1
|
Rowlands K, Simic M, Treasure J, Cardi V. Emotional reactivity and prosocial behaviour in response to witnessing social exclusion in adolescents with eating disorders and healthy controls. J Eat Disord 2023; 11:224. [PMID: 38098100 PMCID: PMC10722719 DOI: 10.1186/s40337-023-00927-4] [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: 02/06/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prosocial behaviour can promote positive social interactions and it is a key skill in adolescence. People with emotional problems or psychiatric disorders, such as people with eating disorders might have impairments in prosocial behaviour, due to broader documented difficulties in underlying processes (e.g., mentalizing). METHODS The aim of this study was to examine prosocial behaviour in adolescents with eating disorders compared to healthy controls, using a computerised behavioural task. Adolescents (N = 123) including patients with eating disorders (n = 61) and healthy adolescents (n = 62) played a four-player computerised Prosocial Cyberball Game with three pre-programmed avatar players. During the task, participants witnessed the exclusion of one of the players, and subsequently had the opportunity to compensate for this by throwing the ball more often to the excluded player. Throughout the game, participants rated the level of negative emotion in themselves and in the excluded player. RESULTS Patients made significantly fewer ball tosses towards the excluded player during the compensation round compared to healthy controls (large effect size). Patients reported a significantly smaller increase in negative emotion after witnessing the exclusion and a significantly smaller decrease in negative emotion following the compensation round (large effect sizes). Patients also estimated a smaller decrease in negative emotion in the excluded player following the compensation round (medium effect size). There were no significant associations between these outcomes and eating disorder psychopathology in patients. CONCLUSIONS Compared to healthy adolescents, adolescent patients with eating disorders demonstrated less prosocial compensatory behaviour towards a computerised victim of social exclusion. In addition, they reported flatter negative emotion in themselves in response to witnessing and compensating for exclusion, and in the excluded player following compensation. If these findings are replicated, interventions to target these difficulties might contribute to improvements in social functioning in this patient group.
Collapse
Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of General Psychology, University of Padova, Padua, Italy.
| |
Collapse
|
2
|
Gezelius CME, Wahlund BA, Wiberg BM. Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward. Eat Weight Disord 2023; 28:82. [PMID: 37816948 PMCID: PMC10564661 DOI: 10.1007/s40519-023-01611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
PURPOSE We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment. METHODS Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. MEASURES Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment. RESULTS The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2). CONCLUSIONS Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding. LEVEL OF EVIDENCE Level IV: evidence obtained from multiple time series with the intervention.
Collapse
Affiliation(s)
- Christina M E Gezelius
- Department of Children and Youth Psychiatry, Center for Clinical Research, Falun Hospital, Falun, Sweden
| | - Björn A Wahlund
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- California Institute of Technology, Pasadena, USA
| | - Britt M Wiberg
- Department of Psychology, Umeå University, 90187, Umeå, Sweden.
| |
Collapse
|
3
|
Budia JM, Alcover CM, Fernández-Muñoz JJ, Blanco-Fernández A, Félix-Alcántara MP. Attachment, motivational systems and anorexia nervosa: A systematic review and proposed framework for eating disorders. Clin Psychol Psychother 2023; 30:913-930. [PMID: 36861498 DOI: 10.1002/cpp.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION There is a direct association between patients with insecure attachment style (IAS), behavioural inhibition (BIS) and behavioural activation (BAS) motivational systems, and anorexia nervosa (AN). However, the possible direct relationships between these three variables have not been studied. OBJECTIVE The main objective of this study is to analyse the relationship between these variables and propose a framework for analysing and understanding these relationships. METHODOLOGY A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching the following terms: 'anorexia', 'attachment' and those related to motivational systems. The final search was limited to publications in English dated between 2014-2022 for 'anorexia and attachment' and 2010-2022 for 'anorexia and BIS/BAS'. RESULTS Of the 587 articles retrieved, 30 were included in this study for the textual data analysis of the relationship between anorexia and attachment (17), anorexia and motivational systems (10) and anorexia, attachment and motivational systems (3). An association between avoidant IAS, AN and hypersensitivity to punishment of the BIS was observed in the analysis. A relationship was also observed with hyperreinforcement sensitivity of the BAS. After reviewing the articles, a possible relationship between the three factors, along with other mediating factors, was found. DISCUSSION AN is directly related to the avoidant IAS and to BIS. Similarly, bulimia nervosa (BN) was directly related with anxious IAS and BAS. However, contradictions were found in the BN-BAS relationship. This study proposes a framework for analysing and understanding these relationships.
Collapse
|
4
|
Sarig-Shmueli Y, Kurman J, Talmon S, Yoeli N, Gur E, Stein D, Rothschild-Yakar L. Mentalizing ability, mentalizing impairments, and anorexia nervosa: Validation of the Hebrew version of the Movie for the Assessment of Social Cognition (MASC). Clin Psychol Psychother 2023; 30:873-881. [PMID: 36869582 DOI: 10.1002/cpp.2848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.
Collapse
Affiliation(s)
| | - Jenny Kurman
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Shira Talmon
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Eitan Gur
- Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | |
Collapse
|
5
|
Mirabella M, Muzi L, Franco A, Urgese A, Rugo MA, Mazzeschi C, Speranza AM, McWilliams N, Lingiardi V. From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders. Eat Weight Disord 2023; 28:35. [PMID: 36997702 PMCID: PMC10063489 DOI: 10.1007/s40519-023-01562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. METHODS Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. RESULTS Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. CONCLUSIONS The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions. LEVEL OF EVIDENCE Level V, narrative review.
