Eating Disorders and Their Relationship to Impulsivity

An exploratory examination of delay discounting in women and girls diagnosed with an eating disorder

Those with eating disorders (EDs) characterized by purging behaviors tend to show more impulsivity than those diagnosed with restrictive eating, who tend to show more compulsivity. Impulsive choice (i.e. a type of impulsivity) is a common factor among eating disorders that is less understood. Delay discounting is a measure of choice impulsivity, examining the decrease in value of delayed outcomes. In this exploratory study, we examined associations between eating disorder type, age and delay discounting among patients at a residential ED treatment center (N = 178). Our findings showed that those diagnosed with bulimia nervosa had higher delay discounting (i.e. more impulsivity) at intake compared to anorexia nervosa, binge eating disorder, and other eating types but there were no significant differences. Those diagnosed with bulimia nervosa, as well as those with ARFID and unspecified ED showed a preference for delayed rewards at discharge, but there were no significant differences among ED types. Moderation analyses showed that age, ED type, nor the interaction did not significantly predict delay discounting at intake or discharge. To conclude, those with bulimia nervosa demonstrate less impulsive choice at discharge from a residential ED treatment center. However, additional research is needed given the variability of sample sizes in this study.

Reading tea leaves or tracking true constructs? An assessment of personality-based latent profiles in eating disorders

Background

Eating disorder (ED) subtyping studies have often extracted an undercontrolled, an overcontrolled and a resilient profile based on trait impulsivity and perfectionism. However, the extent to which methodological choices impact the coherence and distinctness of resulting subtypes remains unclear.

Objective

In this paper, we aimed to assess the robustness of these findings by extracting personality-based subtypes on a sample of ED patients (N = 221) under different analytic conditions.

Methods

We ran four latent profile analyses (LPA), varying the extent to which we constrained variances and covariances during model parametrization. We then performed a comparative analysis also including state ED symptom measures as indicators. Finally, we used cross-method validation via k-means clustering to further assess the robustness of our profiles.

Results

Our results demonstrated a four-profile model based on variances in impulsivity and perfectionism to fit the data well. Across model solutions, the profiles with the most and least state and trait disturbances were replicated most stably, while more nuanced variations in trait variables resulted in less consistent profiles. Inclusion of ED symptoms as indicator variables increased subtype differentiation and similarity across profiles. Validation cluster analyses aligned most with more restrictive LPA models.

Conclusion

These results suggest that ED subtypes track true constructs, since subtypes emerged method-independently. We found analytic methods to constrain the theoretical and practical conclusions that can be drawn. This underscores the importance of objective-driven analytic design and highlights its relevance in applying research findings in clinical practice.

Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls

Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.

Independent associations of food addiction and binge eating measures with real-time eating behaviors and contextual factors: An exploratory ecological momentary assessment study

Food addiction (FA) is a concept centered around the addictive potential of highly palatable processed foods, though there is debate over the discriminative validity of FA as a distinct construct from binge-eating symptomatology. This study explored how trait measures of FA and binge-eating symptoms independently and interactively predicted eating behaviors and posited correlates of FA and binge eating measured via ecological momentary assessment (EMA). Adult participants (N = 49) who met the criteria for FA and/or binge-eating disorder completed baseline measures of FA (Yale Food Addiction Scale [YFAS 2.0]) and binge-eating symptoms (Eating Pathology Symptom Inventory [EPSI] binge eating scale) followed by a 10-day EMA protocol. Generalized linear mixed models examined the independent effects of YFAS 2.0, EPSI, and their interaction predicting EMA outcomes. Higher YFAS 2.0 symptom count scores were uniquely related to greater EMA-measured overeating, loss of control eating, negative and positive affect, and impulsivity when controlling for EPSI scores. Conversely, higher EPSI scores were uniquely related to greater EMA-measured eagerness and urge to eat, and expectancies that eating would improve mood. No interaction effects were significant. These results highlight potential distinctions between phenomena captured by FA and other measures of binge eating, in that FA symptoms may be a marker of heightened binge-eating severity, emotional arousal, and impulsivity.

The network structure of mania symptoms differs between people with and without binge eating

OBJECTIVES

People with bipolar disorder who also report binge eating have increased psychopathology and greater impairment than those without binge eating. Whether this co-occurrence is related to binge eating as a symptom or presents differently across full-syndrome eating disorders with binge eating is unclear.

METHODS

We first compared networks of 13 lifetime mania symptoms in 34,226 participants from the United Kingdom's National Institute for Health and Care Research BioResource with (n = 12,104) and without (n = 22,122) lifetime binge eating. Second, in the subsample with binge eating, we compared networks of mania symptoms in participants with lifetime anorexia nervosa binge-eating/purging (n = 825), bulimia nervosa (n = 3737), and binge-eating disorder (n = 3648).

