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Amaslidou A, Ierodiakonou-Benou I, Bakirtzis C, Nikolaidis I, Tatsi T, Grigoriadis N, Nimatoudis I. Multiple sclerosis and mental health related quality of life: The role of defense mechanisms, defense styles and family environment. AIMS Neurosci 2023; 10:354-375. [PMID: 38188008 PMCID: PMC10767059 DOI: 10.3934/neuroscience.2023027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 01/09/2024] Open
Abstract
Background Multiple sclerosis is a demyelinating chronic neurologic disease that can lead to disability and thus to deterioration of quality of life. Psychological parameters such as ego defense mechanisms, defense styles and family environment are important factors in the adaptation process, and as such they can play important roles in QoL. This study aims to assess the psychological factors as well as the clinical and demographic characteristics related to mental health quality of life (MHQoL). Methods This was an observational, cross-sectional study conducted in a sample of 90 people with MS in the years 2018-2020. All participants completed the following questionnaires: MSQoL-54, DSQ-88, LSI, FES-R, SOC, BDI-II, STAI. Disability was assessed using EDSS. Results In multiple linear regression, significant roles were played by depression (R2: 41.1%, p: 0.001) and, to a lesser extent, the event of a relapse (R2: 3.5%, p: 0.005), expressiveness (R2: 3.6%, p < 0.05) and image distortion style (R2: 4.5%, p: 0.032). After performing a hierarchical-stepwise analysis (excluding depression), the important factors were maladaptive defense style (R2: 23.7%, p: 0.002), the event of relapse (R2: 8.1%, p < 0.001), expressiveness (R2: 5.5%, p: 0.004) and self-sacrificing defense style (R2: 2.4%, p: 0.071). Conclusion Psychological factors play important roles in MHQoL of people with multiple sclerosis. Thus, neurologists should integrate in their practice an assessment by mental health specialists. Moreover, targeted psychotherapeutic interventions could be planned i to improve QoL.
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Affiliation(s)
- Anthi Amaslidou
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioanna Ierodiakonou-Benou
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Christos Bakirtzis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Nikolaidis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Theano Tatsi
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- 2 Department of Neurology, MS Center, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Ioannis Nimatoudis
- 3 Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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2
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Ramzi NH, Auvinen J, Veijola J, Miettunen J, Ala-Mursula L, Sebert S, Keinänen-Kiukaanniemi S, Svento R, Jokelainen J, Drenos F, Dovey TM, Järvelin MR, Blakemore AIF. Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966). J Affect Disord 2023; 331:1-7. [PMID: 36933669 DOI: 10.1016/j.jad.2023.03.026] [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: 11/04/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966). METHODS The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS). RESULTS Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r(3013) = 0.41, p < 0.01, 46 y: r(3013) = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period. LIMITATIONS Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship. CONCLUSIONS Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.
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Affiliation(s)
- Nurul Hanis Ramzi
- Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; Department of Metabolism, Digestion and Reproduction, Division of Diabetes, Endocrinology, and Metabolism, Faculty of Medicine, Imperial College London, United Kingdom; Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom.
| | - Juha Auvinen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juha Veijola
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, University Hospital of Oulu, Oulu, Finland; Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Leena Ala-Mursula
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Rauli Svento
- Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Fotios Drenos
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Terence M Dovey
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Marjo-Riitta Järvelin
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom; Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Alexandra I F Blakemore
- Department of Metabolism, Digestion and Reproduction, Division of Diabetes, Endocrinology, and Metabolism, Faculty of Medicine, Imperial College London, United Kingdom; Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
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3
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Gagliardi M. How Our Caregivers Shape Who We Are: The Seven Dimensions of Attachment at the Core of Personality. Front Psychol 2021; 12:657628. [PMID: 34276482 PMCID: PMC8280313 DOI: 10.3389/fpsyg.2021.657628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Psychology defines personality as the stable traits of an individual, and cognitive research suggests that a set of core beliefs is at the root of these traits. From this perspective, two major questions remain unanswered: (1) What are the core beliefs that make up personality? (2) How are they acquired? An interesting answer is provided by attachment theory, according to which attachment is at the basis of personality. The current theoretical formulation, however, does not sufficiently clarify the relationship between the two. Adopting a cognitive-clinical approach, we put forward a novel version of attachment theory, arguing that it can better account for the relationship between attachment and personality, thereby providing more convincing answers to questions (1) and (2). In particular, we propose that: (A) attachment information is acquired over seven dimensions; (B) the acquisition of each dimension is induced by a specific caregiving feature and (C) realized through a specific acquisition mechanism - imprinting. In a nutshell, we propose an Attachment-Personality Model (APM) according to which seven attachment dimensions constitute the knowledge core of personality. We finally discuss the significant implications of the model, especially its clinical application in terms of conception, assessment, and treatment of mental disorders. The model can be empirically tested, and we suggest three ways to do that.
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Affiliation(s)
- Marcantonio Gagliardi
- Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
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4
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The costs of over-control in anorexia nervosa: evidence from fMRI and ecological momentary assessment. Transl Psychiatry 2021; 11:304. [PMID: 34016948 PMCID: PMC8138008 DOI: 10.1038/s41398-021-01405-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 01/15/2023] Open
Abstract
A growing body of evidence suggests that a high level of self-control may, despite its positive effects, influence cognitive processing in an unfavorable manner. However, the affective costs of self-control have only rarely been investigated. Anorexia nervosa (AN) is an eating disorder that is often characterized by excessive self-control. Here, we used fMRI to explore whether over-control in AN may have negative affective consequences. 36 predominantly adolescent female AN patients and 36 age-matched healthy controls (HC) viewed negative and neutral pictures during two separate fMRI sessions before and after 10 min of rest. We tested whether abnormally elevated neural activity during the initial presentation in a brain region broadly implicated in top-down control, the dorsolateral prefrontal cortex (dlPFC), could predict subsequent activation in limbic areas relevant to bottom-up affective processing. Using ecological momentary assessment (EMA), we also tested for associations between the aforementioned neuroimaging markers and negative affective states in the two weeks following the experiment. fMRI data revealed that higher initial activation of the dlPFC in AN predicted increased amygdala reactivity during the second fMRI session, which in turn was related to increased self-reported tension during two weeks following the scan. These data suggest that over-control in AN patients may come at a cost including negative affective states on a short (minutes) as well as a longer time scale (days). This mechanism may significantly contribute to the persistence of AN.
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5
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Luminet O, Nielson KA, Ridout N. Having no words for feelings: alexithymia as a fundamental personality dimension at the interface of cognition and emotion. Cogn Emot 2021; 35:435-448. [PMID: 33900884 DOI: 10.1080/02699931.2021.1916442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This special issue brings together two important reviews and seven cutting-edge empirical papers concerning the influence of alexithymia on cognitive and emotional processing. Alexithymia is a multifaceted construct that is characterised by difficulties identifying one's feelings; difficulties describing one's feelings to others; and an externally focused, utilitarian cognitive style. In this paper, we begin by considering how emotion science has evolved in its understanding of personality traits, before highlighting the potential importance of alexithymia research for the field of cognition and emotion. After summarising the historical context of alexithymia research, we consider the contributions of the featured papers to the literature of cognition and emotion. The collected works highlight that alexithymia influences several aspects of how one perceives and responds to neutral and emotional situations, by impacting upon multiple processes (attention, appraisals, memory, language and behaviour), showing the importance of drawing better connections amongst multiple processes, toward disentangling the effects of early processes on later ones. A lack of correspondence between processes, as well as amongst alexithymia facets, is another central finding of the special issue. This pattern is thought to lead to ineffective and inflexible emotion regulation and to pose significant risks for physical and mental illness.
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Affiliation(s)
- Olivier Luminet
- Research Institute for Psychological Sciences, UCLouvain, Louvain-la-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Brussels, Belgium
| | - Kristy A Nielson
- Department of Psychology, Marquette University, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ridout
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK
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6
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Luminet O, Nielson KA, Ridout N. Cognitive-emotional processing in alexithymia: an integrative review. Cogn Emot 2021; 35:449-487. [PMID: 33787442 DOI: 10.1080/02699931.2021.1908231] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Alexithymia is a multifaceted personality construct characterised by difficulties identifying one's feelings and distinguishing them from bodily sensations, difficulties describing one's feelings to others, and an externally oriented cognitive style. Over the past 25 years, a burgeoning body of research has examined how alexithymia moderates processing at the cognition-emotion interface. We review the findings in five domains: attention, appraisals, memory, language, and behaviours. The preponderance of studies linked alexithymia with deficits in emotion processing, which was apparent across all domains, except behaviours. All studies on behaviours and a proportion of studies in other domains demonstrated emotional over-responding. Analysis at the facet level revealed deficits in memory and language that are primarily associated with externally oriented thinking, while over-responding was most often linked to difficulty identifying feelings and difficulty describing feelings. The review also found evidence for contextual modulation: The pattern of deficits and over-responding was not restricted to emotional contexts but also occurred in neutral contexts, and in some circumstances, emotional over-responding in alexithymia was beneficial. Taken together, this review highlights alexithymia as a central personality dimension in the interplay between cognition and emotion.
