1
|
Krug I, Dang AB, Sánchez I, Granero R, Agüera Z, Gaspar-Perez A, Jimenez-Murcia S, Fernandez-Aranda F. How to assess eating disorder severity in males?The DSM-5 severity index versus severity based on drive for thinness. Eat Disord 2024; 32:81-97. [PMID: 37791835 DOI: 10.1080/10640266.2023.2259682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Using a male eating disorder (ED) sample, this study assessed the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for males with anorexia nervosa (AN) and bulimia nervosa (BN) and compared it to an alternative transdiagnostic severity categorisation based on drive for thinness (DT). The participants included 143 males with an ED (60 [42.0%] AN and 83 [58.0%] BN) diagnosis, who were classified using these two severity classifications. The different severity categories were then compared based on ED symptoms, general psychopathology, and personality traits. Our results revealed that the DSM-5 "mild" and DT "low" severity categories were most prevalent in the AN and BN male patients. Clinically significant findings were strongest for the DT categorisation for both AN and BN. The current findings provide initial support for an alternative transdiagnostic DT severity classification for males that may be more clinically meaningful than the DSM-5 severity indices.
Collapse
Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Grupo Psiquiatría y Salud Mental-Programa Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Grupo Psiquiatría y Salud Mental-Programa Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anahi Gaspar-Perez
- Grupo Psiquiatría y Salud Mental-Programa Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Susana Jimenez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Grupo Psiquiatría y Salud Mental-Programa Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Grupo Psiquiatría y Salud Mental-Programa Neurociencias, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
2
|
Mora-Maltas B, Lucas I, Granero R, Vintró-Alcaraz C, Miranda-Olivos R, Baenas I, Sánchez I, Jiménez-Del Toro J, Sánchez-González J, Krug I, Tapia J, Jiménez-Murcia S, Fernández-Aranda F. Cognitive flexibility and DSM-5 severity criteria for eating disorders: assessing drive for thinness and duration of illness as alternative severity variables. J Eat Disord 2023; 11:155. [PMID: 37697328 PMCID: PMC10496406 DOI: 10.1186/s40337-023-00875-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The severity criteria for eating disorders (EDs) proposed in the DSM-5 have been established without sufficient empirical support. Drive for thinness (DT) and duration of illness have been proposed as two alternative severity measures, however their empirical evidence is also limited. To date, no research has assessed the validity of current eating disorder (ED) severity criteria regarding cognitive flexibility factors. Cognitive flexibility is often impaired in EDs, becoming a possible severity symptom. The current study assessed for the first time (1) whether the severity indexes for EDs proposed in the DSM-5 were associated with deficits in cognitive flexibility and, (2) whether drive for thinness and illness duration, acted as an alternative, more meaningful severity indices for deficiencies in cognitive flexibility. METHODS Participants were 161 patients diagnosed with an ED, who were categorized according to DSM-5 severity categories, DT and duration of illness. Discriminative capacity of each classification was assessed for cognitive flexibility measured by Wisconsin card sorting test (WCST). RESULTS The findings for the DSM-5 classification comprised: (a) In the anorexia nervosa (AN) group, patients with moderate severity showed better scores in WCST than patients with mild and severe/extreme severity. Also, patients with moderate severity showed lower percentage of cognitive flexibility deficits than the other two severity categories; (b) For the binge spectrum disorders (BSD) group, the patients with mild severity showed a higher percentage of cognitive flexibility deficits than did the moderate and severe/extreme categories. When assessing the alternative severity index of DT, no differences were found in cognitive flexibility in any of the groups. Regarding illness duration, in the AN group the task performance of the patients with longer illness duration was worse than the performance of the short duration group and, in the BSD group, patients with longer duration also showed more deficits in cognitive flexibility than the patients with shorter duration of illness. CONCLUSIONS Our findings point out the limitations of the DSM-5 severity criteria to categorize cognitive flexibility in EDs and support illness duration as an alternative severity approach for EDs.
Collapse
Affiliation(s)
- Bernat Mora-Maltas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Ignacio Lucas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Vintró-Alcaraz
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Romina Miranda-Olivos
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Baenas
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Isabel Sánchez
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Jessica Jiménez-Del Toro
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Jéssica Sánchez-González
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Javier Tapia
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Gerencia Territorial Metropolitana Sud. Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Clinical Psychology Unit, University Hospital Bellvitge and CIBERobn, Feixa Llarga s/n 08907 L'Hospitalet del Llobregat, Barcelona, Spain.