RESULTS

People with binge eating endorsed every mania symptom significantly more often than those without binge eating. Within the subsample, people with bulimia nervosa most often had the highest endorsement rate of each mania symptom. We found significant differences in network parameter statistics, including network structure (M = 0.25, p = 0.001) and global strength (S = 1.84, p = 0.002) when comparing the binge eating with no binge-eating participants. However, network structure differences were sensitive to reductions in sample size and the greater density of the latter network was explained by the large proportion of participants (34%) without mania symptoms. The structure of the anorexia nervosa binge-eating/purging network differed from the bulimia nervosa network (M = 0.66, p = 0.001), but the result was unstable.

CONCLUSIONS

Our results suggest that the presence and structure of mania symptoms may be more associated with binge eating as a symptom rather than any specific binge-type eating disorder. Further research with larger sample sizes is required to confirm our findings.

The usefulness of an intervention with a serious video game as a complementary approach to cognitive behavioural therapy in eating disorders: A pilot randomized clinical trial for impulsivity management

OBJECTIVE

The aim of the present study was to test the usefulness of an add-on serious video game approach (i.e., Playmancer) to treatment as usual (TAU) on reducing impulsive behaviours and psychopathology in individuals diagnosed with an eating disorder (ED).

METHOD

Thirty-seven patients diagnosed with an ED according to the DSM-5 were included in the present randomized clinical trial (RCT; study record 35,405 in ClinicalTrials.gov) and were randomly assigned to either the TAU or TAU + Playmancer group. All participants completed a clinical interview. Impulsivity (UPPS-P self reported questionnaire and Stroop task) and general psychopathology (SCL-90-R) measures were assessed at: baseline, 4 weeks into treatment, at the end of TAU (after 16 weeks), and follow-up (2 years). In addition, patients in the experimental group underwent a total of nine sessions with Playmancer over the span of 3 weeks.

RESULTS

Patients in both treatment groups (TAU + Playmancer or TAU) improved on Stroop task performance and psychological distress. Additionally, patients in TAU-Playmancer improved on the impulsive trait domain of lack of perseverance. No statistical differences were found regarding treatment outcomes (i.e., treatment adherence and remission of eating symptomatology) when comparing the two treatment groups.

CONCLUSION

Our results suggest that the impulsivity associated with EDs should be addressed and could be modified, as some facets of trait impulsivity improved after Playmancer add-on treatment. Yet, there were no significant differences in treatment outcomes when comparing the two groups and further research needs to be conducted.

Eating Disorders and Addictive Behaviors: Implications for Human Health

Eating disorders (EDs) are mental health diseases characterized by dysfunctional eating patterns, including restrictive eating, avoidance of foods, binge eating, and compensative behaviors to avoid weight increases and promote thinness (purging, vomiting, laxative/diuretics misuse, and compulsive exercise) [...].

Individual Differences in Plate Wasting Behavior: The Roles of Dispositional Greed, Impulsivity, Food Satisfaction, and Ecolabeling

This study examines the effects of dispositional greed, impulsivity, food satisfaction, and ecolabeling on consumers' plate waste in all-inclusive hotels. Using a moderated mediation research model, a cross-sectional survey was conducted among 1253 tourists of different nationalities, all staying in five-star hotels in Alanya, Türkiye. The results show that both dispositional greed and impulsivity positively predict and significantly contribute to plate waste. Conversely, food satisfaction was found to be an influential variable that moderates the effects of greed and impulsivity on plate waste, highlighting its critical role in waste reduction strategies. Ecolabels, despite their intended purpose, were not found to have a significant impact on consumer attitudes toward plate waste. Future research is encouraged to explore strategies to counteract dispositional greed and impulsivity, given their significant impact on plate waste behavior. At the same time, refining methods to promote food satisfaction and the effective use of ecolabels may contribute significantly to reducing plate waste in all-inclusive resorts. This research contributes to our understanding of the psychological factors that influence consumer behavior in buffet settings and provides guidance to hospitality industry practitioners seeking to reduce waste.

Neurodevelopmental Model Explaining Associations between Sex Hormones, Personality, and Eating Pathology

Clinical scientists have been investigating the relationships between sex hormones, personality, and eating disorders for decades. However, there is a lack of direct research that addresses whether personality mediates or moderates the relationships between sex hormones and eating pathology. Moreover, the neural mechanisms that underlie the interactive associations between these variables remain unclear. This review aims to summarize the associations between these constructs, describe a neural mechanism mediating these relationships, and offer clinical strategies for the early identification and intervention of eating disorders. The gathered evidence shows that aggressiveness, impulsivity, and obsessive-compulsiveness may mediate or moderate the relationships between sex hormones and eating pathology, but only among females. Furthermore, sex hormone receptor density in the mesocorticolimbic dopamine pathway may explain the neural mechanism of these associations. Future research should use more comprehensive personality measurements and assess the mediation and moderation effects of temperament while taking the hormone levels of women across menstrual cycles into account. Additionally, electroencephalography and functional magnetic resonance imaging should be implemented to directly assess brain activity and corroborate these findings.