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Affiliation(s)
- Olivier Luminet
- Research Institute for Psychological Sciences, UCLouvain, Louvain-la-Neuve, Belgium.,Fund for Scientific Research (FRS-FNRS), Belgium
| | - Kristy A Nielson
- Department of Psychology, Marquette University, Milwaukee, WI, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Nathan Ridout
- Department of Psychology, School of Life & Health Sciences, Aston University, Birmingham, UK
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7
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McAtamney K, Mantzios M, Egan H, Wallis DJ. Emotional eating during COVID-19 in the United Kingdom: Exploring the roles of alexithymia and emotion dysregulation. Appetite 2021; 161:105120. [PMID: 33450300 PMCID: PMC7837231 DOI: 10.1016/j.appet.2021.105120] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/21/2020] [Accepted: 01/09/2021] [Indexed: 12/11/2022]
Abstract
Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research. One quarter of participants reported eating more than usual during COVID-19. One third of participants reported eating less healthfully than usual. Difficulty identifying feelings influences emotional eating via emotion dysregulation. Difficulty describing feelings influences emotional eating via emotion dysregulation.
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Affiliation(s)
- Katherine McAtamney
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Michail Mantzios
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Helen Egan
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Deborah J Wallis
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
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8
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Berkovskaya MA, Tarasenko AA, Fadeev VV, Gurova OY. [Alexithymia and its relation with eating disorders and obesity]. ACTA ACUST UNITED AC 2020; 66:42-48. [PMID: 33351347 DOI: 10.14341/probl12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
This manuscript provides a review of current literature on the relationship between overweight and alexithymia as a psychological factor associated with obesity, as well as the role of alexithymia in the development of various abnormalities and eating disorders (ED). Obesity is a multifactorial disease, and lifestyle characteristics are the most important pathogenetic links on its development, as well as a complex of genetic, epigenetic, biological and psychological factors that cause accumulation of excessive fat and prevent effective reduction and retention of body weight. One possible reason for the increased prevalence of obesity in adults is poor emotional management, which can affect healthy eating behavior and lifestyle. It was found that overweight and obese people have a high prevalence of alexithymia, and also the study shows its prognostic role in the development of ED. Alexithymia is a factor that not only predisposes to weight gain, but is also a significant predictor of inefficiency and premature termination of programs for the treatment of obesity and ED. Timely diagnosis and correction of alexithymic syndrome can help in developing the effective treatment strategies for obese patients.
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Affiliation(s)
| | - Anna A Tarasenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Valentin V Fadeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Olesya Yu Gurova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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9
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Hobson H, Chiu EG, Ravenscroft C, Partridge K, Bird G, Demeyere N. The association between communication impairments and acquired alexithymia in chronic stroke patients. J Clin Exp Neuropsychol 2020; 42:495-504. [PMID: 32576080 DOI: 10.1080/13803395.2020.1770703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Language dysfunction has recently been suggested to be one route to alexithymia, an impairment in recognizing and communicating one's own emotions. Neuropsychological evidence is needed to investigate the possibility that acquired language problems could underlie acquired alexithymia. METHOD This project examined data from a large group of chronic stroke patients (N = 118) to test whether self-reported or behavioral measures of language and communication problems were associated with alexithymia. We also examined the impact of hemisphere of damage on alexithymia. RESULTS We found no differences in alexithymia levels for patients with observed language impairments on brief tests of picture naming, comprehension, and reading vs unimpaired patients. However, self-reported communication difficulties were found to be associated with higher scores of alexithymia, even after controlling for depression and anxiety. Patients with left- versus right-hemisphere damage did not differ in their alexithymia scores. CONCLUSIONS We found partial support for the language hypothesis of alexithymia. We discuss potential reasons for the discrepant findings between the self-report and objective language measures and suggest that self-report measures may be more sensitive to milder, more pragmatic language impairments, as opposed to the severe structural language impairments measured by the cognitive screening tests.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, University of York , York, UK.,Department of Psychology Social Work & Counselling, University of Greenwich, Old Royal Naval College , London, United Kingdom
| | - Evangeline Grace Chiu
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Chloe Ravenscroft
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Kate Partridge
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
| | - Geoffrey Bird
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience , Denmark Hill, London, United Kingdom
| | - Nele Demeyere
- Department of Experimental Psychology, Anna Watts Building, Radcliffe Observatory Quarter , Oxford, United Kingdom
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10
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Vanegas E, Felix M, Ramon GD, López Jove O, Matos Benavides EE, Tinoco-Morán I, Bernstein JA, Cherrez-Ojeda I. Influence of alexithymia on the management of Latin American patients with asthma: A cross-sectional study. SAGE Open Med 2020; 8:2050312120930913. [PMID: 32551114 PMCID: PMC7278303 DOI: 10.1177/2050312120930913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives: In asthmatic patients, studies suggest that alexithymia leads to negative consequences and emotions that can affect physical, psychological, and social aspects of life. We designed this study to determine the frequency of alexithymia in Latin American patients with asthma, as well as to understand how this personality trait and each of its components interact with asthma severity and demographic variables, and their implications on treatment adherence and disease control under such setting. Methods: We conducted a cross-sectional study, involving 265 Latin American patients with asthma. Patient demographics and clinical characteristics were reported. The presence of alexithymia, asthma severity, and control, as well as treatment adherence, was analyzed. To assess the presence of alexithymia, the 20-item Toronto Alexithymia Scale was used. For the statistical analyses, we performed Kendall’s tau-b correlation coefficient, chi-square tests for association, and one-way analysis of variance. Results: A total of 265 patients participated in the study with a gender distribution of 69.4% female and an average age of 54.7 years. In total, 30.2% of individuals presented alexithymia. There was a statistically significant correlation between educational level and 20-item Toronto Alexithymia Scale categories (p < .001), as well as a higher proportion of severe (35.1%, p = .001) and uncontrolled (50.0%, p = .185) asthma in patients with alexithymia. A higher proportion of patients with some level of non-adherence was seen on those with uncontrolled asthma (68.5%, p = .008). Conclusion: Our results suggest that in our sample, 3 in 10 Latin American asthma patients have alexithymia, and such mental condition is more common in those individuals with lower educational levels. Individuals with alexithymia present with severe asthma more frequently than do patients with possible or no alexithymia and are also more likely to have their disease uncontrolled.
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Affiliation(s)
- Emanuel Vanegas
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - Miguel Felix
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
| | - German D Ramon
- Instituto de Alergia e Inmunología del Sur, Bahía Blanca, Argentina
| | - Orlando López Jove
- Servicio de Neumología Clínica, Hospital Zonal Especializado de Agudos y Crónicos "Dr. Antonio Cetrángolo," Buenos Aires, Argentina
| | | | | | - Jonathan A Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Iván Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador.,Respiralab Research Group, Guayaquil, Ecuador
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11
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Simonsen CB, Jakobsen AG, Grøntved S, Kjaersdam Telléus G. The mentalization profile in patients with eating disorders: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:311-322. [PMID: 31910059 DOI: 10.1080/08039488.2019.1707869] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Context: Patients with eating disorders (EDs) may have a lower mentalization ability. To the best of our knowledge, no meta-analysis has so far addressed the multidimensional mentalization profile within these patients.Objective: To summarize the existing evidence of the mentalization profile and its association with EDs.Data sources: We searched for articles in PsychINFO, Embase and PubMed using the search terms mentalization, reflective function, adult attachment interview, alexithymia, Toronto Alexithymia Scale, eye test, Reading the Mind in the Eyes Test, Theory of Mind, mind-mindedness, mind-blindness, facial expression recognition, metacognition, ED, anorexia nervosa (AN) and bulimia nervosa (BN).Studies included: Quantitative studies including diagnosed patients with an ED, healthy controls (HCs) and relevant test methods.Data synthesis: Forty-four studies were included. Nine studies were eligible for the meta-analysis. Significantly lower mentalization ability about oneself was found in patients with an ED when compared to HCs. Groups were more comparable when dealing with mentalization ability of others. Non-significant but clinically relevant results include a tendency for a lower mentalization ability in patients with AN compared to patients with BN.Conclusion: The mentalization profile is complex and varies across dimensions of mentalization in patients with an ED. Different degrees of mentalization between various EDs were found, implying the necessity for further research on mentalization profiles in different ED diagnoses. The sparse existing literature was a limitation for this meta-analysis, emphasizing that further research on the mentalization profile in patients with EDs is needed.