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
3
|
Imperatori C, Massullo C, Carbone GA, Farina B, Colmegna F, Riboldi I, Giacomo ED, Clerici M, Dakanalis A. Electroencephalographic (EEG) alterations in young women with high subclinical eating pathology levels: a quantitative EEG study. Eat Weight Disord 2020; 25:1631-1642. [PMID: 31667777 DOI: 10.1007/s40519-019-00801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/17/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To explore electroencephalographic (EEG) alterations in young women with different eating disorder (ED) psychopathology levels. METHODS Thirty-seven young women completed general and ED psychopathology (i.e., the ED Examination Questionnaire; EDE-Q) measures. EEG power spectra data were investigated in two conditions: (a) 5 min of resting state (RS) and (b) 5 min of RS after a single taste of a milkshake (ML-RS). EEG analyses were performed using exact Low-Resolution Electromagnetic Tomography software (eLORETA). RESULTS Cluster analysis performed on the EDE-Q responses revealed a group of 17 women with high levels of ED pathology falling into the subclinical (i.e., sub-threshold) EDs category and a group of 20 women with low levels of ED pathology (controls). In the RS conditions, no significant modifications were observed between groups. Compared to controls, women with subclinical EDs showed an increase in theta activity in the parieto-occipital areas in the ML-RS condition. After controlling for body mass index and general psychopathology, theta activity in these brain structures was positively associated with EDE-Q global and subscale (restraint, shape and weight concern) scores. CONCLUSIONS Our results may reflect the neurophysiological substrate of ED psychopathology core features like shape/weight concerns. Previous brain imaging and qEEG studies with full-syndrome ED patients also underscored the involvement of parieto-occipital areas in ED pathophysiology. These studies also found brain alterations in the RS condition, not observed here. This is notable given that full-syndrome and subclinical EDs are considered as different manifestations of the same disease along a severity spectrum. LEVEL OF EVIDENCE Level V, cross-sectional, electroencephalographic, descriptive study.
Collapse
Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Chiara Massullo
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Giuseppe Alessio Carbone
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163, Rome, Italy
| | - Fabrizia Colmegna
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Ester Di Giacomo
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Massimo Clerici
- Department of Psychiatry, San Gerardo Hospital, ASST Monza, Via G. B. Pergolesi 33, 20900, Monza, Italy.,Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.
| |
Collapse
|
4
|
Larsen A, Lilja M, Sturidsson K, Blatny M, Hrdlicka M, Stickley A, Ruchkin V. Bulimia symptoms in Czech youth: prevalence and association with internalizing problems. Eat Weight Disord 2020; 25:1543-1552. [PMID: 31621001 PMCID: PMC7581576 DOI: 10.1007/s40519-019-00790-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status. METHOD The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations. RESULTS The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems. DISCUSSION Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies. LEVEL OF EVIDENCE V, cross-sectional descriptive study (according to Oxford (UK) CEBM Levels of Evidence, 2011).
Collapse
Affiliation(s)
- Anna Larsen
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Marie Lilja
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Knut Sturidsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Säter Forensic Psychiatric Clinic, 783 27, Säter, Sweden
| | - Marek Blatny
- Department of Psychology, Faculty of Arts MU, Brno, Czech Republic
| | - Michal Hrdlicka
- Department of Child Psychiatry, Charles University Second Faculty of Medicine, University Hospital Motol, Prague, Czech Republic
| | - Andrew Stickley
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, 751 85, Uppsala, Sweden. .,Child Study Center, Yale University Medical School, New Haven, CT, 06520, USA. .,Säter Forensic Psychiatric Clinic, 783 27, Säter, Sweden.
| |
Collapse
|
5
|
Krug I, Binh Dang A, Granero R, Agüera Z, Sánchez I, Riesco N, Jimenez-Murcia S, Menchón JM, Fernandez-Aranda F. Drive for thinness provides an alternative, more meaningful, severity indicator than the DSM-5 severity indices for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 29:482-498. [PMID: 32964518 DOI: 10.1002/erv.2776] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess an alternative trans-diagnostic indicator for severity based on drive for thinness (DT) for anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), and other specified feeding or eating disorder (OSFED), and to compare this new approach to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) severity categories for EDs. METHOD A total of 2,811 ED [428 AN-restrictive (AN-R), 313 AN-binge purging (AN-BP), 1,340 BN, 329 BED, 154 OSFED/atypical AN (AT), and 223 OSFED/purging disorder (PD)] patients were classified using: (a) The DSM-5 severity categories and (b) a DT categorisation. These severity classifications were then compared based on ED symptoms, general psychopathology, personality, and impulsive behaviours. RESULTS For the DSM-5 categories, most ED patients fell into the 'mild' to 'moderate' categories. Using the DT categories, AN patients were mainly represented in the 'low' DT category, and BN, OSFED/AT, and PD in the 'high' DT category. The clinically significant findings were stronger for the DT than the DSM-5 severity approach (medium-to-large effect sizes). AN-BP and AN-R provided the most pronounced effects. CONCLUSION Our findings question the clinical value of the DSM-5 severity categorisation, and provide initial support for an alternative DT severity approach for AN. HIGHLIGHTS : This study assessed an alternative trans-diagnostic drive for thinness (DT) severity. Category for all eating disorder (ED) sub-types, and then compared this to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) severity indices for EDs. ED symptoms, general psychopathology, personality, and impulsive behaviours were assessed using both classifications in a total of 2,811 female patients diagnosed with EDs. Clinically significant findings were stronger for the DT than the DSM-5 severity category (medium-to-large effect sizes); there was differentiation of the anorexia nervosa (AN) patients into mainly 'low' DT, and bulimia nervosa (BN) spectrum patients into mainly 'high' DT, vs. most patients were clustered in the 'mild-to-moderate' DSM-5 categories. Our findings provide initial support for an alternative trans-diagnostic DT severity category that may be more clinically meaningful than the DSM-5 severity indices for EDs.
