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Martinelli MK, Schreyer CC, Vanzhula IA, Guarda AS. Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program. Front Psychiatry 2024; 15:1325252. [PMID: 38832324 PMCID: PMC11145411 DOI: 10.3389/fpsyt.2024.1325252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited. Methods Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout. Results Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge. Conclusion Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.
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Affiliation(s)
- Mary K. Martinelli
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Meneguzzo P, Antoniades A, Garolla A, Tozzi F, Todisco P. Predictors of psychopathology response in atypical anorexia nervosa following inpatient treatment: A propensity score matching study of weight suppression and weight loss speed. Int J Eat Disord 2024; 57:1002-1007. [PMID: 38191854 DOI: 10.1002/eat.24135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/27/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION This study examines weight suppression (WS) and weight loss speed (WLS) in atypical anorexia nervosa (AN) and its implications for treatment outcomes, compared to people with AN and bulimia nervosa (BN). METHOD A mixed cross-sectional and prospective design was employed, assessing WS and WLS in people with atypical AN, AN, and BN. Participants were matched for age, gender, age of onset, and disorder duration. Clinical measurements and eating disorders questionnaire (EDE-Q) scores were employed to evaluate the response to treatment. RESULTS Individuals with atypical individuals exhibited WS patterns similar to AN, distinct from BN. Rapid WLS predicted clinical responses in atypical AN and BN, underscoring its treatment relevance. Atypical AN showed higher eating psychopathology scores than AN or BN, emphasizing the need for a reframed diagnosis. DISCUSSION Understanding atypical AN's connection to restrictive behaviors and weight loss informs screening, assessment, and treatment practices. Recognition of atypical AN's severity and adoption of tailored approaches are essential for recovery. This study highlights the significance of WS and WLS in atypical AN treatment outcomes, offering insights into clinical practice and care. The proposal to reframe atypical AN as a restrictive eating disorder emphasizes its clinical relevance. PUBLIC SIGNIFICANCE STATEMENT The phenomenon of weight suppression, involving the discrepancy between past highest weight and current weight, has garnered attention due to cultural pressures emphasizing fitness and appearance. This study focuses on its implications in atypical anorexia nervosa, aiming to uncover the relationship between WS, its speed, and treatment outcomes. The investigation contributes insights into tailored interventions for atypical anorexia nervosa and enriches the understanding of this complex disorder's dynamics.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | | | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Italy
| | - Federica Tozzi
- Research & Development, Stremble Ventures, Limassol, Cyprus
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3
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Meneguzzo P, Baron E, Marchesin S, Andretta AM, Nalesso L, Stella S, Todisco P. Tuning in to recovery: influence of music on emotional well-being during mealtime in inpatient facilities for eating disorders. J Eat Disord 2024; 12:7. [PMID: 38225626 PMCID: PMC10789025 DOI: 10.1186/s40337-024-00970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND In rehabilitating eating disorders (ED), mealtimes are critical but often induce stress, both for restrictive and binge-purge disorders. Although preliminary data indicate a positive effect of music during mealtime, few studies employ an experimental approach. This study examines the influence of background music during mealtime in an inpatient ward setting, offering a real-world perspective. METHODS Fifty-one women diagnosed with ED participated in this within-subjects study. Over two weeks, during lunch and dinner, they were exposed to three randomized music conditions: no music, focus piano music, and pop music. The self-report questionnaires captured affective states, noise levels, and hunger, while trained dietitians recorded food consumption and eating rituals. RESULTS The absence of music led to an increase in uneaten food (p = 0.001) and the presence of eating rituals (p = 0.012) during mealtimes. Significantly, only silence during mealtime reduced positive emotional states, while background music maintained positive emotions (p < 0.001). No specific differences emerged between the two types of music (focus piano and pop). CONCLUSIONS These findings affirm the positive impact of background music during mealtime in real-world settings, enhancing the potential of inpatient eating rehabilitation programs for individuals with ED. More studies are needed to validate and extend these results, particularly in outpatient settings.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Elisa Baron
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Silvia Marchesin
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Anna Maria Andretta
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Lisa Nalesso
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Sonia Stella
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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Time evaluation and its accuracy in eating disorders: differences in relation to interoceptive awareness. Eat Weight Disord 2022; 27:2551-2560. [PMID: 35410413 PMCID: PMC9556400 DOI: 10.1007/s40519-022-01394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Time evaluation has been poorly studied in eating disorder (ED) patients despite its relationship with body awareness, which is a core psychopathological feature in EDs and is influenced by impulsivity, interoception, and working memory. This study aims to evaluate time estimation and its accuracy across the ED spectrum in connection with specific and general psychopathology. METHODS A group of 215 women was enrolled in a computerized task involving the estimation of 1-min intervals. Impulsivity and body awareness constructs (self-monitoring, depersonalization, interoceptive deficit) were evaluated and examined for significant correlations with time estimation and the accuracy of the measure. RESULTS Patients with EDs showed an impaired ability to estimate time, with an accuracy that positively correlated with compulsive self-monitoring (p = 0.03). Differences between diagnostic subgroups showed an overestimation of time in anorexia nervosa patients and an underestimation of time in binge eating disorder patients, whose time estimation was also less accurate. CONCLUSION The relationship between time estimation and compulsive self- monitoring might corroborate the presence of an imbalanced integration of information in patients with EDs that was not present in the community women included in the study. Time perception should be further evaluated in the ED field, and longitudinal changes due to psychopathological recovery or BMI changes should be examined. LEVEL OF EVIDENCE Level III: Evidence obtained from a well-designed cohort or case-control analytic study.