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Affiliation(s)
- Caroline Bach Simonsen
- Faculty of Psychology, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Simon Grøntved
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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12
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Khosravi M. Eating disorders among patients with borderline personality disorder: understanding the prevalence and psychopathology. J Eat Disord 2020; 8:38. [PMID: 32821383 PMCID: PMC7429899 DOI: 10.1186/s40337-020-00314-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment protocols can be bolstered and etiological and maintenance factors can be recognized more easily by a superior understanding of emotions and emotion regulation in the comorbidity of borderline personality disorder (BPD) and feeding and eating disorders (FEDs). Therefore, the present study aimed at investigating the prevalence and psychopathology of FEDs in patients with BPD. METHODS In this cross-sectional study, 220 participants were examined in three groups, namely BPD (n = 38), BPD + FEDs (n = 72), and healthy controls (n = 110), from August 2018 to November 2019. The participants were selected by systematic random sampling among the patients who referred to Baharan psychiatric hospital in Zahedan, Iran, with the sampling interval of 3. The subjects were evaluated by 28-item General Health Questionnaire (GHQ-28), Borderline Personality Inventory (BPI), Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), Structured Clinical Interviews for DSM-5: Research Version (SCID-5-RV), the 26-item Eating Attitudes Test (EAT-26), 20-item Toronto Alexithymia Scale (TAS-20), Beck Anxiety Inventory (BAI), and Beck Depression Inventory-II (BDI-II). RESULTS The results showed a 65.4% (n = 72) prevalence of FEDs in patients with BPD. Also, the highest and lowest prevalence rates were reported for other specified feeding and eating disorders (51.3%) and bulimia nervosa (6.9%), respectively. Although the highest mean score of TAS-20 was related to anorexia nervosa, there was no significant difference between the scores of various types of FEDs. The mediation analysis showed that anxiety and depression would play a mediating role in the relationship between alexithymia and eating-disordered behaviors. CONCLUSIONS The results have suggested that alexithymia, anxiety, and depression should receive clinical attention as potential therapeutic targets in the comorbidity of BPD and FEDs. The clinical implications of the research have been conducted to date, and directions for future research have been discussed.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry and Clinical Psychology, Baharan Psychiatric Hospital, Zahedan University of Medical Sciences, Zahedan, 9813913777 Iran
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13
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Pinna F, Manchia M, Paribello P, Carpiniello B. The Impact of Alexithymia on Treatment Response in Psychiatric Disorders: A Systematic Review. Front Psychiatry 2020; 11:311. [PMID: 32372987 PMCID: PMC7177022 DOI: 10.3389/fpsyt.2020.00311] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/27/2020] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED Treatment of psychiatric disorders relies heavily on a trial and error approach, often prolonging the time required to obtain symptomatic improvements. The identification of reliable predictors of treatment response is instrumental to enact an individualized approach. Alexithymia represents a personality trait reflecting an intrinsic difficulty in recognizing the emotional components of subjective experiences. Thus, its modulating role on treatment outcome has gathered substantial attention during the past years. In the present paper, we aimed at exploring the available evidence for Alexithymia role in influencing the treatment outcome on a wide range of psychiatric conditions by means of a systematic review. DATA SOURCE We performed a systematic review in Medline and Scopus, augmented by tracking the reference list of the pertinent articles. INCLUSION CRITERIA To be included in this review, research studies had to assess alexithymia impact on a treatment intervention delivered to manage a primary psychiatric disorder. STUDY EVALUATION AND DATA SYNTHESIS After removing duplicates, titles were screened first, then abstracts, and last full texts were read, eventually leading to the inclusion or exclusion of the papers according to the criteria established before the online search. Then results of the search were downloaded in.xml format and uploaded in Rayyan, a free web software, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. After uploading, screening of the literature was performed in blind by two investigators. Disagreement between reviewers was resolved by joint discussion with a third senior investigator. The quality of evidence was assessed using the Newcastle Ottawa Scale. Thereafter, the data considered relevant was extracted and synthetized in this paper. RESULTS Our search yielded a total of 30 articles dealing with a wide range of psychiatric conditions and exploring both pharmacological and psychotherapeutic interventions. Several lines of evidence suggest a complex role for alexithymia in influencing the psychiatric treatment outcome, further underscoring the need for additional research in this area to better address the existing knowledge gaps.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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14
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Gaggero G, Bonassi A, Dellantonio S, Pastore L, Aryadoust V, Esposito G. A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research. Front Psychiatry 2020; 11:611489. [PMID: 33362614 PMCID: PMC7758403 DOI: 10.3389/fpsyt.2020.611489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.
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Affiliation(s)
- Giulia Gaggero
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Andrea Bonassi
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.,Mobile and Social Computing Lab, Bruno Kessler Foundation, Trento, Italy
| | - Sara Dellantonio
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Luigi Pastore
- Department of Education, Psychology, Communication, University of Bari, Bari, Italy
| | - Vahid Aryadoust
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.,Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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15
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Koushiou M, Merwin RM, Anderson D, Karekla M. An investigation of the affective experience of females at high risk for eating disorders in general and pathology-specific contexts. Appetite 2019; 141:104306. [PMID: 31167110 DOI: 10.1016/j.appet.2019.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/19/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Difficulties with emotional experiences have long been implicated in the development or maintenance of eating disorders (EDs). However, the vast majority of this work is theoretical or self-report, with few studies examining the somatic-affective experience of individuals with EDs under experimental conditions. The aim of the current study was to: i) examine physiological reactivity and subjective report of emotional experiences in response to ED pathology-specific and general affective film clips, and ii) examine the impact of film on body size estimation in females at risk for EDs. METHOD Females aged 14-24 years old of either high (N = 42) or low (N = 43) risk for EDs viewed pathology-specific and general affective film clips and provided their affective ratings and body-size estimations post film clips. Heart Rate and Skin Conductance Levels were recorded during each clip. RESULTS High risk participants evidenced greater physiological arousal across conditions and in both general and pathology-specific affective contexts. Negative affect induced via the ED-pathology specific film clip had a greater impact on the high risk group's body-size estimations. CONCLUSIONS Individuals at risk for EDs seem to experience greater physiological arousal and this may influence the experience of their bodies, or direct attention to their body as a way to attenuate unwanted emotion or due to somatic feedback.
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Affiliation(s)
- Maria Koushiou
- University of Nicosia, Cyprus; ACThealthy, University of Cyprus, Cyprus
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16
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Tapajóz F, Soneira S, Catoira N, Aulicino A, Allegri RF. Impaired theory of mind in unaffected first‐degree relatives of patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:692-699. [DOI: 10.1002/erv.2701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/08/2019] [Accepted: 08/25/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Fernanda Tapajóz
- CONICET‐Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
- Service of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni Buenos Aires Argentina
| | - Sebastian Soneira
- Section of Eating Disorders and Nutritional Psychiatry, Psychiatry Service, Fleni Buenos Aires Argentina
| | - Natalia Catoira
- Casa Hospital San Juan de Dios (Ramos Mejía) Buenos Aires Argentina
| | - Alfredo Aulicino
- Section of Eating Disorders, Hospital General Cosme Argerich Buenos Aires Argentina
| | - Ricardo F. Allegri
- CONICET‐Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
- Service of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni Buenos Aires Argentina
- Universidad de la Costa (CUC) Barranquilla Colombia
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17
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Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1351-1358. [PMID: 29101588 DOI: 10.1007/s10802-017-0365-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.
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18
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Hobson H, Brewer R, Catmur C, Bird G. The Role of Language in Alexithymia: Moving Towards a Multiroute Model of Alexithymia. EMOTION REVIEW 2019. [DOI: 10.1177/1754073919838528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Alexithymia is characterized by difficulty identifying and describing one’s own emotion. Identifying and describing one’s emotion involves several cognitive processes, so alexithymia may result from a number of impairments. Here we propose the alexithymia language hypothesis—the hypothesis that language impairment can give rise to alexithymia—and critically review relevant evidence from healthy populations, developmental disorders, adult-onset illness, and acquired brain injury. We conclude that the available evidence is supportive of the alexithymia–language hypothesis, and therefore that language impairment may represent one of multiple routes to alexithymia. Where evidence is lacking, we outline which approaches will be useful in testing this hypothesis.
