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Nguyen N, Woodside DB, Lam E, Quehenberger O, German JB, Shih PAB. Fatty Acids and Their Lipogenic Enzymes in Anorexia Nervosa Clinical Subtypes. Int J Mol Sci 2024; 25:5516. [PMID: 38791555 PMCID: PMC11122126 DOI: 10.3390/ijms25105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Disordered eating behavior differs between the restricting subtype (AN-R) and the binging and purging subtype (AN-BP) of anorexia nervosa (AN). Yet, little is known about how these differences impact fatty acid (FA) dysregulation in AN. To address this question, we analyzed 26 FAs and 7 FA lipogenic enzymes (4 desaturases and 3 elongases) in 96 women: 25 AN-R, 25 AN-BP, and 46 healthy control women. Our goal was to assess subtype-specific patterns. Lauric acid was significantly higher in AN-BP than in AN-R at the fasting timepoint (p = 0.038) and displayed significantly different postprandial changes 2 h after eating. AN-R displayed significantly higher levels of n-3 alpha-linolenic acid, stearidonic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid, and n-6 linoleic acid and gamma-linolenic acid compared to controls. AN-BP showed elevated EPA and saturated lauric acid compared to controls. Higher EPA was associated with elevated anxiety in AN-R (p = 0.035) but was linked to lower anxiety in AN-BP (p = 0.043). These findings suggest distinct disordered eating behaviors in AN subtypes contribute to lipid dysregulation and eating disorder comorbidities. A personalized dietary intervention may improve lipid dysregulation and enhance treatment effectiveness for AN.
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Affiliation(s)
- Nhien Nguyen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA
| | - D. Blake Woodside
- Centre for Mental Health, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Eileen Lam
- Centre for Mental Health, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Oswald Quehenberger
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA
| | - J. Bruce German
- Department of Food Science & Technology, University of California, Davis, Davis, CA 95616, USA;
| | - Pei-an Betty Shih
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA
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2
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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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3
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Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. TRAUMA, VIOLENCE & ABUSE 2024; 25:947-964. [PMID: 37125723 PMCID: PMC10913314 DOI: 10.1177/15248380231167399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
There is growing evidence of prior experiences of trauma and trauma-related symptoms among people with eating disorders; however, there is little understanding as to how post-traumatic stress disorder (PTSD) and exposure to traumatic events affect treatment outcomes. Without this knowledge, eating disorder clinicians are unable to tailor treatment to ensure good outcomes for the large percentage of this population that is affected by PTSD and trauma. This systematic review aimed to identify how PTSD and trauma exposure influence outcomes in eating disorder treatment. Systematic searches of PsycINFO, MEDLINE, PubMed, and Scopus databases identified 16 articles that met the inclusion criteria. The results indicated a negative effect on rates of eating disorder treatment completion and eating disorder psychopathology posttreatment. These findings were evident across studies that investigated the impact of a history of traumatic events as well as studies that investigated the impact of the presence of trauma-related symptoms seen in PTSD. Several methodological limitations were identified in the literature. These include: heterogeneous and unstandardized measures of PTSD and trauma, high attrition rates with follow-up, and insufficient data to enable comparisons by treatment setting, diagnostic presentation, and type of trauma exposure. The findings of this review have implications for future research and clinical care, including the importance of considering PTSD and trauma in assessment, treatment planning, and provision of both trauma-informed care and trauma-focused treatments for individuals with eating disorders.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, NSW, Australia
| | - Wadad. Kathy Tannous
- Translational Health Research Institute, School of Business, Western Sydney University, Penrith, NSW, Australia
| | - Scott J. Fatt
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Billman Miller MG, Gioia AN, Essayli JH, Forrest LN. Few differences in psychiatric comorbidities and treatment response among people with anorexia nervosa and atypical anorexia nervosa. Int J Eat Disord 2024; 57:809-818. [PMID: 37737487 DOI: 10.1002/eat.24046] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes. METHOD We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination-Questionnaire (EDE-Q). RESULTS No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology. DISCUSSION To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another. PUBLIC SIGNIFICANCE This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP.