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Meneguzzo P, Mancini C, Ormitti A, Garolla A, Bonello E, Donini LM, Todisco P. Impulsivity and eating disorders: The relationship between serum 25-hydroxyvitamin D and different impulsivity facets in a transdiagnostic sample. World J Biol Psychiatry 2022; 23:401-409. [PMID: 34842504 DOI: 10.1080/15622975.2021.2011404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Eating disorders (EDs) are severe psychiatric conditions characterised by malnutrition, dysfunctional behaviours, and hypovitaminosis D. In various psychiatric conditions, including EDs, preliminary evidence has correlated impulsivity to a low level of 25-hydroxyvitamin D [25(OH)D]. This study aims to reinforce this evidence by examining different facets, both behavioural and psychological, of the impulsivity construct in patients with ED. METHODS A sample of 119 women was evaluated with a validated questionnaire and computerised neuropsychological tasks: the UPPS-P impulsive behaviour scale, a go/no-go task, and the Balloon Analogue Risk Task (BART). A clinical evaluation for EDs and blood sample collection were also performed to assess specific psychopathology and determine the serum level of 25(OH)D. RESULTS Significant correlations were found between serum levels of 25(OH)D and BART scores (p = 0.012) and lack of perseverance (p = 0.034). Moreover, regression analyses showed that higher BART scores may be explained by hypovitaminosis D and higher levels of lack of perseverance in patients with EDs. CONCLUSIONS The specific aspect of impulsivity linked to goal strategy and behaviours may be explained in patients with EDs by hypovitaminosis D. A possible connection to the brain inflammatory system is also discussed, along with possible directions for future research.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neurosciences, University of Padova, Padova, Italy
| | - Cecilia Mancini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Aurora Ormitti
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Lorenzo M Donini
- Experimental Medicine Department, Food Science and Human Nutrition Research Unit, Sapienza University of Rome, Rome, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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7
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Meneguzzo P, Mancini C, Terlizzi S, Sales C, Francesconi MF, Todisco P. Urinary free cortisol and childhood maltreatments in eating disorder patients: New evidence for an ecophenotype subgroup. EUROPEAN EATING DISORDERS REVIEW 2022; 30:364-372. [PMID: 35274398 PMCID: PMC9314975 DOI: 10.1002/erv.2896] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 12/14/2022]
Abstract
Introduction Increasing neurobiological evidence has suggested the presence of a specific ecophenotype in people with eating disorders (EDs) linked to early maltreatment. Urinary‐free cortisol could strengthen the data and show specific relationships between maltreated subtypes and the hormonal profiles of patients with EDs. This study aims to evaluate the presence of different urinary cortisol in drug‐free patients in the acute phase of the disorder and its relationship with childhood maltreatment. Methods A sample of 78 female patients with ED is included in the study. Childhood maltreatment history and 24‐h urinary free cortisol (24‐h UFC) are evaluated at a specialised ED ward admission. Results Patients with a maltreatment history show more blunted 24‐h UFC levels than peers without childhood maltreatment (p = 0.001). Regression analysis showed that child abuse is a predictor of the reduction of 24‐h UFC (p < 0.001), with physical abuse (p = 0.011) and sexual abuse (p = 0.050) that could have a more specific impact than other maltreatment subtypes. Discussion Childhood maltreatment should be evaluated in ED patients due to its biological impact on the hormonal stress axis, which could impair the ability of patients to respond to standardized ED treatment. Eating disorder patients with history of maltreatment showed a reduced 24‐h urinary free cortisol. New data support the evidence about the presence of an ecophenotype ED subgroup. Reduced 24‐h urinary free cortisol is significantly correlated with child abuses.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
- Department of NeuroscienceUniversity of Padovavia Giustiniani 2PadovaItaly
- Padova Neuroscience CenterUniversity of PadovaPadovaItaly
| | - Cecilia Mancini
- Experimental Medicine DepartmentFood Science and Human Nutrition Research UnitSapienza University of RomeRomeItaly
| | - Samira Terlizzi
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
| | - Chiara Sales
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
| | | | - Patrizia Todisco
- Eating Disorders UnitCasa di Cura“Villa Margherita”, Arcugnano (VI)VicenzaItaly
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A Multi-Faceted Evaluation of Impulsivity Traits and Early Maladaptive Schemas in Patients with Anorexia Nervosa. J Clin Med 2021; 10:jcm10245895. [PMID: 34945191 PMCID: PMC8703582 DOI: 10.3390/jcm10245895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: patients with Anorexia Nervosa (AN) are classified either as restrictive (ANr) or binge/purge (ANbp) according to the absence or presence of impulsive eating and compensatory behaviors. The aim of the present study was to assess the levels of impulsivity in both AN subtypes and to explore whether individual differences in impulsivity may be explained by differences in the presence of early maladaptive schemas. (2) Methods: the sample group included 122 patients with ANr, 112 patients with ANbp, and 131 healthy women (HW). All of these participants completed the UPPS-P scale for an assessment of impulsive behaviors and the Young Schema Questionnaire (YSQ-S3) for an assessment of early maladaptive schemas. (3) Results: the patients with ANbp displayed higher levels of impulsivity compared with the patients with ANr and HW. Patients with AN, especially the restrictive subtype, also reported higher levels of early maladaptive schemas than HW, and regression analyses revealed that specific maladaptive schemas partially explain the variability in impulsivity in both patients and HW. (4) Conclusions: it appears that maladaptive beliefs developed during childhood or adolescence may predict the development of impulsivity, a personality trait usually associated with maladaptive behaviors, and appears to be prevalent among ANbp patients. The clinical effects of this, as well as directions for future study, are also discussed in this paper.