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Affiliation(s)
- Hannah Hobson
- Department of Psychology, Social Work & Counselling, University of Greenwich, UK
| | - Rebecca Brewer
- Department of Psychology, Royal Holloway University of London, UK
| | - Caroline Catmur
- Institute of Psychology, Psychiatry and Neuroscience, King’s College London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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19
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Slanbekova GK, Chung MC, Karipbaev BI, Sabirova RS, Alimbayeva RT. Posttraumatic Stress and Interpersonal Sensitivity: Alexithymia as Mediator and Emotional Expressivity as Moderator. Psychiatr Q 2019; 90:249-261. [PMID: 30515699 DOI: 10.1007/s11126-018-9612-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined 1) the link between PTSD from past trauma, interpersonal sensitivity and psychiatric co-morbidity, 2) mediational effects of alexithymia on 1), and 3) moderated mediational effects with emotional expressivity as the moderator. Five hundred and fifteen Kazakh students completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28, Toronto Alexithymia Scale-20, Berkeley Expressivity Questionnaire and Interpersonal Sensitivity Measure. The results showed that 28% met the criteria for full-PTSD. Controlling for academic year, age and university major, PTSD from past trauma was significantly correlated with interpersonal sensitivity and psychiatric co-morbidity. Alexithymia mediated the impact of PTSD on interpersonal sensitivity and psychiatric co-morbidity. Alexithymia, however, did not interact with type of emotional expressivity to influence outcomes. Moderated mediational effects were not found. To conclude, following trauma, Kazakh students can experience heightened levels of interpersonal sensitivity and psychological symptoms. These problems are particularly severe for those who have difficulty getting in touch with their emotions.
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Affiliation(s)
| | - Man Cheung Chung
- Department of Educational Psychology, Faculty of Education, The Chinese University of Hong Kong, Ho Tim Building, Shatin, NT, Hong Kong.
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20
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Gagnon C, Bégin C, Laflamme V, Grondin S. Temporal Processing of Joyful and Disgusting Food Pictures by Women With an Eating Disorder. Front Hum Neurosci 2018; 12:129. [PMID: 29681806 PMCID: PMC5897655 DOI: 10.3389/fnhum.2018.00129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/19/2018] [Indexed: 01/22/2023] Open
Abstract
The present study used the presentation of food pictures and judgements about their duration to assess the emotions elicited by food in women suffering from an eating disorder (ED). Twenty-three women diagnosed with an ED, namely anorexia (AN) or bulimia nervosa (BN), and 23 healthy controls (HC) completed a temporal bisection task and a duration discrimination task. Intervals were marked with emotionally pre-rated pictures of joyful and disgusting food, and pictures of neutral objects. The results showed that, in the bisection task, AN women overestimated the duration of food pictures in comparison to neutral ones. Also, compared to participants with BN, they perceived the duration of joyful food pictures as longer, and tended to overestimate the duration of the disgusting ones. These effects on perceived duration suggest that AN women experienced an intense reaction of fear when they were confronted to food pictures. More precisely, by having elevated the arousal level and activated the defensive system, food pictures seemed to have speeded up the rhythm of the AN participants’ internal clock, which led to an overestimation of images’ duration. In addition, the results revealed that, in both tasks, ED women presented a lower temporal sensitivity than HC, which was related to their ED symptomatology (i.e., BMI, restraint and concern) and, particularly, to their weaker cognitive abilities in terms of attention, processing speed and working memory. Considered all together, the findings of the present experiment highlight the role of fear and anxiety in the manifestations of AN and point out the importance of considering non-temporal factors in the interpretation of time perception performance.
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Affiliation(s)
| | | | | | - Simon Grondin
- École de Psychologie, Université Laval, Québec, QC, Canada
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21
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Christensen BJ, Schmidt JB, Nielsen MS, Tækker L, Holm L, Lunn S, Bredie WLP, Ritz C, Holst JJ, Hansen T, Hilbert A, le Roux CW, Hulme OJ, Siebner H, Morville T, Naver L, Floyd AK, Sjödin A. Patient profiling for success after weight loss surgery (GO Bypass study): An interdisciplinary study protocol. Contemp Clin Trials Commun 2018; 10:121-130. [PMID: 30023446 PMCID: PMC6046467 DOI: 10.1016/j.conctc.2018.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022] Open
Abstract
Despite substantial research efforts, the mechanisms proposed to explain weight loss after gastric bypass (RYGB) and sleeve gastrectomy (SL) do not explain the large individual variation seen after these treatments. A complex set of factors are involved in the onset and development of obesity and these may also be relevant for the understanding of why success with treatments vary considerably between individuals. This calls for explanatory models that take into account not only biological determinants but also behavioral, affective and contextual factors. In this prospective study, we recruited 47 women and 8 men, aged 25–56 years old, with a BMI of 45.8 ± 7.1 kg/m2 from the waiting list for RYGB and SL at Køge hospital, Denmark. Pre-surgery and 1.5, 6 and 18 months after surgery we assessed various endpoints spanning multiple domains. Endpoints were selected on basis of previous studies and include: physiological measures: anthropometrics, vital signs, biochemical measures and appetite hormones, genetics, gut microbiota, appetite sensation, food and taste preferences, neural sensitivity, sensory perception and movement behaviors; psychological measures: general psychiatric symptom-load, depression, eating disorders, ADHD, personality disorder, impulsivity, emotion regulation, attachment pattern, general self-efficacy, alexithymia, internalization of weight bias, addiction, quality of life and trauma; and sociological and anthropological measures: sociodemographic measures, eating behavior, weight control practices and psycho-social factors. Joining these many endpoints and methodologies from different scientific disciplines and creating a multi-dimensional predictive model has not previously been attempted. Data on the primary endpoint are expected to be published in 2018. Trial registration Clinicaltrials. gov ID NCT02070081.
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Affiliation(s)
- Bodil Just Christensen
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Denmark
| | - Julie Berg Schmidt
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Mette Søndergaard Nielsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark.,The Danish Diabetes Academy, Denmark
| | - Louise Tækker
- Department of Psychology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Lotte Holm
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Denmark
| | - Susanne Lunn
- Department of Psychology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Wender L P Bredie
- Department of Food Science, Faculty of Science, University of Copenhagen, Denmark
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Jens Juul Holst
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Denmark
| | - Torben Hansen
- NNF Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anja Hilbert
- Universitätsmedizin Leipzig, Integrated Research and Treatment Center Adiposity Diseases, Department of Medical Psychology and Medical Sociology, Germany
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - Oliver J Hulme
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Hartwig Siebner
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Tobias Morville
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Denmark
| | - Lars Naver
- Bariatric Clinic, Køge Hospital, Denmark
| | | | - Anders Sjödin
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
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22
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Klabunde M, Collado D, Bohon C. An interoceptive model of bulimia nervosa: A neurobiological systematic review. J Psychiatr Res 2017; 94:36-46. [PMID: 28651098 PMCID: PMC6026544 DOI: 10.1016/j.jpsychires.2017.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/18/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022]
Abstract
The objective of our study was to examine the neurobiological support for an interoceptive sensory processing model of bulimia nervosa (BN). To do so, we conducted a systematic review of interoceptive sensory processing in BN, using the PRISMA guidelines. We searched PsychInfo, Pubmed, and Web of Knowledge databases to identify biological and behavioral studies that examine interoceptive detection in BN. After screening 390 articles for inclusion and conducting a quality assessment of articles that met inclusion criteria, we reviewed 41 articles. We found that global interoceptive sensory processing deficits may be present in BN. Specifically there is evidence of abnormal brain function, structure and connectivity in the interoceptive neural network, in addition to gastric and pain processing disturbances. These results suggest that there may be a neurobiological basis for global interoceptive sensory processing deficits in BN that remain after recovery. Data from taste and heart beat detection studies were inconclusive; some studies suggest interoceptive disturbances in these sensory domains. Discrepancies in findings appear to be due to methodological differences. In conclusion, interoceptive sensory processing deficits may directly contribute to and explain a variety of symptoms present in those with BN. Further examination of interoceptive sensory processing deficits could inform the development of treatments for those with BN.