Latent classes of eating disorders and addictions by sex: Implication of alexithymia and stressful life events in youths

Introduction

Eating disorders (EDs) and behavioural addictions show common psychological vulnerability factors such as alexithymia and stressful life events (SLE). This study aims, firstly, to explore the prevalence and latent profiles of participants based on their risk of suffering EDs, gambling disorder (GD), alcohol and/or drug abuse, and compulsive buying (CB) by sex. Secondly, it aimed to test whether alexithymia and having experienced SLE are associated with group membership.

Methods

The sample was predominantly drawn from university students and social networks. It was composed of 352 young adults between 18 and 35 years old, of whom 77.8% were women and 22.2% men.

Results

The results showed that the most prevalent disorders of the sample were alcohol, EDs, CB, drugs and GD, respectively. Moreover, latent class analyses were conducted based on the risk of suffering EDs or addictions by sex. Three main profiles were found: 'Men with addictions', 'Healthy women' and 'Women with EDs'. Finally, differences in SLE and alexithymia levels were tested by latent classes. "Men with addictions" and "Women with EDs" had higher scores on alexithymia and SLE than the group of "Healthy women". However, the group of "Women with EDs" (class 3) reported significantly higher levels of SLE and alexithymia than the other two groups.

Discussion and conclusion

In conclusion, we discuss the possibility that some vulnerability factors operate generally and transdiagnostically in EDs and addictive disorders. The identification of clinical phenotypes could complement and deepen prediction, prevention and treatment research in clinical settings. The need to take sex and gender differences into account is reinforced.

Non-suicidal self-injury motivations in the light of self-harm severity indicators and psychopathology in a clinical adolescent sample

Introduction

Adolescents with psychiatric problems are also considered a vulnerable population in terms of non-suicidal self-injury (NSSI). In the current study, we examined the associations of interpersonal and intrapersonal NSSI motivations with several NSSI severity indicators and psychopathological characteristics.

Materials and methods

In a cross-sectional research design, 158 adolescents (83.5% girls; mean age = 16.10 years; SD = 1.49) who have received inpatient or outpatient psychiatric treatment completed the Inventory of Statements About Self-Injury, the Strengths and Difficulties Questionnaire, and the Self-Critical Rumination Scale.

Results

More than two-thirds of the sample (75.3%; n = 119) reported at least one episode of NSSI in their life, and 45.38% (n = 54) have engaged in NSSI in the past month (current self-injury). The results indicated that only intrapersonal NSSI functions were linked to NSSI severity indicators (current and repetitive NSSI, versatility), interpersonal functions were not. Furthermore, a number of psychopathological features (co-occurring mental disorders, presence of a mood disorder, more internalizing mental illness symptoms, and more pronounced self-critical rumination) were associated with engaging in NSSI for intrapersonal reasons. We also identified other differences within the specific intrapersonal NSSI motivations. It should be highlighted that the anti-suicide function of NSSI behaved in exactly the opposite way as the other intrapersonal motivations.

Discussion

All this points to the fact that in clinical settings, detailed assessment of NSSI motivations and severity indicators can help to develop a more effective treatment plan.

Dating app usage and motivations for dating app usage are associated with increased disordered eating

The centrality of physical appearance in dating app environments may constitute an appearance-related pressure that increases the likelihood of body dissatisfaction (BD) and disordered eating (DE), thus exacerbating the relationship between DE-predictive traits and DE itself. Although dating app use has been linked to BD and DE, prior research has also neglected the role of individuals' dating app use motivations and relevant traits in eating pathology. To address these gaps, the current study investigated whether dating app usage moderated the effects of appearance-based rejection sensitivity, fear of negative evaluation, emotion dysregulation, and perceived social rank on DE. We also examined the unique effects of individuals' dating app use motivations on DE. Participants (N = 690) completed baseline measures of demographic and trait variables including dating app usage. DE was positively associated with female gender, higher body mass index, a history of eating disorder (ED) diagnosis, appearance-based rejection sensitivity, and emotion dysregulation. There was a small, positive association between dating app usage and DE, indicating that dating app users were more likely to report DE symptoms, appearance-based rejection sensitivity, and emotion dysregulation. No investigated predictor was moderated by dating app usage, but four of the six measured motivations for using dating apps (love, self-worth, ease of communication, and thrill of excitement motivations) were associated with DE among the dating app user sample (casual sex and trendiness motivations were not). Given that DE behaviours can lead to EDs, the present findings suggest that lifetime dating app usage may increase socio-cultural appearance pressures that confer risk for DE.

