on the overall BIS scores. In relation to the FMPS, the global score, and the subscales 'concern over mistakes' and 'doubts about actions' are all highly correlated with both eating pathology (Eating Disorder Examination Questionnaire, EDE-Q) and low global functioning (Structured Clinical Interview for DSM IV, SCID). The subscale 'obsessing' on the OCI-R shows a strong correlation with eating pathology. The overall score and also the subscales of the BIS do not show strong correlations with eating pathology or poor global functioning. In conclusion, therapies should seek to address these specific areas which are highly correlated with eating disorder pathology.

Treatment responses of inpatient eating disorder women with and without co-occurring obsessive-compulsive disorder

We analyzed the influence of co-occurring obsessive-compulsive disorder (OCD) on response to eating disorder (ED) treatment among 2,971 female inpatients. We assessed treatment response using Eating Disorder Inventory-2 and DSM-IV ED criteria. Multivariate analyses included sociodemographics, illness severity, and co-occurring Axis I/II diagnoses. ED inpatients with OCD had greater ED severity than those without OCD. However, no differences occurred in short- and intermediate-term ED outcomes. Patients with and without OCD evidenced the same degree of change in EDI-2 scores admission-to-discharge and discharge-to-one-year; and 93% of patients both with and without OCD no longer evidenced a DSM-IV ED diagnosis one-year post-discharge. Results suggest that with co-occurring OCD treated using evidence-based interventions ED inpatients with and without OCD may have similar prognoses.

Abnormal eating behaviors in adolescent and young adult women from southern Brazil: reassessment after four years

OBJECTIVE

To investigate whether abnormal eating behaviors in young women could predict eating disorders after 4 years.

METHOD

56 women were identified as presenting abnormal eating behaviors in a cross-sectional study (Eating Attitudes Test-26 and Edinburgh Bulimic Investigation Test). They were matched for age and neighborhood to two controls (n = 112). Four years later, they were re-assessed with the two screening questionnaires plus the Composite International Diagnostic Interview (CIDI 2.1).

RESULTS

Women with abnormal eating behaviors at baseline showed a high probability of presenting abnormal eating behaviors but it was not associated with eating disorders 4 years later. They were also at higher risk for obsessive-compulsive disorder, post-traumatic stress disorder, and specific phobia.

DISCUSSION

Abnormal eating behaviors were related to the maintenance of the disturbed behavior over the years, and were associated with increased probability for psychiatric diagnoses.

Anorexia nervosa and obsessive-compulsive disorder in a prepubertal patient with bone dysplasia: a case report

OBJECTIVE

The current article describes the case of a 13-year-old girl with body dysplasia, anorexia nervosa, and obsessive-compulsive disorder (OCD).

METHOD

She was given cognitive-behavioral therapy and pharmacologic treatment for the obsessive-compulsive symptomatology and exogenous growth hormone to increase her height.

RESULTS

She experienced an adequate weight and height increase and remission of obsessive-compulsive symptomatology, and reestablished adequate social and academic functioning.

CONCLUSION

After a follow-up of almost 2 years, she had had her menarche, continued her positive eating habits, and had not relapsed into OCD.

Neurosurgical interventions for neuropsychiatric syndromes

Psychosurgical procedures have been used for the treatment of intractable mental illness for more than 50 years. With improvements in surgical techniques, including new implantable stimulators, advances in functional neuroimaging, and progress in our fundamental understanding of the pathophysiology of mental illness there is a renewed interest in neurosurgical treatment of refractory psychiatric illness. This article will review the history of psychosurgery and recent developments in surgical techniques and implantable devices used in this context. The results of psychosurgery for the treatment of several psychiatric conditions and neuropsychiatric symptoms will be presented, including obsessive-compulsive disorder, Tourette's syndrome, depression, anxiety, aggression, self-injurious behavior, and schizophrenia. Lastly, a perspective on the current and future role of psychosurgery for the treatment of mental illnesses will be discussed.

Transtornos alimentares e os espectros do humor e obsessivo-compulsivo

Revisamos os estudos clínicos e biológicos que sugerem que os transtornos alimentares (TA) são expressões fenotípicas de outros transtornos psiquiátricos e parte de espectros de psicopatologia, em especial dos espectros dos transtornos do humor e do transtorno obsessivo-compulsivo. A investigação da relação entre os TA e outros transtornos psiquiátricos através dos modelos espectrais pode proporcionar um melhor entendimento da fisiopatologia destas síndromes e a elaboração de tratamentos mais eficazes. Entretanto, o reconhecimento de que os TA possuem características peculiares e a adoção de uma postura crítica em relação a modelos que eliminam limites diagnósticos são também fundamentais para a evolução do conhecimento no campo.