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Affiliation(s)
- Megan Klabunde
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States.
| | - Danielle Collado
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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23
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Westwood H, Kerr-Gaffney J, Stahl D, Tchanturia K. Alexithymia in eating disorders: Systematic review and meta-analyses of studies using the Toronto Alexithymia Scale. J Psychosom Res 2017; 99:66-81. [PMID: 28712432 PMCID: PMC5986724 DOI: 10.1016/j.jpsychores.2017.06.007] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this review was to synthesise the literature on the use of the Toronto Alexithymia Scale (TAS) in eating disorder populations and Healthy Controls (HCs) and to compare TAS scores in these groups. METHOD Electronic databases were searched systematically for studies using the TAS and meta-analyses were performed to statistically compare scores on the TAS between individuals with eating disorders and HCs. RESULTS Forty-eight studies using the TAS with both a clinical eating disorder group and HCs were identified. Of these, 44 were included in the meta-analyses, separated into: Anorexia Nervosa; Anorexia Nervosa, Restricting subtype; Anorexia Nervosa, Binge-Purge subtype, Bulimia Nervosa and Binge Eating Disorder. For all groups, there were significant differences with medium or large effect sizes between the clinical group and HCs, with the clinical group scoring significantly higher on the TAS, indicating greater difficulty with identifying and labelling emotions. CONCLUSION Across the spectrum of eating disorders, individuals report having difficulties recognising or describing their emotions. Given the self-report design of the TAS, research to develop and evaluate treatments and clinician-administered assessments of alexithymia is warranted.
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Affiliation(s)
- Heather Westwood
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Jess Kerr-Gaffney
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK.
| | - Daniel Stahl
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Biostatistics, London, UK.
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK; South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, UK; Ilia State University, Tbilisi, Georgia.
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24
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Ambrosecchia M, Ardizzi M, Russo E, Ditaranto F, Speciale M, Vinai P, Todisco P, Maestro S, Gallese V. Interoception and Autonomic Correlates during Social Interactions. Implications for Anorexia. Front Hum Neurosci 2017; 11:219. [PMID: 28567008 PMCID: PMC5434670 DOI: 10.3389/fnhum.2017.00219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/18/2017] [Indexed: 01/01/2023] Open
Abstract
The aim of this study is to investigate the bodily-self in Restrictive Anorexia, focusing on two basic aspects related to the bodily self: autonomic strategies in social behavior, in which others' social desirability features, and social cues (e.g., gaze) are modulated, and interoception (i.e., the sensitivity to stimuli originating inside the body). Furthermore, since previous studies carried out on healthy individuals found that interoception seems to contribute to the autonomic regulation of social behavior, as measured by Respiratory Sinus Arrhythmia (RSA), we aimed to explore this link in anorexia patients, whose ability to perceive their bodily signal seems to be impaired. To this purpose, we compared a group of anorexia patients (ANg; restrictive type) with a group of Healthy Controls (HCg) for RSA responses during both a resting state and a social proxemics task, for their explicit judgments of comfort in social distances during a behavioral proxemics task, and for their Interoceptive Accuracy (IA). The results showed that ANg displayed significantly lower social disposition and a flattened autonomic reactivity during the proxemics task, irrespective of the presence of others' socially desirable features or social cues. Moreover, unlike HCg, the autonomic arousal of ANg did not guide behavioral judgments of social distances. Finally, IA was strictly related to social disposition in both groups, but with opposite trends in ANg. We conclude that autonomic imbalance and its altered relationship with interoception might have a crucial role in anorexia disturbances.
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Affiliation(s)
- Marianna Ambrosecchia
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Martina Ardizzi
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Elisa Russo
- Casa di Cura, Villa MargheritaVicenza, Italy
| | - Francesca Ditaranto
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | | | | | | | - Sandra Maestro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
- Institute of Philosophy, School of Advanced Study, University of LondonLondon, UK
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Abstract
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
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Affiliation(s)
- Lindsay Moskowitz
- Department of Psychiatry, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
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Eating Disorders in Adolescents With Chronic Pain. J Pediatr Health Care 2017; 31:67-74. [PMID: 27021242 DOI: 10.1016/j.pedhc.2016.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Given that youth with chronic pain frequently experience disruptions in eating patterns that may place them at risk for disordered eating, the purpose of this study was to examine the clinical characteristics and illness course of adolescents with chronic pain and comorbid eating disorders. METHODS Using a retrospective chart review, 34 adolescents with chronic pain and concurrent eating disorders were identified. These adolescents were compared with 34 age-, gender-, and eating disorder symptom-matched adolescents who had an eating disorder without chronic pain. RESULTS The majority of adolescents with chronic pain and an eating disorder had a primary medical diagnosis of abdominal pain (n = 14), followed by autonomic dysfunction (n = 10) and headache (n = 6). Although in 41.2% of teens with chronic pain, eating disorder symptoms developed after the onset of their pain, 35.3% reported having eating disorder symptoms before they experienced chronic pain. Body mass index did not differ between the groups, but the duration of eating disorder symptoms was significantly longer for the chronic pain group (p < .001). DISCUSSION Despite comparable severity, eating disorders are undetected for longer periods in patients with chronic pain, which may contribute to a poorer prognosis. Implications for eating disorder conceptualization, detection, and treatment are discussed.
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Luca C, Silvia C, Giulia B, Renata T. Do parental traumatic experiences have a role in the psychological functioning of early adolescents with binge eating disorder? Eat Weight Disord 2016; 21:635-644. [PMID: 27438789 DOI: 10.1007/s40519-016-0303-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/11/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Few studies have addressed the psychological characteristics of adolescents with binge eating disorder (BED). No research has focused on the psychological functioning of these adolescents' parents or on the prevalence of traumatic experiences among them. METHODS In this study, 202 adolescents aged 11-13 and their parents were recruited from mental health clinics to complete the youth self-report (YSR), the response evaluation measure for youth (REM-71), the Toronto Alexithymia Scale (TAS-20), the Symptom Check-List (SCL-90-R), and the traumatic experience checklist (TEC). RESULTS Female adolescents scored higher than males on withdrawal, internalizing problems, dissociation, and somatization subscales. Boys scored higher than girls on externalizing problems and acting out subscales. Maternal depression predicted withdrawal and dissociation in female adolescents. Maternal sexual abuse predicted social problems in males and self-destructive behaviors in females. Paternal physical abuse predicted delinquent behavior and acting out in males. CONCLUSIONS Our data suggest that parental traumatic experiences play a role in their offspring's mental health; the data also showed different psychopathological configurations in male and female adolescents with BED and their parents, suggesting the development of prevention and treatment polices specific to gender.
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Affiliation(s)
- Cerniglia Luca
- Uninettuno International Telematic University, Corso Vittorio Emanuele II, 39, Rome, Italy.
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Krause ED, Robins CJ, Lynch TR. A Mediational Model Relating Sociotropy, Ambivalence Over Emotional Expression, and Disordered Eating. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/j.1471-6402.2000.tb00215.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Two factors that have been found to predict eating disorders are sociotropy or dependent personality style and ambivalence over emotional expression, but there has been little consideration of the relationship between them and how this relationship may contribute to an understanding of eating disorders. A mediational model is proposed in which high sociotropy leads to greater ambivalence over expressing emotions, which in turn increases vulnerability to eating disorders. Consistent with predictions, among 115 college women, a high level of sociotropy was associated with a high level of ambivalence over emotional expression, which in turn was associated with increased disordered eating. Furthermore, ambivalence over emotional expression significantly mediated the effect of sociotropy on disordered eating, even when controlling for depression level. Findings are considered within a developmental framework, and treatment implications are discussed.