Collapse
Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
| | - Anna Franco
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Alessia Urgese
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Michele A Rugo
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Lambertville, NJ, USA
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
6
|
Klein EM, Benecke C, Kasinger C, Brähler E, Ehrenthal JC, Strauß B, Ernst M. Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning. J Psychosom Res 2022; 160:110975. [PMID: 35763941 DOI: 10.1016/j.jpsychores.2022.110975] [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: 01/19/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although the relationship between insecure attachment patterns and eating disorder (ED) psychopathology has repeatedly been demonstrated, the underlying mechanisms of this association are not fully understood. Therefore, the current study aimed to examine personality functioning, defined as an impairment in self and interpersonal functioning, as a mediator between attachment insecurity and ED psychopathology. METHODS In a representative population-based sample (N = 2508; age range 14-92 years) ED symptomatology, personality functioning, and attachment insecurity (anxiety and avoidance) were assessed. Besides descriptive uni-/bivariate analysis, path analysis was used to test a mediation model while controlling for the effects of age, gender, mental distress, and BMI. RESULTS ED symptomatology was associated with lower levels of personality functioning (r = 0.22) and higher levels of attachment anxiety (r = 0.14) but did not correlate with attachment avoidance (r = 0.02). Path analysis revealed that personality functioning fully mediated the effect of attachment anxiety on ED symptomatology: The indirect effect via personality functioning (β = 0.04, p < .001) accounted for 77% of the total effect. Fit indices were excellent. Sensitivity analyses revealed that the main results were mainly applicable to women and the middle age group. CONCLUSION The present findings contribute to the growing body of research using dimensional conceptualizations of personality functioning, suggesting that it provides an informative, overarching framework for understanding and treating ED psychopathology. Findings indicate that underlying individual differences, e.g., with respect to insecure attachment configurations, have relevant implications for symptom manifestations. Potential clinical implications and avenues for future research are discussed.
Collapse
Affiliation(s)
- Eva M Klein
- DFG Research Training Group "Life Sciences, Life Writing", University Medical Center of the Johannes Gutenberg-University Mainz, Am Pulverturm 13, 55131 Mainz, Germany.
| | - Cord Benecke
- Department of Psychology, University of Kassel, Holländische Straße 36-38, 34127 Kassel, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig 04103, Germany
| | - Johannes C Ehrenthal
- Department of Psychology, University of Cologne, Bernhard-Feilchenfeld-Str. 11, 50969 Cologne, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Stoystr. 3, 07740 Jena, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany
| |
Collapse
|
7
|
Quattropani MC, Geraci A, Lenzo V, Sardella A, Schimmenti A. Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: a Study On a Sample of Italian Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:365-374. [PMID: 35600515 PMCID: PMC9120272 DOI: 10.1007/s40653-022-00450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 05/27/2023]
Abstract
Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.
Collapse
Affiliation(s)
| | - Alessandra Geraci
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
| |
Collapse
|
8
|
Sonntag M, Russell J. The mind-in-mind study: A pilot randomised controlled trial that compared modified mentalisation based treatment with supportive clinical management for patients with eating disorders without borderline personality disorder. EUROPEAN EATING DISORDERS REVIEW 2022; 30:206-220. [PMID: 35132749 DOI: 10.1002/erv.2888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Mentalisation-based treatment (MBT) aims to improve reflective functioning. There is a growing evidence base outlining positive clinical outcomes for the use of MBT in eating disorder patients with co-morbid borderline personality disorder (BPD). The use of MBT has not been studied for eating disorder patients without BPD. This pilot study is an exploratory randomised controlled trial in which outcomes from MBT are compared with standard clinical management in a cohort of patients diagnosed with an eating disorder but not BPD. The main objectives were two-fold-to explore the use of MBT as a therapeutic modality and to test the acceptability and feasibility of the protocol design. METHOD Thirty-two participants were randomised to receive either MBT or standard treatment during an inpatient eating disorders program. All patients enrolled in the study were diagnosed with an eating disorder but did not meet DSM-5 criteria for BPD. On admission patients were categorised as very underweight (BMI 15.0-16.4 kg/m2 ), underweight (BMI 16.5-18.4 kg/m2 ) or healthy weight range (BMI ≥ 18.5-24.9 kg/m2 ). Upon discharge participants were further categorised as weight restored (BMI ≥ 18.5 kg/m2 ) or non-weight restored (BMI < 18.5 kg/m2 ). The primary outcome was the subscale score on the Reflective Functioning Questionnaire (RFQ-8). Secondary outcomes were subscale scores on the Eating Disorder Examination Questionnaire and the Depression, Anxiety and Stress Scale (DASS)-21. Participants were assessed at baseline and on discharge. Statistical significance was determined using repeated measurements analysis of variance (ANOVA). RESULTS Both groups experienced improvements in eating disorder symptoms and measures of psychological well-being. Participants within the MBT group exhibited greater improvements in reflective capacity as defined by the RFQ-8 however these benefits appeared to be limited to patients who achieved weight restoration at discharge. The eligibility criteria-which excluded comorbid BPD-led to challenges in recruitment which limited the power of the study analysis. As participants with a range of different eating disorder diagnoses were included this led to complexities in estimating the treatment effect within a defined cohort. CONCLUSIONS Although the small sample size must be noted as a limitation-the finding that weight restoration appears to be associated with improvements in reflective capacity in MBT would be worth exploring in a subsequent larger study. Modification of eligibility criteria and recruitment from a defined cohort may increase the efficiency of a future study.
Collapse
Affiliation(s)
- Miranda Sonntag
- Level 7 Eating Disorders, Northside Clinic, St Leonards, Sydney, New South Wales, Australia.,Drug & Alcohol Consultation Liaison Service, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia
| | - Janice Russell
- Peter Beumont Eating Disorders Service, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| |
Collapse
|