Collapse
Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona-UAB, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain
| | - Nadine Riesco
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain
| | - Susana Jimenez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Madrid, Spain
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and CIBERobn, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
6
|
Krug I, Granero R, Giles S, Riesco N, Agüera Z, Sánchez I, Jiménez-Murcia S, Del Pino-Gutierrez A, Codina E, Baenas I, Valenciano-Mendoza E, Menchón JM, Fernández-Aranda F. A cluster analysis of purging disorder: Validation analyses with eating disorder symptoms, general psychopathology and personality. EUROPEAN EATING DISORDERS REVIEW 2020; 28:643-656. [PMID: 32944981 DOI: 10.1002/erv.2769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/29/2020] [Accepted: 07/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the natural grouping of Purging Disorder (PD) patients based on purging symptomatology and to evaluate the derived classes (a) against each other and (b) to a control group on a range of clinical and psychological measures. METHOD Participants included 223 PD women consecutively admitted to a tertiary ED treatment centre and 822 controls. Purging behaviours (self-induced vomiting, laxative and diuretic use) were used as indicators, while the EDI-2 (ED symptoms), the SCL-90-R (general psychopathology), and the TCI-R (personality traits) were used as validators. RESULTS Three distinct PD clusters emerged: Cluster 1 (only self-induced vomiting), Cluster 2 (self-induced vomiting and laxative use) and Cluster 3 (all purging methods). Significant differences between Cluster 1 and Cluster 3 were found for the EDI-2 drive for thinness and perfectionism subscales, and the TCI-persistence scale. All clusters differed significantly from the controls on all the EDI-2 and the SCL-90-R scales, but findings for the TCI-R scales were less consistent. CONCLUSIONS This study adds to a growing literature on the validity and distinctiveness of PD and provides evidence of dimensional symptom differences amongst PD clusters.
Collapse
Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, Universitat Autònoma de Barcelona-UAB, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nadine Riesco
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Amparo Del Pino-Gutierrez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Ester Codina
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| |
Collapse
|
7
|
Dakanalis A, Clerici M, Stice E. Prevention of eating disorders: current evidence-base for dissonance-based programmes and future directions. Eat Weight Disord 2019; 24:597-603. [PMID: 31147968 DOI: 10.1007/s40519-019-00719-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, USA
| |
Collapse
|
8
|
Zayas LV, Wang SB, Coniglio K, Becker K, Murray HB, Klosterman E, Kay B, Bean P, Weltzin T, Franko DL, Eddy KT, Thomas JJ. Gender differences in eating disorder psychopathology across DSM-5 severity categories of anorexia nervosa and bulimia nervosa. Int J Eat Disord 2018; 51:1098-1102. [PMID: 30193008 PMCID: PMC7192048 DOI: 10.1002/eat.22941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study examined whether patterns of eating-disorder (ED) psychopathology differed by gender across DSM-5 severity specifiers in anorexia nervosa (AN) and bulimia nervosa (BN). METHOD We tested whether ED psychopathology differed across DSM-5 severity specifiers among 532 adults (76% female) in a residential treatment center with AN or BN. We hypothesized that severity of ED psychopathology would increase in tandem with increasing severity classifications for both males and females with AN and BN. RESULTS Among females with BN, DSM-5 severity categories were significantly associated with increasing ED psychopathology, including Eating Disorder Examination-Questionnaire dietary restraint, eating concern, shape concern, and weight concern; and Eating Disorder Inventory drive for thinness and bulimia. ED psychopathology did not differ across DSM-5 severity levels for males with BN. For both males and females with AN, there were no differences in ED psychopathology across severity levels. DISCUSSION Results demonstrate that DSM-5 severity specifiers may function differently for males versus females with BN. Taken together, data suggest DSM-5 severity specifiers may not adequately capture severity, as intended, for males with BN and all with AN. Future research should evaluate additional clinical validators of DSM-5 severity categories (e.g., chronicity, treatment non-response), and consider alternate classification schemes.