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Amianto F, Bertorello A, Migliore F, Abbate-Daga G, Fassino S. Alexithymia in anorexia and bulimia: Ubiquitous and primary trait? COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1185994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- F. Amianto
- Neuroscience Department, Psychiatry Section, University of Turin, Psychiatric Clinic, V. Cherasco 11, 10126 Turin, Italy
| | - A. Bertorello
- Neuroscience Department, Psychiatry Section, University of Turin, Psychiatric Clinic, V. Cherasco 11, 10126 Turin, Italy
| | - F. Migliore
- Neuroscience Department, Psychiatry Section, University of Turin, Psychiatric Clinic, V. Cherasco 11, 10126 Turin, Italy
| | - G. Abbate-Daga
- Neuroscience Department, Psychiatry Section, University of Turin, Psychiatric Clinic, V. Cherasco 11, 10126 Turin, Italy
| | - S. Fassino
- Neuroscience Department, Psychiatry Section, University of Turin, Psychiatric Clinic, V. Cherasco 11, 10126 Turin, Italy
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Khalsa SS, Lapidus RC. Can Interoception Improve the Pragmatic Search for Biomarkers in Psychiatry? Front Psychiatry 2016; 7:121. [PMID: 27504098 PMCID: PMC4958623 DOI: 10.3389/fpsyt.2016.00121] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/21/2016] [Indexed: 01/04/2023] Open
Abstract
Disrupted interoception is a prominent feature of the diagnostic classification of several psychiatric disorders. However, progress in understanding the interoceptive basis of these disorders has been incremental, and the application of interoception in clinical treatment is currently limited to panic disorder. To examine the degree to which the scientific community has recognized interoception as a construct of interest, we identified and individually screened all articles published in the English language on interoception and associated root terms in Pubmed, Psychinfo, and ISI Web of Knowledge. This search revealed that interoception is a multifaceted process that is being increasingly studied within the fields of psychiatry, psychology, neuroscience, and biomedical science. To illustrate the multifaceted nature of interoception, we provide a focused review of one of the most commonly studied interoceptive channels, the cardiovascular system, and give a detailed comparison of the most popular methods used to study cardiac interoception. We subsequently review evidence of interoceptive dysfunction in panic disorder, depression, somatic symptom disorders, anorexia nervosa, and bulimia nervosa. For each disorder, we suggest how interoceptive predictions constructed by the brain may erroneously bias individuals to express key symptoms and behaviors, and outline questions that are suitable for the development of neuroscience-based mental health interventions. We conclude that interoception represents a viable avenue for clinical and translational research in psychiatry, with a well-established conceptual framework, a neural basis, measurable biomarkers, interdisciplinary appeal, and transdiagnostic targets for understanding and improving mental health outcomes.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, USA
| | - Rachel C Lapidus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, USA; Department of Psychology, University of Tulsa, Tulsa, OK, USA
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Fox JR, Dean M, Whittlesea A. The Experience of Caring For or Living with an Individual with an Eating Disorder: A Meta-Synthesis of Qualitative Studies. Clin Psychol Psychother 2015; 24:103-125. [PMID: 26472481 DOI: 10.1002/cpp.1984] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/11/2022]
Abstract
Eating disorders (ED) has the highest mortality rate of psychiatric disorders and a high incidence of comorbidity. Because of the average age of onset, care typically befalls family members. However, despite the severity of the disorder and the burden placed on the family, research into the caregiving experience is still developing. Studies have shown caregivers of individuals with ED to experience high levels of distress, burden and expressed emotion. Recent theoretical models have underscored the importance of caregivers' responses as a maintenance factor for the ED, and family therapy has proved efficacious. However, the literature pertaining to the experience of family members living with or caring for an individual with an ED has not been systematically reviewed. This review aimed to synthesize qualitative studies relating to the caring experience and its impact, thereby gaining an understanding from the perspective of the individuals themselves. Relevant search terms were utilized to systematically search key databases. Twenty studies, with a total sample of 239 participants, met the inclusion criteria. Nine core themes emerged from the synthesis, forming the basis of an explanatory theory. The ED was found to have a pervasive impact upon family members, mediated by a number of factors. Cognitive appraisals affected the caregiving experience and responses to the individual. The experience of caregiving was continually reappraised leading to a process of adaptation. The majority of studies identified unmet carer needs. The implications of the findings are discussed with reference to existing theoretical models and in terms of clinical practice. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGES Carers experience a significant amount of guilt and distress once they have found out about their loved one's eating disorder. Across the studies, there were many themes of unmet need for carers. Siblings have often been overlooked by both clinicians and researchers. Interventions for people with eating disorders should also acknowledge carers and close family members.
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Affiliation(s)
- John Re Fox
- Department of Psychology, Royal Holloway, University of London, Surrey, UK.,Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK
| | - Madeleine Dean
- Enfield Complex Care Team, Barnet, Enfield and Haringey NHS Trust, London, UK
| | - Anna Whittlesea
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Pace CS, Cavanna D, Guiducci V, Bizzi F. When parenting fails: alexithymia and attachment states of mind in mothers of female patients with eating disorders. Front Psychol 2015; 6:1145. [PMID: 26321978 PMCID: PMC4532914 DOI: 10.3389/fpsyg.2015.01145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/23/2015] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION In recent years alexithymia and attachment theory have been recognized as two parallel research lines trying to improve the information on the development and maintenance of eating disorders (EDs). However, no research has analyzed these constructs among patients' families. In this study we compared alexithymia and attachment in mothers of patients with EDs and a control group. Further, we hypothesized that mothers of daughters with EDs with insecure and unresolved states of mind will reported high levels of alexithymia. Lastly, we explored the daughters' evaluations of maternal alexithymia. METHODS 45 mothers of ED women and 48 mothers of healthy controls (N = 93) matched for age and socio-demographic variables were administered by the Toronto Alexithymia Scale-20 (TAS-20) (S), while two sub-groups of "ED" mothers (n = 20) and "non-ED" ones (n = 22) were assessed by the Adult Attachment Interview (AAI). Moreover, the Observer Alexithymia Scale (OAS) was administered to the daughters for evaluating maternal alexithymia. RESULTS Regarding alexithymia, no differences were found between ED and non-ED mothers according to the TAS-20, while ED mothers showed more unresolved AAI classifications than non-ED mothers. No correlations were found between the TAS-20 and the AAI. Lastly, ED mothers were evaluated more alexithymic by their daughters with the OAS than those in the control group, and their alexithymic traits were significantly correlated with dismissing states of mind (idealization and lack of memory) in the AAIs. DISCUSSION Our results highlighted an interesting discrepancy among mothers with ED daughters between the low level of alexithymia provided by their self-reports and the high level of alexithymia observed by their daughters, although the OAS showed severe methodological limitations. Maternal attachment states of mind characterized by the lack of resolution of past losses could be connected to a confusing and incoherent quality of parenting.
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Affiliation(s)
| | - Donatella Cavanna
- Department of Educational Science, University of Genoa , Genoa, Italy
| | | | - Fabiola Bizzi
- Department of Educational Science, University of Genoa , Genoa, Italy
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Lavender JM, Wonderlich SA, Engel SG, Gordon KH, Kaye WH, Mitchell JE. Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clin Psychol Rev 2015; 40:111-22. [PMID: 26112760 DOI: 10.1016/j.cpr.2015.05.010] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/10/2015] [Accepted: 05/31/2015] [Indexed: 12/14/2022]
Abstract
Several existing conceptual models and psychological interventions address or emphasize the role of emotion dysregulation in eating disorders. The current article uses Gratz and Roemer's (2004) multidimensional model of emotion regulation and dysregulation as a clinically relevant framework to review the extant literature on emotion dysregulation in anorexia nervosa (AN) and bulimia nervosa (BN). Specifically, the dimensions reviewed include: (1) the flexible use of adaptive and situationally appropriate strategies to modulate the duration and/or intensity of emotional responses, (2) the ability to successfully inhibit impulsive behavior and maintain goal-directed behavior in the context of emotional distress, (3) awareness, clarity, and acceptance of emotional states, and (4) the willingness to experience emotional distress in the pursuit of meaningful activities. The current review suggests that both AN and BN are characterized by broad emotion regulation deficits, with difficulties in emotion regulation across the four dimensions found to characterize both AN and BN, although a small number of more specific difficulties may distinguish the two disorders. The review concludes with a discussion of the clinical implications of the findings, as well as a summary of limitations of the existing empirical literature and suggestions for future research.
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Affiliation(s)
- Jason M Lavender
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn H Gordon
- North Dakota State University, Department of Psychology, Fargo, ND, USA
| | - Walter H Kaye
- University of California, San Diego School of Medicine, San Diego, CA, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA; University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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O’Hara CB, Campbell IC, Schmidt U. A reward-centred model of anorexia nervosa: A focussed narrative review of the neurological and psychophysiological literature. Neurosci Biobehav Rev 2015; 52:131-52. [DOI: 10.1016/j.neubiorev.2015.02.012] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 12/13/2022]
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Vinai P, Provini F, Antelmi E, Marcatelli M, Cardetti S, Vinai L, Vinai P, Bruno C, Speciale M, Allison KC. Alexithymia is not related to severity of night eating behavior: a useful distinction from other eating disorders. Eat Behav 2015; 17:94-8. [PMID: 25679368 DOI: 10.1016/j.eatbeh.2015.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 12/08/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Patients affected by Night Eating Syndrome (NES) complain of insomnia, mood, anxiety and overeating, which have all been linked to difficulties in dealing with emotions, but no research has examined the levels of alexithymia among NES patients. We compared the levels of alexithymia among samples of: NES patients, insomniac patients who do not eat at night, and a control group. METHOD The study included 153 participants: 34 with NES, 47 with insomnia, and 72 in the control group. Half of the NES group was recruited in a weight and eating disorders center in Philadelphia and the other in a sleep disorders center in Bologna, Italy. Alexithymia was evaluated through the Toronto Alexithymia Scale (TAS). RESULTS All groups scored in the normal range of the TAS. There was no relationship between alexithymia and the severity of NES. The insomnia participants reported the highest levels of alexithymia and NES patients the lowest. All NES patients' scores were under the clinical cut-off for alexithymia. DISCUSSION These data differ from the high levels of alexithymia reported by the literature among patients affected by Binge Eating Disorder (BED), suggesting that abnormal diurnal and nocturnal eating patterns, even though they may share several symptoms, are distinct syndromes having different psychopathological pathways.