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Affiliation(s)
| | - Ayla N Gioia
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Jamal H Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Rossi E, Cassioli E, Cecci L, Arganini F, Martelli M, Redaelli CA, Anselmetti S, Bertelli S, Fernandez I, Ricca V, Castellini G. Eye movement desensitisation and reprocessing as add-on treatment to enhanced cognitive behaviour therapy for patients with anorexia nervosa reporting childhood maltreatment: A quasi-experimental multicenter study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:322-337. [PMID: 37903082 DOI: 10.1002/erv.3044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE This quasi-experimental study aimed to compare the outcome of patients with Anorexia Nervosa (AN) reporting moderate/severe childhood maltreatment (CM) treated exclusively with Enhanced Cognitive Behaviour Therapy (CBT-E) or with CBT-E plus Eye Movement Desensitisation and Reprocessing (EMDR). METHOD A total of 75 patients with AN reporting moderate/severe CM were initially assessed regarding body mass index (BMI), general and eating disorder (ED)-specific psychopathology, and dissociative symptoms, and re-evaluated after 40 CBT-E sessions (T1). Then, 18 patients received EMDR, whereas the others were placed on a waiting list and continued CBT-E. T2 assessment was performed after 20-25 sessions of EMDR or CBT-E. A control group of 67 patients without CM was also enroled and treated with CBT-E. RESULTS Contrary to patients without CM, neither of the traumatised groups improved in BMI, general and ED psychopathology, or dissociation at T1. However, at T2, both traumatised groups improved in BMI and ED-specific psychopathology, with the CBT + EMDR group demonstrating greater improvements. Moreover, only the CBT + EMDR group improved in general psychopathology and dissociative symptoms. The reduction of ED symptoms in traumatised patients was mediated by the amelioration of dissociation. DISCUSSION The addition of EMDR to CBT-E may benefit patients with AN reporting moderate/severe CM.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lucia Cecci
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Arganini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Michela Martelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Cascino G, Monteleone AM. Early traumatic experiences and the hypothalamus-pituitary-adrenal axis in people with eating disorders: A narrative review. Psychoneuroendocrinology 2024; 159:106665. [PMID: 37944210 DOI: 10.1016/j.psyneuen.2023.106665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Exposure to trauma during childhood is a non-specific risk factor for psychiatric disorders, including eating disorders (EDs), over the life course. Moreover, an association between stressful life events and the onset/maintenance of EDs has been documented. Therefore, the hypothalamus-pituitary-adrenal (HPA) axis, namely the main component of the endogenous stress response system, has been proposed to be implicated in the pathophysiology of EDs. In this narrative review the current knowledge concerning the effects of early trauma exposure on the HPA axis activity and their putative role in the pathophysiology of EDs will be illustrated. Research findings corroborate the idea that childhood trauma exposure has long-lasting dysregulating effects on the activity of the HPA axis, which may contribute to the biological background of the early trauma-related risk for the development of EDs across the life span. Moreover, literature data support the existence of a "maltreated ecophenotype" in EDs characterized by specific clinic and neuroendocrine features, which may have important implications in treatment programming for such a type of patients.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
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Smith S, Sutandar K, Woodside B. Premature termination of inpatient eating disorder treatment: Does timing matter? J Eat Disord 2023; 11:210. [PMID: 38012804 PMCID: PMC10680217 DOI: 10.1186/s40337-023-00934-5] [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: 02/21/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.