Impact of Impulsivity and Therapy Response in Eating Disorders from a Neurophysiological, Personality and Cognitive Perspective

Impulsivity, as a multidimensional construct, has been linked to eating disorders (EDs) and may negatively impact treatment response. The study aimed to identify the dimensions of impulsivity predicting poor remission of ED symptoms. A total of 37 ED patients underwent a baseline assessment of impulsive personality traits and inhibitory control, including the Stroop task and the emotional go/no-go task with event-related potentials (ERPs) analysis. The remission of EDs symptomatology was evaluated after 3 months of cognitive-behavioral therapy (CBT) and at a 2-year follow-up. Poor remission after CBT was predicted by poor inhibitory control, as measured by the Stroop task. At 2 years, the risk of poor remission was higher in patients with higher novelty seeking, lower inhibitory control in the Stroop and in ERPs indices (N2 amplitudes) during the emotional go/no-go task. The present results highlight inhibitory control negatively impacting both short- and long-term symptomatology remission in ED patients. On the other hand, high novelty seeking and ERPs indices of poor inhibition seem to be more specifically related to long-term remission. Therefore, a comprehensive assessment of the impulsivity dimension in patients with ED is recommended to tailor treatments and improve their efficacy.

Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder

BACKGROUND AND AIMS

Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD.

METHODS

A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated.

RESULTS

The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD.

DISCUSSION

Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder.

CONCLUSIONS

Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.

Impulsiveness as potential moderators of the relation between social media dependence and eating disorders risk

BACKGROUND

Social media dependence (SMD) and eating disorders (ED) risk are often thought to be inextricably linked. Because social media dependence often precedes an ED, predicts poor outcome, and persists even after recovery from an ED, it is important to examine whether certain factors have the ability to potentially attenuate or intensify SMD's effect on eating disorders.

METHODS

In the current study, we examined one possible moderating factor: impulsiveness. 767 undergraduates (mean age = 18.78 years, SD = 1.20) in Shaanxi province of China, completed anonymous questionnaires regarding social media dependence, eating disorders, impulsiveness.

RESULTS

Revealed that non-planned impulsiveness (NPI) moderated the relation between SMD and ED risk. Individuals who were low in SMD and who reported low levels of NPI reported much lower levels of ED risk than those with low SMD and high NPI. However, Individuals who were high in SMD and who reported low levels of NPI reported much higher levels of ED risk than those with high SMD and high NPI. Contrary to our hypotheses, Motor impulsiveness and cognitive impulsiveness did not emerge as moderators of the relation between SMD and ED risk.

CONCLUSIONS

Results provide growing support that factors that interact with SMD can lessen or aggravate SMD's effect on ED risk. These findings can be beneficial to our understanding of how and when social media dependence impacts undergraduates' eating disorders risk.

Association between impulsivity and orthorexia nervosa: any moderating role of maladaptive personality traits?

OBJECTIVES

To explore the possible moderating relation between impulsive behavior and maladaptive personality traits in regards to orthorexia nervosa (ON).

METHODS

This cross-sectional study was conducted between July and December 2019 and recruited 519 Lebanese adults from seven community pharmacies randomly selected from a list provided by the Lebanese Order of Pharmacists. The Teruel Orthorexia Scale (TOS) was employed to assess orthorexic eating tendencies, the I-8 measured impulsivity and the Personality Inventory for DSM-5 (PID) evaluated maladaptive personality traits.

RESULTS

Our results showed that, for I-8 subscales, only higher perseverance (B = 0.31) was significantly associated with higher ON. In regard to PID-5 subscales, only higher negative affect (B = - 0.34) was significantly associated with lower ON. Furthermore, significant interactions were found between personality traits and impulsivity to predict TOS-ON.

CONCLUSION

The current results show that female gender, maladaptive personality traits and impulsivity present contributing factors regarding orthorexic eating. Certain impulsivity dimensions were confirmed to interact with personality traits in the prediction of orthorexic eating thereby highlighting possible risk factors and psychopathological mechanisms.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Elevated cognitive dietary restraint mediates the relationship between greater impulsivity and more frequent binge eating in individuals with binge-spectrum eating disorders

PURPOSE

The current study aimed to examine the relationships between impulsivity, dietary restraint, and binge eating frequency in individuals with binge-spectrum eating disorders.

METHODS

Secondary data analysis was conducted on baseline data from three ongoing or recently completed clinical trials. 148 participants diagnosed with a DSM-5 eating disorder characterized by binge eating were administered a clinical interview to assess dietary restraint and binge eating frequency and completed a self-report measure of trait impulsivity.

RESULTS

Mediation analyses found that increased dietary restraint mediated the relationship between higher impulsivity, particularly greater positive urgency and sensation-seeking, and more frequent binge eating episodes.

CONCLUSION

While more research using momentary assessment methods is necessary to confirm our findings, results from the current study call attention to the potential role of dietary restraint in the impulsivity-binge eating relationship for individuals with binge-spectrum eating disorders.

LEVEL OF EVIDENCE

Level V descriptive study.

Eating disorders symptoms and excessive internet use in adolescents: the role of internalising and externalising problems

BACKGROUND

Both eating disorders and excessive internet use represent significant health issues for contemporary adolescents. Yet, the link between them has seldom been investigated. We aim to study this association through their common underlying psychological factors: internalising problems and externalising problems.