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Affiliation(s)
- Piergiuseppe Vinai
- "Studi Cognitivi" Post-graduate Cognitive Psychotherapy School Research Group, Foro Buonaparte, 57, 20121 Milano, Italy; "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy.
| | - Federica Provini
- IRCSS, Institute of Neurological Sciences and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elena Antelmi
- IRCSS, Institute of Neurological Sciences and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Marcatelli
- IRCSS, Institute of Neurological Sciences and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Silvia Cardetti
- "Studi Cognitivi" Post-graduate Cognitive Psychotherapy School Research Group, Foro Buonaparte, 57, 20121 Milano, Italy; "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy
| | - Luisa Vinai
- "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy
| | - Paolo Vinai
- "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy
| | - Cecilia Bruno
- "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy
| | - Maurizio Speciale
- "Studi Cognitivi" Post-graduate Cognitive Psychotherapy School Research Group, Foro Buonaparte, 57, 20121 Milano, Italy; "GNOSIS" Research and Psychotherapy Group V, Cottolengo 19, Mondovì, Italy
| | - Kelly C Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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The Clinical Implications and Neurophysiological Background of Useing Self-Mirroring Technique to Enhance the Identification of Emotional Experiences: An Example with Rational Emotive Behavior Therapy. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2015. [DOI: 10.1007/s10942-015-0205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Courty A, Godart N, Lalanne C, Berthoz S. Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Compr Psychiatry 2015; 56:217-28. [PMID: 25443977 DOI: 10.1016/j.comppsych.2014.09.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022] Open
Abstract
Socio-affective difficulties, in particular difficulties in representing, communicating and feeling emotions, may play a critical role in anorexia nervosa (AN). The aim of this longitudinal study was to explore the links between alexithymia and two types of difficulties in AN: eating symptoms and social avoidance. Sixty adolescent girls with AN were recruited following hospitalisation in a specialised department. They completed self-administered questionnaires of alexithymia (TAS-20), of central symptoms of the eating disorders (EDI), and of anxious and depressive affects (SCL-90). Anxiety and social avoidance were assessed in the course of a standardised interview (LSAS). These measures were performed at inclusion, and at 6-, 12- and 18-months' follow-up. The relationship between TAS-20 and EDI or LSAS total scale scores across the four time points was assessed using mixed-effects models, including anxiety, depression, BMI, anorexia subtype, and age as co-factors. Partial least square regression was used to refine this multivariate analysis at subscale level, at inclusion and 18 months. Robust associations between TAS-20 and EDI scores were found, independently from anxious and depressive scores, nutritional state and AN subtype. These effects appeared more particularly linked to the implication of the dimensions difficulties identifying and describing feelings, interpersonal mistrust, feelings of inadequacy and interoceptive awareness deficit. There was also a durable association between alexithymia and social anxiety and avoidance, after adjusting for the confounding effects of depression, and anxiety, and the state of starvation. Difficulties in describing feelings appeared particularly involved here. Thus alexithymia does appear as a factor in the persistence of disorders in AN, and difficulties identifying and describing feelings could compound the social difficulties and major the relational isolation of these patients.
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Affiliation(s)
- Annaig Courty
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, France; Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France; Inserm U669 - Maison de Solenn, Paris Descartes and Paris Sud Universities, France
| | - Nathalie Godart
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France; Inserm U669 - Maison de Solenn, Paris Descartes and Paris Sud Universities, France
| | - Christophe Lalanne
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France; AP-HP, Department of Clinical Research, Saint-Louis Hospital, Paris, France
| | - Sylvie Berthoz
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France; Inserm U669 - Maison de Solenn, Paris Descartes and Paris Sud Universities, France.
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Pinna F, Sanna L, Carpiniello B. Alexithymia in eating disorders: therapeutic implications. Psychol Res Behav Manag 2014; 8:1-15. [PMID: 25565909 PMCID: PMC4278740 DOI: 10.2147/prbm.s52656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A high percentage of individuals affected by eating disorders (ED) achieve incomplete recovery following treatment. In an attempt to improve treatment outcome, it is crucial that predictors of outcome are identified, and personalized care approaches established in line with new treatment targets, thus facilitating patient access to evidence-based treatments. Among the psychological factors proposed as predictors of outcome in ED, alexithymia is of outstanding interest. The objective of this paper is to undertake a systematic review of the literature relating to alexithymia, specifically in terms of the implications for treatment of ED. In particular, issues concerning the role of alexithymia as a predictor of outcome and as a factor to be taken into account in the choice of treatment will be addressed. The effect of treatments on alexithymia will also be considered. A search of all relevant literature published in English using PubMed, PsycINFO, and Scopus databases was carried out on the basis of the following keywords: alexithymia, anorexia nervosa, bulimia nervosa, eating disorders, and treatment; no time limits were imposed. Despite the clinical relevance of alexithymia, the number of studies published on the above cited aspects is somewhat limited, and these studies are largely heterogeneous and feature significant methodological weaknesses. Overall, data currently available mostly correlate higher levels of alexithymia with a less favorable outcome in ED. Accordingly, alexithymia is seen as a relevant treatment target with the aim of achieving recovery of these patients. Treatments focusing on improving alexithymic traits, and specifically those targeting emotions, seem to show greater efficacy, although alexithymia levels often remain high even after specific treatment. Further investigations are needed to overcome the methodological limitations of previous studies, to understand the actual impact of alexithymia on ED outcome, and to allow more precise implications for treatment to be drawn. Additional research should also be undertaken to specify which of the alexithymic dimensions are specifically relevant to the course and outcome of ED, and to identify treatment protocols producing a significantly greater efficacy in ED patients with relevant alexithymic traits.
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Affiliation(s)
- Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Lucia Sanna
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine - Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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Psychological flexibility is not a single dimension: The distinctive flexibility profiles of underweight, overweight, and obese people. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2014. [DOI: 10.1016/j.jcbs.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Guillén V, Santos B, Muñoz P, Fernández de Corres B, Fernández E, Pérez I, González-Pinto AM, Yllá L, González-Pinto A. Toronto alexithymia scale for patients with eating disorder: [corrected] performance using the non-parametric item response theory. Compr Psychiatry 2014; 55:1285-91. [PMID: 24791683 DOI: 10.1016/j.comppsych.2014.03.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patient's condition. SUBJECTS AND METHODS We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale. RESULTS We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.
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Affiliation(s)
- Virginia Guillén
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Bizkaia Mental Health Network (RSMB), Basque Health Service-Osakidetza, Spain
| | - Borja Santos
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain
| | - Pedro Muñoz
- Bizkaia Mental Health Network (RSMB), Basque Health Service-Osakidetza, Spain
| | - Blanca Fernández de Corres
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain
| | - Esther Fernández
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain
| | - Isabel Pérez
- Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain
| | - Ana Ma González-Pinto
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Psychiatry Service, Santiago Apóstol Hospital, Basque Health Service-Osakidetza, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain.
| | - Luis Yllá
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain
| | - Asunción González-Pinto
- Department of Neurosciences, Psychiatry, Medical School, University of the Basque Country UPV/EHU, Spain; Biomedical Research Centre in Mental Health (CIBERSAM), Group G10, Spain
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Eshkevari E, Rieger E, Musiat P, Treasure J. An Investigation of Interoceptive Sensitivity in Eating Disorders Using a Heartbeat Detection Task and a Self-report Measure. EUROPEAN EATING DISORDERS REVIEW 2014; 22:383-8. [DOI: 10.1002/erv.2305] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/02/2014] [Accepted: 06/04/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Ertimiss Eshkevari
- Department of Psychology; Royal Holloway University of London; Egham UK
- Section of Eating Disorders, Institute of Psychiatry; King's College London; London UK
| | - Elizabeth Rieger
- Research School of Psychology; The Australian National University; Canberra Australia
| | - Peter Musiat
- Section of Eating Disorders, Institute of Psychiatry; King's College London; London UK
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry; King's College London; London UK
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Posttraumatic stress symptoms and well-being following relationship dissolution: past trauma, alexithymia, suppression. Psychiatr Q 2014; 85:155-76. [PMID: 24272131 DOI: 10.1007/s11126-013-9280-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To investigate whether posttraumatic stress disorder (PTSD) from past trauma, alexithymia and suppression would impact on the experience of Posttraumatic Stress symptoms (PTSS) and psychological well-being following romantic relationship dissolution. One hundred and eighty-nine participants completed questionnaires measuring PTSD, alexithymia, suppression, PTSS and psychological well-being. The results showed that following relationship dissolution, higher levels of intrusion and avoidance (PTSS) and lower levels of psychological well-being were associated with PTSD from past trauma. Difficulty describing feelings was associated negatively with intrusion; difficulty identifying feelings was associated positively with psychological well-being. Suppression was associated negatively with avoidance. To conclude, PTSD from past traumas was related to PTSS symptoms and poor psychological well-being. Alexithymia and suppression were also related to the above outcomes but in a symptom-specific manner.