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Affiliation(s)
- Sarah Smith
- Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, 25 Sheppard Ave West, Suite 300, Toronto, ON, M2N 6S6, Canada
| | - Blake Woodside
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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8
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Convertino AD, Mendoza RR. Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord 2023; 56:1055-1074. [PMID: 36916450 PMCID: PMC10247514 DOI: 10.1002/eat.23933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Rebecca R. Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
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9
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Sjögren M, Lichtenstein MB, Støving RK. Trauma Experiences Are Common in Anorexia Nervosa and Related to Eating Disorder Pathology but Do Not Influence Weight-Gain during the Start of Treatment. J Pers Med 2023; 13:jpm13050709. [PMID: 37240879 DOI: 10.3390/jpm13050709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/16/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE The main characteristics of Anorexia Nervosa (AN) in adults are restriction of energy intake relative to requirements leading to significant weight loss, disturbed body image, and intense fear of becoming fat. Traumatic experiences (TE) have been reported as common, although less is known about the relationship with other symptoms in severe AN. We investigated the presence of TE, PTSD, and the relation between TE, eating disorder (ED) symptoms, and other symptoms in moderate to severe AN (n = 97) at admission to inpatient weight-restoration treatment. All patients were enrolled in the Prospective Longitudinal all-comer inclusion study on Eating Disorders (PROLED). METHODS TE were assessed using the Post-traumatic stress disorder checklist, Civilian version (PCL-C), and ED symptoms using the Eating Disorder Examination Questionnaire (EDE-Q); depressive symptoms were assessed using the Major Depression Inventory (MDI), and the presence of Post-traumatic Stress Disorder (PTSD) was diagnosed according to ICD-10 criteria. RESULTS The mean score on PCL-C was high (mean 44.6 SD 14.7), with 51% having a PCL-C score at or above 44 (n = 49, suggested cut-off for PTSD), although only one individual was clinically diagnosed with PTSD. There was a positive correlation between baseline scores of PCL-C and EDE-Q-global score (r = 0.43; p < 0.01) as well as of PCL-C and all EDE-Q subscores. None of the included patients were admitted for treatment of TE/PTSD during the first 8 weeks of treatment. CONCLUSIONS In a group of patients with moderate to severe AN, TE were common, and scores were high, although only one had a diagnosis of PTSD. TE were related to ED symptoms at baseline, but this association diminished during the weight restoration treatment.
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Affiliation(s)
- Magnus Sjögren
- Eating Disorder Research Unit, Psychiatric Center Ballerup, 2750 Ballerup, Denmark
- Institute for Clinical Science, Sundsvall Regional Hospital, Umeå University, 851 86 Sundsvall, Sweden
| | - Mia Beck Lichtenstein
- Center for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5230 Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, 5230 Odense, Denmark
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, 5000 Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, 5230 Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, 5230 Odense, Denmark
- Clinical Institute, University of Southern Denmark, 5000 Odense, Denmark
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10
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. J Eat Disord 2023; 11:48. [PMID: 36973828 PMCID: PMC10044735 DOI: 10.1186/s40337-023-00773-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). METHODS ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. RESULTS Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. CONCLUSIONS Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Timothy D. Brewerton, MD, LLC, Mount Pleasant, SC, USA.
- Monte Nido and Affiliates, Miami, FL, USA.
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, FL, USA
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11
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Elwyn R, Mitchell J, Kohn MR, Driver C, Hay P, Lagopoulos J, Hermens DF. Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome. Neurosci Biobehav Rev 2023; 148:105122. [PMID: 36907256 DOI: 10.1016/j.neubiorev.2023.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
Anorexia nervosa (AN) is a severe illness with diverse aetiological and maintaining contributors including neurobiological, metabolic, psychological, and social determining factors. In addition to nutritional recovery, multiple psychological and pharmacological therapies and brain-based stimulations have been explored; however, existing treatments have limited efficacy. This paper outlines a neurobiological model of glutamatergic and γ-aminobutyric acid (GABA)-ergic dysfunction, exacerbated by chronic gut microbiome dysbiosis and zinc depletion at a brain and gut level. The gut microbiome is established early in development, and early exposure to stress and adversity contribute to gut microbial disturbance in AN, early dysregulation to glutamatergic and GABAergic networks, interoceptive impairment, and inhibited caloric harvest from food (e.g., zinc malabsorption, competition for zinc ions between gut bacteria and host). Zinc is a key part of glutamatergic and GABAergic networks, and also affects leptin and gut microbial function; systems dysregulated in AN. Low doses of ketamine in conjunction with zinc, could provide an efficacious combination to act on NMDA receptors and normalise glutamatergic, GABAergic and gut function in AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Jules Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Michael R Kohn
- AYA Medicine Westmead Hospital, CRASH (Centre for Research into Adolescent's Health) Western Sydney Local Health District, Sydney University, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Christina Driver
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI) School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
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12
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Kovács-Tóth B, Oláh B, Kuritárné Szabó I, Túry F. Adverse childhood experiences increase the risk for eating disorders among adolescents. Front Psychol 2022; 13:1063693. [PMID: 36578685 PMCID: PMC9791097 DOI: 10.3389/fpsyg.2022.1063693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents. Methods Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years. Results Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401). Conclusion Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.