METHODS

A representative sample of 7,083 adolescents (M_age = 13.48 years; SD_age = 1.32; 50.3% girls) from Slovakia was obtained from the Health Behaviour in School-aged Children (HBSC) project in 2018. Study variables included the Excessive Internet Use Scale (EIU) and the Strength and Difficulties Questionnaire (SDQ). Eating disorders symptoms (EDS) were assessed by SCOFF and selected items from the Eating Disorder Screen for Primary Care (ESP). Data were analysed separately for boys and girls with Structural Equation Modelling.

RESULTS

There was a partial correlation between EDS and EIU (r = 0.36 for boys and r = 0.29 for girls) after controlling for the internalising and externalising of problems. Internalising and externalising problems were positively associated with EDS, while EIU was only associated with externalising problems. The results were comparable for both genders.

CONCLUSION

The study provides evidence that, during adolescence, EDS and EIU are related and have a tendency to occur together. Also, they are related even when controlled for their shared underlying psychological factors, namely the emotional and attentional/behavioural difficulties.

Prevalence and early risk factors for bulimia nervosa symptoms in inner-city youth: gender and ethnicity perspectives

BACKGROUND

Research on risk factors associated with bulimia nervosa symptoms (BN) in ethnic minorities has been limited. This study adds to the existing literature by providing the ethnicity- and gender-specific prevalence of BN in US inner-city youth and by exploring the longitudinal associations between a clinical level of BN and early risk factors assessed one year previously.

METHODS

The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2794; 54.1% female; age 11-16 years old (M(SD) = 12.77(1.29)); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on BN and early risk factors (e.g., depressive and anxiety symptoms, posttraumatic stress, somatic complaints). Multivariate analysis of covariance was used to examine the longitudinal associations.

RESULTS

The 3-month BN prevalence was higher in girls (5.1%) than in boys (2.3%) (ratio 2.22:1). Significant differences in BN rates were found between White and African American students (higher in Whites), whereas Hispanic-Americans did not differ significantly from either group. Individuals with BN had significantly higher levels of early risk factors one year prior.

CONCLUSIONS

Timely recognition of BN and associated early risk factors is important for early prevention and intervention strategies.

Examining the roles of emotion dysregulation and impulsivity in the relationship between psychological trauma and substance abuse among women with bulimic-spectrum pathology

Individuals with bulimia nervosa report elevated rates of childhood maltreatment, which appears to increase risk for co-occurring substance use problems and negatively impact clinical course. The current study sought to examine the mechanistic pathways by which specific forms of childhood maltreatment may give rise to substance use problems among individuals with bulimic-spectrum pathology. Women with bulimic-spectrum disorders (N = 204) completed measures of childhood trauma, emotion dysregulation, impulsivity, and substance use. Path analysis was used to examine emotion dysregulation and impulsivity as mediators of the relationship between distinct forms of childhood trauma (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse) and the presence of problematic alcohol/drug use. In the full path model, significant pathways from childhood emotional abuse to emotion dysregulation, childhood emotional neglect to impulsivity, and emotion dysregulation to problematic substance use emerged. Further, emotion dysregulation significantly mediated the relationship between emotional abuse and substance use. Results indicate that emotion dysregulation may be an important mechanism linking a history of childhood emotional maltreatment to later eating and substance use problems, and therefore may be an important treatment target among individuals with co-occurring eating and substance use concerns.Childhood emotional abuse was related to greater emotion dysregulation.Childhood emotional neglect was related to greater impulsivity.Emotion dysregulation was related to greater problematic substance use.Emotional abuse may impact substance use through emotion dysregulation.Creating emotion dysregulation may improve substance and eating disorder symptoms.

The neural correlates of delay discounting in obesity and binge eating disorder

BACKGROUND AND AIMS

Increased delay discounting is associated with obesity and binge eating disorder (BED). Although BED and obesity frequently co-occur, the neural mechanisms underlying delay discounting in these conditions remain poorly understood.

METHODS

Thirtyfive women with obesity, including 10 participants with obesity and BED and 31 controls completed a monetary delay discounting task during functional magnetic resonance imaging.

RESULTS

We identified that increased discounting rates were associated with decreased activity in the left anterior insula in participants with obesity compared to controls when choosing immediate rewards over delayed rewards (PFWE < 0.05). An exploratory analysis comparing the BED subsample to the other groups did not detect significant differences.

DISCUSSION AND CONCLUSIONS

Our findings suggest decreased activity in the anterior insula may underlie heightened delay discounting in individuals with obesity, contributing the probability of choosing immediate rewards over delayed rewards based on emotional states. Future studies including larger, more diverse samples are required to confirm these effects.

Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study

PURPOSE

The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs).

METHODS

320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient.

RESULTS

Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037).

DISCUSSION

Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings.

LEVEL OF EVIDENCE

III, cohort or case-control analytic studies.

Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review

BACKGROUND

An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others.

METHOD

A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed.

RESULTS

Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful.

CONCLUSION

Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.