Collapse
Affiliation(s)
- Lazaro V. Zayas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Shirley B. Wang
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Kathryn Coniglio
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Rutgers University, Piscataway, New Jersey,Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Kendra Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Helen B. Murray
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychology, Rutgers University, Piscataway, New Jersey,Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | - Eric Klosterman
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Brian Kay
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Pamela Bean
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Theodore Weltzin
- Eating Disorder Center, Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Debra L. Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
9
|
Personality and eating and weight disorders: an open research challenge. Eat Weight Disord 2018; 23:143-147. [PMID: 29177759 DOI: 10.1007/s40519-017-0463-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
|
10
|
Dakanalis A, Colmegna F, Zanetti MA, Di Giacomo E, Riva G, Clerici M. Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth. Child Psychiatry Hum Dev 2018; 49:137-145. [PMID: 28510006 DOI: 10.1007/s10578-017-0735-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.
Collapse
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | | | | | - Ester Di Giacomo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
11
|
Dakanalis A, Gaudio S, Riva G, Clerici M. Severity of bulimia nervosa and its impact on treatment outcome. Eat Weight Disord 2017; 22:727-729. [PMID: 28744624 DOI: 10.1007/s40519-017-0422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, IRCSS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| |
Collapse
|
12
|
Nakai Y, Nin K, Noma S, Teramukai S, Fujikawa K, Wonderlich SA. The impact of DSM-5 on the diagnosis and severity indicator of eating disorders in a treatment-seeking sample. Int J Eat Disord 2017; 50:1247-1254. [PMID: 28857236 DOI: 10.1002/eat.22777] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/18/2017] [Accepted: 08/20/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the impact of the DSM-5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including subtypes of anorexia nervosa (AN) between the DSM-IV and DSM-5 criteria. In addition, we studied the association of the DSM-5 severity criteria and clinical variables. METHOD Participants were 304 outpatients, aged 16-45 years, with eating disorders, diagnosed using semi-structured clinical interviews and the eating disorder examination questionnaire (EDE-Q). The severity of AN, bulimia nervosa (BN), and binge-eating disorder (BED) was rated from mild to extreme using the DSM-5 severity criteria. RESULTS The DSM-5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE-Q subscales significantly decreased as severity ratings increased in the DSM-5 AN. Furthermore, while the AN binge-eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables. DISCUSSION The DSM-5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM-5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders.
Collapse
Affiliation(s)
| | - Kazuko Nin
- School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shun'ichi Noma
- Department of Psychiatry, School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Kei Fujikawa
- The Center for Quality Assurance in Research and Development, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Stephen A Wonderlich
- Department of Clinical Neuroscience, University of North Dakota, School of Medicine and Health Sciences, Fargo, North Dakota
| |
Collapse
|
13
|
Dakanalis A, Clerici M. The nature of the association between binge-eating severity and metabolic syndrome. Eat Weight Disord 2017; 22:553-554. [PMID: 28405909 DOI: 10.1007/s40519-017-0386-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/25/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| |
Collapse
|
14
|
Dakanalis A, Riva G, Gaudio S, Clerici M. Cognitive-behavioral or psychodynamic therapy for people with bulimia nervosa. Eat Weight Disord 2017; 22:555-556. [PMID: 28674751 DOI: 10.1007/s40519-017-0412-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 06/18/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, IRCSS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Santino Gaudio
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Uppsala, Sweden
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| |
Collapse
|
15
|
Reas DL, Rø Ø. Investigating the DSM-5 severity specifiers based on thinness for adults with anorexia nervosa. Int J Eat Disord 2017; 50:990-994. [PMID: 28593630 DOI: 10.1002/eat.22729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The DSM-5 severity classification scheme for adults with anorexia nervosa (AN) is based upon current body mass index (BMI; kg/m2 ). This study examined the utility of the DSM-5 severity specifiers for adults with AN in relation to core cognitive and behavioral features of eating pathology and associated psychosocial impairment. METHODS A clinical sample of 146 adult AN patients (140 women, 6 men) were categorized using DSM-5 current BMI severity specifiers and assessed with the Eating Disorder Examination-Questionnaire (EDE-Q) and Clinical Impairment Assessment (CIA). RESULTS A total of 34 (23.3%) patients were categorized as mild (>=17.0 BMI), 35 (24.0%) as moderate (16-16.99 BMI), 32 (21.9%) as severe (15-15.99 BMI), and 45 (30.8%) as extreme (<15 BMI). No significant group differences were found for age, CIA and EDE-Q global or subscale scores, frequency of laxative use, self-induced vomiting, binge eating, or excessive exercise. DISCUSSION This study found little empirical evidence to support the utility of DSM-5 severity rating scheme to differentiate adults with AN in terms of core eating disorder pathology or associated psychosocial impairment.
Collapse
Affiliation(s)
- Deborah Lynn Reas
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Psychology, Faculty of Social Sciences, University of Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|