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Affiliation(s)
- Beáta Kovács-Tóth
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,*Correspondence: Beáta Kovács-Tóth,
| | - Barnabás Oláh
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ildikó Kuritárné Szabó
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ferenc Túry
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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13
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Ten Napel-Schutz MC, Karbouniaris S, Mares SHW, Arntz A, Abma TA. Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences. J Eat Disord 2022; 10:188. [PMID: 36451217 PMCID: PMC9710063 DOI: 10.1186/s40337-022-00712-9] [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: 07/21/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prognosis for underweight individuals with an eating disorder (ED) and posttraumatic stress disorder (PTSD) is worse than for their peers without these comorbid symptoms. This qualitative study explores the experiences of trauma-focused Imagery Rescripting (ImRs) therapy of underweight inpatients being treated for an ED. OBJECTIVE To test the feasibility and to improve ImRs by understanding the experiences and perspectives of people with an ED and PTSD who, when underweight, received ImRs as an adjunct to their inpatient ED treatment. METHOD To explore how underweight people with an ED experience and perceive ImRs, we used a qualitative study design involving semi-structured interviews with 12 participants. After analysis, the data were summarized and classified within a thematic framework that focused on experiences and improving the ImRs method. RESULTS The thematic analysis resulted in the following 6 main themes; (1) Expectations of ImRs; (2) Ability to participate in ImRs; (3) Effect of ImRs; (4) Experience of ImRs technique; (5) Conditions under which ImRs is given; (6) In depth-analysis. The results show that despite the fear of disappointment the participants appreciate addressing the PTSD and ED symptoms simultaneously. Further, results showed that it had been possible for them to attend ImRs but that the effects of ImRs were not uniformly perceived. Also, participants indicated that a caring context is important and that ImRs should not be scheduled immediately before a meal. Finally, the treatment generated hope. CONCLUSIONS The findings of this study demonstrated the feasibility of the integration of ImRs trauma treatment for individuals who are being treated in an ED inpatient treatment setting, and are in contrast to standard practice where the focus of inpatient treatment has been ED-symptom improvement without comprehensively addressing past traumatic experiences during an underweight phase. Trial registration International Clinical Trials Registry Platform (ICTRP) (NTR6094). Date of registration 09/23/2016. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6094.
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Sciences, Radboud University, Nijmegen, The Netherlands.
| | - Simona Karbouniaris
- Utrecht University of Applied Sciences, Utrecht, The Netherlands.,Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Tineke A Abma
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leyden Academy on Vitality and Ageing, Leiden, The Netherlands
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14
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Convertino AD, Morland LA, Blashill AJ. Trauma exposure and eating disorders: Results from a United States nationally representative sample. Int J Eat Disord 2022; 55:1079-1089. [PMID: 35719053 PMCID: PMC9545485 DOI: 10.1002/eat.23757] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Sexual assault, child abuse, and combat have been linked to eating disorders (EDs). However, noninterpersonal trauma is relatively understudied, and therefore it is unknown whether noninterpersonal trauma is associated with EDs. Furthermore, most previous studies do not account for multiple trauma exposures, or the relative association of traumatic events with EDs in the same statistical model. METHOD Multinomial regression was used to examine the association of lifetime ED diagnosis (anorexia nervosa [AN], bulimia nervosa [BN], binge eating disorder [BED]) with trauma type (sexual interpersonal, other interpersonal, war/combat, and noninterpersonal) in a nationally representative dataset of US adults in bivariate and multivariable (i.e., with all trauma types) models. RESULTS Sexual interpersonal trauma was significantly positively associated with AN and BED in bivariate and multivariable models. In the multivariable model, only BED was found to be equally associated with sexual interpersonal, other interpersonal, and noninterpersonal trauma. DISCUSSION These results indicate a strong positive association between sexual trauma and EDs, even when controlling for experiences of other trauma events. Future research should examine longitudinal mediators between trauma and EDs, especially sexual trauma, to identify what factors may explain this relationship. PUBLIC SIGNIFICANCE STATEMENT Individuals with eating disorders often experience traumatic events but it is unclear whether specific trauma types are more or less common in this population. This study found that only events such as rape and sexual assault are associated with anorexia nervosa, but that most trauma types are associated with binge eating disorder. Therefore, the relationship between trauma and binge eating disorder may function differently than other eating disorders.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