Eating disorders in New Zealand: Implications for Māori and health service delivery

OBJECTIVE

Lifetime prevalence rates in Te Rau Hinengaro (The New Zealand Mental Health Survey) suggest eating disorders are at least as common in the Māori population as the non-Māori population, yet little is known at a population level about those accessing specialist mental health treatment for eating disorders in New Zealand. The aim of this study was to describe the population undergoing specialist mental health treatment for eating disorders and compare Māori and non-Māori clinical characteristics and service use.

METHOD

This study uses the Programme for the Integration of Mental Health Data data set, managed by the New Zealand Ministry of Health to describe the characteristics of people with eating disorders and their use of specialist mental health services from 2009 to 2016.

RESULTS

There were 3,835 individuals with a diagnosed eating disorder who had contact with specialist mental health services in this time period, 7% of whom were Māori. Within the cohort, Māori had a higher prevalence for a bulimia nervosa diagnosis, fewer diagnosed with anorexia nervosa, and a higher prevalence of other psychiatric comorbidity than non-Māori.

DISCUSSION

There is discrepancy between the proportion of service users accessing specialist mental health services who are Māori and the assessed crude prevalence of eating disorders for Māori in national estimates. Once Māori are in specialist services; however, their use of services is comparable to non-Māori. Further research is needed to highlight the experiences of those Māori with eating disorders and address barriers to accessing services for Māori with eating disorders.

The Effects of Non-invasive Brain Stimulation on Impulsivity in People with Mental Disorders: a Systematic Review and Explanatory Meta-Analysis

Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), have been used to modulate impulsivity. To date, no reviews have systematically examined their effects on modulating impulsivity in people with mental health disorders. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline and PsycINFO databases on the use of rTMS and tDCS to modulate impulsivity in people with mental health disorders. Results from 11 tDCS and 18 rTMS studies indicate that tDCS has a significant, albeit small, effect on modulating impulsivity (g = 0.29; 95% CI, 0.09 to 0.48; p = .004) whereas rTMS has no significant effect on impulsivity (g = -0.08; 95% Cl, -0.35 to 0.19; p = .550). Subgroup analyses identified the key parameters required to enhance the effects of tDCS and rTMS on impulsivity. Gender and stimulation intensity acted as significant moderators for effects of rTMS on impulsivity. There is insufficient evidence to support the use of tDCS or rTMS in clinical practice to reduce impulsivity in people with mental health disorders. The use of standardized non-invasive brain stimulation protocols and outcome measures in patients with the same diagnosis is advised to minimize methodological heterogeneity.

Mindfulness-based emotional eating awareness training: taking the emotional out of eating

PURPOSE

Emotional eating is important to study and address because it predicts poor outcome in weight loss interventions. Interventions have only touched the surface in terms of addressing emotional eating. Mindfulness approaches can address emotional eating by modification of emotion regulation and appetitive traits. The current study involved development of an emotional eating-specific mindfulness intervention and assessment of its effect on appetitive traits associated with emotional eating.

METHODS

Participants (n = 14; age M = 29 years; 90% female) completed baseline and end-of-intervention self-report measures of emotional eating, food-cue reactivity, mindfulness, intuitive eating, emotional impulse regulation, stress, and a behavioural measure of inhibitory control. During the 6-week intervention, mindfulness meditation skills were taught weekly embedded in a psycho-educational curriculum about emotional eating.

RESULTS

Paired t tests, controlled for type 1 error, revealed significant improvements in food-cue reactivity, intuitive eating, emotional impulse regulation, inhibitory control and stress (ps < 0.05; d: 0.58-1.54). Changes in emotional eating approached significance (p = 0.075, d = 0.66).

CONCLUSION

The intervention purposefully did not focus on weight loss and recruited participants who had self-declared difficulties with emotional eating. The positive outcomes suggest that intervening with mindfulness training before weight loss is attempted has the potential to change psychological factors that underpin overeating and undermine weight loss efforts. The study provides proof of principle as a basis to design a randomized control trial to assess rigorously the effectiveness of the intervention as a precursor to a weight loss intervention.

LEVEL OF EVIDENCE

Level IV, uncontrolled trial.

Relation between vitamin D and impulse behaviours in patients with eating disorder: a pilot observational study

OBJECTIVE

There is growing evidence that vitamin D levels have a role not only in bone health and energy metabolism, but also for supporting nervous system and brain functions, including impulsivity. Impulsive behaviours are considered characteristics of great relevance in patients with Eating Disorders (ED) both for the course of the illness and for the treatment. The aim of this study is to examine the relationship between impulsive behaviours and vitamin D in patients with ED.

METHOD

236 patients with a diagnosis of ED, consecutively recruited at an ED ward between 2014 and 2018, were enrolled. Patients were classified as impulsive or non-impulsive based on the presence of clinically relevant impulsive behaviours.

RESULTS

Impulsive patients were found to have statistically significant lower levels of vitamin D than non-impulsive (p = .007). A threshold value of 20.4 ng/ml for discriminating impulsive from non-impulsive patients was found.

DISCUSSION

This hypothesis generating study partially confirmed a relationship between vitamin D deficiency and impulsive behaviours in ED spectrum mediated by body weight, even if results were not confirmed after corrected by obesity. No definitive conclusion may be taken on whether the effect is reduced due to the loss of power. Future directions are discussed.