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Caglar-Nazali HP, Corfield F, Cardi V, Ambwani S, Leppanen J, Olabintan O, Deriziotis S, Hadjimichalis A, Scognamiglio P, Eshkevari E, Micali N, Treasure J. A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42:55-92. [PMID: 24333650 DOI: 10.1016/j.neubiorev.2013.12.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/08/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
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Abstract
Alexithymia, a deficit characterized by difficulties identifying, differentiating, and articulating emotions, is associated with significant physical and mental health impairment. It is generally accepted that alexithymia has a negative impact on a variety of physical and mental health treatments. Less clear is the extent to which alexithymia itself can be modified. In this article we review studies that have examined the effects of psychological interventions on alexithymia. Taken together, findings from investigations included in this review suggest that alexithymia is partly modifiable with therapeutic interventions. Studies that directly targeted alexithymic symptoms tended to report significant reductions in alexithymia scores following treatment, whereas studies that measured changes in alexithymia but did not employ any psychological interventions specifically intended to treat alexithymia had more inconsistent results. We close by considering the practical implications of the findings, and by offering suggestions for future research.
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Brockmeyer T, Skunde M, Wu M, Bresslein E, Rudofsky G, Herzog W, Friederich HC. Difficulties in emotion regulation across the spectrum of eating disorders. Compr Psychiatry 2014; 55:565-71. [PMID: 24411653 DOI: 10.1016/j.comppsych.2013.12.001] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 11/14/2013] [Accepted: 12/01/2013] [Indexed: 10/25/2022] Open
Abstract
Theoretical models consider difficulties in emotion regulation (ER) as central trans-diagnostic phenomena across the spectrum of eating disorders (ED). However, there is a lack of studies directly comparing ED subtypes regarding ER problems. Furthermore, patients with anorexia nervosa-restricting type (AN-R) and patients with AN-binge/purge type (AN-BP) have usually been merged into one overall AN group in previous research on ER. In order to overcome these limitations of previous studies, the present study investigated specific ER difficulties in 120 patients with different ED subtypes, including AN-R, AN-BP, bulimia nervosa (BN), and binge-eating disorder (BED). As compared to 60 healthy normal-weight controls (NWC) and 29 healthy over-weight controls (OWC), all ED subtypes reported greater difficulties in ER. ED subtypes did not differ regarding most domains of ER except BED showing less severe ER difficulties in some domains. In addition, AN-BP but not BN reported greater impulse control difficulties than AN-R and BED. The findings underscore the relevance of ER difficulties in ED and support the trans-diagnostic view of ER difficulties being present across the whole spectrum of ED. In addition, the present results suggest that certain domains of ER may be linked more closely to certain ED subtypes than to others.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Mandy Skunde
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Mudan Wu
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Esther Bresslein
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Gottfried Rudofsky
- Division of Endocrinology and Metabolism, Department of Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Sagardoy RC, Solórzano G, Morales C, Soledad Kassem M, Codesal R, Blanco A, Morales LTG. Procesamiento emocional en pacientes TCA adultas vs. adolescentes. Reconocimiento y regulación emocional. CLÍNICA Y SALUD 2014. [DOI: 10.1016/s1130-5274(14)70024-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vann A, Strodl E, Anderson E. Thinking about internal states, a qualitative investigation into metacognitions in women with eating disorders. J Eat Disord 2013; 1:22. [PMID: 24999403 PMCID: PMC4081666 DOI: 10.1186/2050-2974-1-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a need for qualitative research to help develop case conceptualisations to guide the development of Metacognitive Therapy interventions for Eating Disorders. METHOD A qualitative study informed by grounded theory methodology was conducted involving open-ended interviews with 27 women aged 18-55 years, who were seeking or receiving treatment for a diagnosed ED. RESULTS The categories identified in this study appeared to be consistent with a metacognitive model including constructs of a Cognitive Attentional Syndrome and metacognitive beliefs. These categories appear to be transdiagnostic, and the interaction between the categories is proposed to explain the maintenance of EDs. CONCLUSIONS The transdiagnostic model proposed may be useful to guide the development of future metacognitive therapy interventions for EDs with the hope that this will lead to improved outcomes for individuals with EDs.
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Affiliation(s)
- Alix Vann
- Queensland University of Technology School of Psychology & Counselling, Level 5, O Block, B Wing, QUT Kelvin Grove Campus, Victoria Park Road, Kelvin Grove Queensland 4059, Brisbane, Australia
| | - Esben Strodl
- Queensland University of Technology School of Psychology & Counselling, Level 5, O Block, B Wing, QUT Kelvin Grove Campus, Victoria Park Road, Kelvin Grove Queensland 4059, Brisbane, Australia
| | - Erin Anderson
- Eating Disorders Outreach Service, 14 Cartwright Street, Herston Queensland 4029, Brisbane, Australia
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Ohmann S, Popow C, Wurzer M, Karwautz A, Sackl-Pammer P, Schuch B. Emotional aspects of anorexia nervosa: results of prospective naturalistic cognitive behavioral group therapy. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2013; 27:119-128. [PMID: 23775391 DOI: 10.1007/s40211-013-0065-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 04/20/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Anorexic girls have difficulties in handling their emotions. We examined emotional problems of adolescent girls with anorexia nervosa (AN) during the course of cognitive behavioral group therapy (G-CBT). METHODS Overall, 29 girls with AN (age 13-17 years) participated in four groups of manual based G-CBT. We assessed the body mass index (BMI), eating behavior psychopathology, emotions, depression, hedonistic activities, self-care and-efficacy, social phobia, sense of coherence (SOC), and alexithymia before, during and up to 1 year after therapy. RESULTS Out of 29, 16 (55 %, intent to treat, or 76 %, per protocol) girls were successfully treated, 5 (17 or 24 %) had a "poor outcome", and 8 (28 %) dropped out. BMI, eating behavior, mood, social anxiety, self-care, and self-efficacy persistently improved. Anorexic girls had multiple emotional deficits, low self-confidence, and exaggerated needs of control and of being accepted. Emotional deficits were resistant to change. Hedonistic activities, social skills, and recovery from depression were positive, comorbid disorders and parental psychopathology negative prognostic factors.
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Affiliation(s)
- Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Gradaschi R, Noli G, Cornicelli M, Camerini G, Scopinaro N, Adami GF. Do clinical and behavioural correlates of obese patients seeking bariatric surgery differ from those of individuals involved in conservative weight loss programme? J Hum Nutr Diet 2013; 26 Suppl 1:34-8. [PMID: 23650988 DOI: 10.1111/jhn.12080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical practice has suggested that, in severely obese patients seeking bariatric surgery, clinical conditions, behavioural characteristics and psychological status might all differ from those of their counterparts starting conventional conservative therapy. METHODS Two groups of obese patients with closely similar body mass values were considered. The first group included individuals voluntarily and spontaneously seeking biliopancreatic diversion and the second group comprised patients at the beginning of a weight loss programme. After anthropometric and metabolic evaluation, the patients underwent an alimentary interview; eating behaviour and psychological status were assessed by Three Factor Eating Questionnaire and by Toronto Alexithymia Scale (TAS). RESULTS Among bariatric candidates, a greater number of individuals with type 2 diabetes and dyslipidaemia and high tendency to disinhibition and susceptibility to hunger scores was observed, whereas the other aspects of eating pattern were essentially similar. In the two groups, no difference in TAS score and or number of patients with alexithymic traits was observed. Finally, a logistic regression model showed that only age and metabolic derangement predicted the bariatric option, whereas eating behaviour or psychological status did not influence individual therapeutic choice. CONCLUSIONS Independently of the degree of obesity, bariatric surgery was requested by the more metabolically deranged patients, whereas, in the surgical candidates, the eating pattern and psychological conditions were very similar to those of obese persons at the beginning of a conservative weight loss programme. These results suggest a highly realistic and practical attitude in severely obese patients towards obesity and bariatric surgery.
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Affiliation(s)
- R Gradaschi
- Department of Clinical Nutrition, Ospedale San Martino and University of Genova, Largo Rosanna Benzi 8, Genoa, Italy
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