| | - Leslie A. Morland
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA,Veterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA,National Center for PTSD–Pacific Islands DivisionHonoluluHawaiiUSA
| | - Aaron J. Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia,Department of PsychologySan Diego State UniversitySan DiegoCaliforniaUSA
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15
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Ten Napel-Schutz MC, Vroling M, Mares SHW, Arntz A. Treating PTSD with Imagery Rescripting in underweight eating disorder patients: a multiple baseline case series study. J Eat Disord 2022; 10:35. [PMID: 35264254 PMCID: PMC8908690 DOI: 10.1186/s40337-022-00558-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorder patients with posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without posttraumatic stress disorder. Many eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for posttraumatic stress disorder symptoms during an underweight state. We propose that treatment of posttraumatic stress disorder is possible for underweight patients and that their trauma symptoms decrease with the use of Imagery Rescripting. We also investigated whether treatment of trauma influences eating disorder pathology in general and the process of weight gain specifically. METHOD Ten patients in clinical treatment (BMI 14-16.5) participated. A multiple baseline design was used, with baseline varying from 6 to 10 weeks, a 6-week treatment phase, a 3-week follow-up period and a 3-month follow-up measurement. Data were analysed with mixed regression. RESULTS Evidence was found that Imagery Rescripting had strong positive effects on posttraumatic stress disorder symptoms without interfering with eating disorder treatment. Positive effects were also found on a range of secondary emotional and cognitive measures. CONCLUSION Imagery Rescripting of traumatic memories is a possible and safe intervention for underweight eating disorder patients. It also had positive clinical effects. Trial registration Netherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906 .
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Affiliation(s)
- Marieke C Ten Napel-Schutz
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands. .,Radboud Centre Social Science, Radboud University, Nijmegen, The Netherlands. .,Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Maartje Vroling
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
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16
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Talmon A, Widom CS. Childhood Maltreatment and Eating Disorders: A Prospective Investigation. CHILD MALTREATMENT 2022; 27:88-99. [PMID: 33525891 DOI: 10.1177/1077559520988786] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine whether childhood maltreatment is a risk factor for two eating disorders (anorexia nervosa and bulimia nervosa) using objective and subjective case definitions. METHODS Using a prospective cohorts design, children with documented cases of physical abuse, sexual abuse, and neglect (ages 0-11) from 1967 to 1971 in a Midwestern metropolitan county area were matched on age, race, sex, and approximate family socioeconomic status with non-maltreated children. Both groups were followed up. Retrospective self-reports about childhood maltreatment were collected at age 29. DSM-IV anorexia nervosa (AN) and bulimia nervosa (BN) disorders were assessed at age 41 (N = 807). Logistic and linear regression results are reported. RESULTS Using documented cases, childhood maltreatment was not a significant risk factor for AN or BN diagnoses or symptoms in adulthood. However, adults who retrospectively reported any maltreatment and physical and sexual abuse reported significantly more symptoms of AN than those who did not. CONCLUSIONS The prediction that childhood maltreatment is a risk factor for anorexia nervosa and bulimia nervosa was partially supported in this longitudinal study. While misattribution of cases might have occurred, these results suggest that researchers and clinicians should use caution in drawing inferences about these relationships and designing interventions.