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9
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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10
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Meneguzzo P, Garolla A, Bonello E, Todisco P. Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother 2021; 29:718-724. [PMID: 34432335 PMCID: PMC9291290 DOI: 10.1002/cpp.2665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive–behavioural therapy and a flexible and personalized component implemented by third‐wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re‐evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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11
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Meneguzzo P, Tenconi E, Todisco P, Favaro A. Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit. EUROPEAN EATING DISORDERS REVIEW 2021; 29:770-782. [PMID: 34118097 PMCID: PMC8453548 DOI: 10.1002/erv.2848] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022]
Abstract
Objective Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used. Results The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients. Conclusion This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type. Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol CRT improves flexibility, drive to change, and therapy engagement No differences between restrictive or binge/purge subgroups Both adolescent and adult patients improved their cognitive styles
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura 'Villa Margherita', Arcugnano, Vicenza, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
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12
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Meneguzzo P, Cazzola C, Castegnaro R, Buscaglia F, Bucci E, Pillan A, Garolla A, Bonello E, Todisco P. Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis. Front Psychol 2021; 12:661924. [PMID: 33868136 PMCID: PMC8044897 DOI: 10.3389/fpsyg.2021.661924] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology. Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators. Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology. Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Chiara Cazzola
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Roberta Castegnaro
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | | | - Enrica Bucci
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Anna Pillan
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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13
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Devoe DJ, Anderson A, Bahji A, Singh M, Patten SB, Soumbasis A, Ramirez Pineda A, Flanagan J, Richardson C, Lange T, Dimitropoulos G, Paslakis G. The Prevalence of Impulse Control Disorders and Behavioral Addictions in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:724034. [PMID: 35069274 PMCID: PMC8770943 DOI: 10.3389/fpsyt.2021.724034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Aim: Individuals with eating disorders (EDs) may present with impulse control disorders (ICDs) and behavioral addictions (BAs), which may result in additional suffering and treatment resistance. However, the prevalence of ICDs and BAs in EDs has not been systematically examined. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of ICDs and BAs in ED samples. Methods: A comprehensive electronic database search of the peer-reviewed literature was conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from their inception to May 2021. We restricted review eligibility to research studies reporting prevalence for ICDs or BAs in individuals with diagnosed EDs. The outcome for this review was the prevalence of ICDs or BAs in individuals with EDs. A series of random-effects meta-analyses were performed on eligible studies to estimate the pooled proportions and 95% confidence intervals (CIs). Results: Thirty-five studies met the inclusion criteria, including a total of 9,646 individuals identified as having an ED, 18 of these studies specifically examined ICDs/BAs in AN, BN, and BED. Random-effects pooled estimates demonstrated that the comorbid prevalence of any ICD was 22%. The prevalence of comorbid pathological/compulsive buying was highest (19%), followed by kleptomania (18%), pathological internet use (12%), intermittent explosive disorder (4%), trichotillomania (3%), and gambling disorder (2%). In addition, the prevalence of stealing/shoplifting behaviors was 30% in those with EDs. Conclusion: This is the first meta-analysis on the comorbid prevalence of EDs and ICDs/BAs. We found a moderate prevalence for these comorbid conditions, with approximately one out of five individuals with an ED also displaying a comorbid ICD/BA. Although causal inferences cannot be drawn, the numbers strongly suggest that clinical screening/monitoring of ICDs/BAs should be part of the clinical routine in cohorts with EDs. ED settings need either the capacity to manage these disorders or adequate access to relevant services. Further investigations are needed to reveal common underlying pathomechanisms. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020202044.
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Affiliation(s)
- Daniel J Devoe
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alida Anderson
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Anees Bahji
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Manya Singh
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Andrea Soumbasis
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Ana Ramirez Pineda
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Jordyn Flanagan
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Tom Lange
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Gina Dimitropoulos
- Mathison Centre for Mental Health Research and Education, Department of Psychiatry, University of Calgary, Calgary, AB, Canada.,Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Lübbecke, Germany
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14
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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: 17] [Impact Index Per Article: 4.3] [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.
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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
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