Psychological Predictors of Unhealthy Eating Attitudes in Young Adults

The objective of this study was to determine the predictive role of psychological risk factors for restrained and compulsive eating in young women and men. We examined the relationship between resilience, impulsivity, emotional intelligence and self-esteem, and restrained and compulsive eating. It was assumed that resilience and impulsivity can directly explain unhealthy eating attitudes (restrained and compulsive: both emotional eating and external eating). The study group comprised 211 individuals (105 men and 106 women) aged 20-29, all of whom were living in southern Poland. Measures included the Resilience Measurement Scale (SPP-25), the Eysenck's Impulsivity Inventory (IVE), the Multidimensional Self-Esteem Inventory (MSEI), the Emotional Intelligence Questionnaire (INTE), and the Polish adaptation of the Dutch Eating Behavior Questionnaire (DEBQ). The statistical analysis showed significant and positive correlations between emotional eating and general self-esteem, impulsivity, and weaker (but still significant) correlations with physical attractiveness. External eating was positively and significantly correlated with impulsivity and self-esteem (including physical attractiveness). Restrained eating was also positively and significantly correlated with general self-esteem. Both types of compulsive eating attitudes (emotional and external eating) were significantly and negatively correlated with resilience. Women showed a significantly higher positive correlation between impulsivity and external eating compared to men. The level of intensity of other measures proved similar across the entire study group regardless of sex. Impulsivity had the strongest and most direct significant influence on both emotional eating and external eating, and a negative effect on emotional intelligence. Resilience proved to have a significant impact on all three examined types of eating attitude (a direct negative effect on emotional eating and external eating, and positive direct effect on restrained eating), self-esteem, and emotional intelligence. An important psychological intervening variable in generating unhealthy eating attitudes proved to be self-esteem among both men and women. Emotional intelligence, which remains correlated with resilience, proved independent, with no effect on unhealthy eating attitudes. These results suggest that preventive treatment and educational programs implemented particularly among adolescents and young adults may support development of their psychological resources.

Recent Research on Bulimia Nervosa

Estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7% across studies. There has been a decrease in the presentation of BN in primary care but an increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status, disordered eating is associated with long-term significant impairment to both physical and mental quality of life, and BN is associated with a significantly higher likelihood of self-harm, suicide, and death. Assessment should adopt a motivationally enhancing stance given the high level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders outperforms other active psychological comparisons.

Shared Neural Correlates Underlying Addictive Disorders and Negative Urgency

Negative urgency is a personality trait reflecting the tendency to act rashly in response to extreme negative emotions and is considered a transdiagnostic endophenotype for problematic levels of addictive behaviors. Recent research has begun to identify the neural correlates of negative urgency, many of which appear to overlap with neural circuitry underlying addictive disorders associated with negative urgency. The goal of this qualitative review is to summarize the extant literature concerning the neural correlates of negative urgency, to compare these correlates with those implicated with addictive disorders, and to propose new ways to begin to leverage such findings in treatment and intervention approaches. We also address current limitations in the field and make recommendations for areas for future growth in this research domain. Patterns of structure and function in the ventral striatum, frontal regions, such as the prefrontal cortex (PFC) and orbitofrontal cortex (OFC), and amygdala are common across addictive disorders and are related to both real-world risky behaviors and self-report measures of negative urgency. We propose that the time has come to move past considering this trait and these disorders as completely separate entities, and instead for the field to consider how general patterns of convergence across these disorders can lead to a more transdiagnostic approach to treatment and intervention. We suggest future work utilize these convergent patterns in the development of animal models of negative urgency, in the identification and testing of prime pharmacological and physiological interventions, and as objective biomarkers to be used when testing behavioral, pharmacological, and physiological intervention effectiveness. Little empirical work has been done to date in these areas and advances in these nascent fields would advance understanding and applications of the neuroscience of negative urgency.

Thai adaptation and reliability of three versions of the Barratt Impulsiveness Scale (BIS 11, BIS-15, and BIS-Brief)

Long, short, and brief versions of the Barratt Impulsiveness scale (BIS-11, BIS-15, and BIS-Brief) were tested in an adult Thai population. The BIS-11T and BIS-15T were translated, back-translated, and administered to a non-clinical population (n = 305) of native Thai speakers who returned 2 weeks later for re-test. BIS-Brief-T psychometrics were calculated post-hoc. Impulsivity scores were normally distributed for the BIS-11T and BIS-15T, but not BIS-Brief-T. Excellent internal consistency was observed, with Cronbach's alpha coefficients above 0.80 for all translated instruments: BIS-11T (α = 0.86), BIS-15T (α = 0.81), BIS-Brief-T (α = 0.81). A total of 260 participants completed both instruments (85%), with test-retest reliability exceeding r = 0.81. All three instruments were highly correlated (r = 0.83-0.89). Confirmatory factor analysis supports a three factor structure (attention, motor, non-planning) for BIS-15T and two factor structure for BIS-11T. BIS scales can support measurement of a range of impulsivity scores in an adult Thai population, though predictive validity of these scales remains unexplored.

Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder

Evidence points to eating disorder patients displaying altered rates of delay discounting (one's degree of preference for immediate rewards over larger delayed rewards). Anorexia nervosa (AN) patients are believed to have an increased capacity to delay reward, which reflects their ability to override the drive to eat. Contrarily, binge eating disorder (BED) patients are associated with a reduced predisposition to delay gratification. Here, we investigated monetary delay discounting and impulsivity in 80 adult women with EDs (56 AN and 24 BED), diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and 80 healthy controls. AN-restrictive (AN-R) subtype patients showed less steep discounting rates than BED and AN-bingeing/purging subtype patients. Compared with healthy controls and AN-R patients, BED and AN-bingeing/purging patients presented higher delay discounting and positive and negative urgency levels. Our findings suggest that restriction in AN-R patients is associated with disproportionate self-control, whereas bingeing behaviours could be more driven by emotional states and impulsivity traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The Perception of Time Is Underestimated in Adolescents With Anorexia Nervosa

Research has revealed reduced temporal discounting (i.e., increased capacity to delay reward) and altered interoceptive awareness in anorexia nervosa (AN). In line with the research linking temporal underestimation with a reduced tendency to devalue a reward and reduced interoceptive awareness, we tested the hypothesis that time duration might be underestimated in AN. Our findings revealed that patients with AN displayed lower timing accuracy in the form of timing underestimation compared with controls. These results were not predicted by clinical, demographic factors, attention, and working memory performance of the participants. The evidence of a temporal underestimation bias in AN might be clinically relevant to explain their abnormal motivation in pursuing a long-term restrictive diet, in line with the evidence that increasing the subjective temporal proximity of remote future goals can boost motivation and the actual behavior to reach them.

'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder

Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.

Attentional and motor impulsivity interactively predict 'food addiction' in obese individuals

BACKGROUND

Impulsivity is a multifaceted construct and constitutes a common risk factor for a range of behaviors associated with poor self-control (e.g., substance use or binge eating). The short form of the Barratt Impulsiveness Scale (BIS-15) measures impulsive behaviors related to attentional (inability to focus attention or concentrate), motor (acting without thinking), and non-planning (lack of future orientation or forethought) impulsivity. Eating-related measures appear to be particularly related to attentional and motor impulsivity and recent findings suggest that interactive effects between these two facets may play a role in eating- and weight-regulation.

METHODS

One-hundred thirty-three obese individuals presenting for bariatric surgery (77.4% female) completed the BIS-15 and the Yale Food Addiction Scale (YFAS) 2.0, which measures addiction-like eating based on the eleven symptoms of substance use disorder outlined in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders.

RESULTS

Sixty-three participants (47.4%) were classified as being 'food addicted'. Scores on attentional and motor impulsivity interactively predicted 'food addiction' status: higher attentional impulsivity was associated with a higher likelihood of receiving a YFAS 2.0 diagnosis only at high (+1 SD), but not at low (-1 SD) levels of motor impulsivity.

CONCLUSIONS

Results support previous findings showing that non-planning impulsivity does not appear to play a role in eating-related self-regulation. Furthermore, this is the first study that shows interactive effects between different impulsivity facets when predicting 'food addiction' in obese individuals. Self-regulatory failure in eating-regulation (e.g., addiction-like overeating) may particularly emerge when both attentional and motor impulsivity levels are elevated.

Impulsivity-related traits distinguish women with co-occurring bulimia nervosa in a psychiatric sample

OBJECTIVE

This study investigated impulsivity-related personality traits using the Revised NEO Personality Inventory (NEO PI-R) in women diagnosed with co-occurring bulmia nervosa and borderline personality disorder (BN-BPD), borderline personality disorder (BPD no-BN), or major depressive disorder (MDD-only).

METHOD

The sample included 672 adult female admissions to a psychiatric day hospital treatment program. The NEO PI-R facets of impulsiveness (N5), excitement-seeking (E5), self-discipline (C5), and deliberation (C6) provided a proxy assessment of impulsivity-related traits tapping negative urgency, sensation-seeking, lack of perseverance, and lack of premeditation/planning.

RESULTS

After adjusting for age, BN-BPD displayed significantly higher levels of negative urgency and lack of premeditation than BPD without co-occurring BN. Women with BN-BPD also had significantly higher levels of impulsivity traits than MDD across domains, except for lack of perseverance.

DISCUSSION

Impulsivity-related traits of negative urgency and lack of premeditation significantly differentiated women with versus without co-occurring BN among women with borderline personality disorder. Lower levels of impulsivity-related traits in women with MDD indicated that effects were not simply attributable to any form of psychopathology. Of the impulsivity traits, negative urgency demonstrated the strongest effect, providing further evidence of the important relationship between negative urgency and the expression of bulimic symptomology. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1093-1096).