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Affiliation(s)
- Anat Talmon
- Psychology Department, 6429Stanford University, Stanford, CA, USA
| | - Cathy Spatz Widom
- Psychology Department, 14775John Jay College, and Graduate Center, City University of New York, NY, USA
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17
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Lie SØ, Bulik CM, Andreassen OA, Rø Ø, Bang L. Stressful life events among individuals with a history of eating disorders: a case-control comparison. BMC Psychiatry 2021; 21:501. [PMID: 34645394 PMCID: PMC8513319 DOI: 10.1186/s12888-021-03499-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Experiencing stressful life events (SLEs) can negatively impact mental health and increase risk for psychiatric disorders including eating disorders (EDs). Previous research has shown that childhood sexual abuse is associated with some EDs, but less is known about the association between other non-sexual SLEs and EDs. METHOD A case-control study of individuals with (n = 495, age mean ± SD = 29.1 ± 9.8 years) and without (n = 395, age = 30.2 ± 11.7) self-reported lifetime history of EDs was conducted to compare history of self-reported SLEs. Participants reported history of sexual (e.g., rape, other sexual assault) and non-sexual (e.g., emotional abuse, assault, bereavement) life events using an adaptation of the Stressful Life Events Screening Questionnaire. Individuals with EDs were divided into ED subtypes along the restricting - binge eating/purging spectrum to examine subtype differences. Logistic regressions were conducted for each SLE and ED subtype to obtain odds ratios (ORs). We report p-values corrected for multiple comparisons. RESULTS Exposure to any SLE was significantly more common in individuals with EDs than in controls (OR = 2.47, p < .001). Specifically, rape, other sexual assault, and emotional abuse were significantly more common among individuals with a history of binge-eating/purging ED subtypes (ORs = 2.15-3.58, p's < .01) compared with controls. Furthermore, history of life-threatening disease and loss of a close relative/partner/friend were associated with some ED subtypes. The association between SLEs and EDs was stronger for individuals who had experienced multiple SLEs. CONCLUSION By investigating a range of different SLEs, we showed that both sexual and non-sexual SLEs were more common in individuals with a history of EDs (binge-eating/purging subtypes) than controls. Results highlight the importance of assessing a variety of past SLEs in risk assessment for different EDs.
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Affiliation(s)
- Selma Ø. Lie
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cynthia M. Bulik
- grid.4714.60000 0004 1937 0626Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,grid.10698.360000000122483208Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Ole A. Andreassen
- grid.5510.10000 0004 1936 8921NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lasse Bang
- grid.55325.340000 0004 0389 8485Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
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18
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Kiefer R, Goncharenko S, Contractor AA, DePina MZ, Weiss NH. Posttraumatic stress disorder symptoms moderate the relation between childhood sexual abuse and disordered eating in a community sample. Int J Eat Disord 2021; 54:1819-1828. [PMID: 34411318 DOI: 10.1002/eat.23593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Previous work has found clear associations between childhood sexual abuse (CSA) and disordered eating in adulthood. However, further research is needed to clarify factors that may influence this relationship. The current study advanced existing research by examining the moderating influence of posttraumatic stress disorder (PTSD) symptom severity in the association between CSA and disordered eating. METHOD Data were collected from 463 individuals with a history of sexual assault or other unwanted sexual experience(s) (Mage = 34.71, 54.9% women, 77.5% white) who were recruited from MTurk. RESULTS Results indicated significant positive relations among CSA, PTSD symptom severity, and disordered eating. CSA was found to be associated with disordered eating at high, but not low, levels of PTSD symptom severity. DISCUSSION This study highlights the importance of assessing disordered eating and PTSD symptoms in individuals who report a history of CSA. Clinicians aiming to reduce their patients' symptoms of disordered eating may benefit from considering the potential role of PTSD symptom severity as a barrier to achieving treatment gains.
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Affiliation(s)
- Reina Kiefer
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Svetlana Goncharenko
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Maria Z DePina
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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19
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Samudra M, Davis S, Gupta N, Chaudhury S, Saldanha D. Association of childhood psychological trauma with eating disorders in undergraduate medical students. Ind Psychiatry J 2021; 30:S120-S126. [PMID: 34908677 PMCID: PMC8611587 DOI: 10.4103/0972-6748.328802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/27/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of the study was to study the association of childhood psychological trauma with eating disorders (EDs) and to assess and compare the relationship with food, concerns about weight gain, and restrictive or compensatory practices in male and female undergraduate medical students. MATERIALS AND METHODS A cross-sectional, analytical study was performed in a Tertiary Care Medical College and Research Hospital in a suburban area of India. After obtaining ethical clearance, 100 final-year undergraduate students were included in the study with their informed consent. Self-made questionnaire, Childhood Trauma Questionnaire, Stirling ED Scale with Disordered Eating Attitude Scale were used. Spearman's correlation coefficient (Rho) was calculated. RESULTS There was a significant correlation of history of childhood psychological trauma in the form of emotional abuse, emotional neglect or physical abuse and physical neglect with higher prevalence of disordered eating behaviors and relationship with food, concern about weight gain, and compensatory practices. No significant relationship was found in a history of sexual abuse. CONCLUSION The importance of a healthy psychosocial upbringing and nurturing by parents to prevent development of psychiatric comorbidities is an important finding in this study.
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Affiliation(s)
- Madhura Samudra
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Supriya Davis
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Nishtha Gupta
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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20
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Mitchell KS, Singh S, Hardin S, Thompson-Brenner H. The impact of comorbid posttraumatic stress disorder on eating disorder treatment outcomes: Investigating the unified treatment model. Int J Eat Disord 2021; 54:1260-1269. [PMID: 33876442 DOI: 10.1002/eat.23515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Many women with eating disorders (EDs) have comorbid posttraumatic stress disorder (PTSD). However, there have been few studies on how comorbid PTSD may impact ED treatment outcomes. METHOD Participants were 2,809 patients from residential ED treatment facilities who were treated using the Unified Treatment Model (UTM). We investigated whether PTSD diagnosis at admission was associated with changes in Eating Disorder Examination-Questionnaire (EDE-Q) scores, binge eating, self-induced vomiting, and restriction, across three time points, as well as clinically significant improvement and treatment drop-out. RESULTS Using latent growth models, with time modeled as a second-order polynomial, we found that EDE-Q scores and behavioral symptoms decreased from admission to discharge, but increased from discharge to 6-month follow-up. PTSD diagnosis was associated with higher baseline EDE-Q scores and restriction, and lower binge-eating frequency. PTSD diagnosis was not associated with symptom change over time, treatment dropout, or clinically significant change. DISCUSSION Although PTSD diagnoses were associated with higher ED symptom levels at admission, PTSD was not associated with worse treatment outcomes, suggesting the UTM is a promising treatment for patients with and without PTSD. Future studies should investigate the impact of ED treatment on PTSD symptoms in order to determine the need for integrated treatments for these comorbid conditions.
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Affiliation(s)
- Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Simar Singh
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sabrina Hardin
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
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21
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Afari N, Gasperi M, Dochat C, Wooldridge JS, Herbert MS, Schur EA, Buchwald DS. Genetic and environmental influences on posttraumatic stress disorder symptoms and disinhibited eating behaviors. Eat Disord 2021; 29:226-244. [PMID: 33404377 PMCID: PMC8257777 DOI: 10.1080/10640266.2020.1864587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Posttraumatic stress disorder (PTSD) and eating disorders (ED) frequently co-occur, but the mechanisms underlying this association remain unclear. EDs are characterized by features of maladaptive eating behaviors including disinhibited eating and cognitive dietary restraint. Identifying the genetic overlap between PTSD symptoms and maladaptive eating behaviors may elucidate biological mechanisms and potential treatment targets. A community sample of 400 same-sex twins (102 monozygotic and 98 dizygotic pairs) completed the PTSD Checklist-Civilian (PCL-C) for PTSD symptoms and the Three-Factor Eating Questionnaire-Reduced (TFEQ-R18) for eating behaviors (uncontrolled eating, emotional eating, and cognitive dietary restraint). We used biometric modeling to examine the genetic and environmental relationships between PCL-C and TFEQ-R18 total and subscales scores. Heritability was estimated at 48% for PTSD symptoms and 45% for eating behavior overall. Bivariate models revealed a significant genetic correlation between PTSD symptoms and eating behavior overall (rg =.34; CI:.07,.58) and Uncontrolled Eating (rg =.53; CI:.24,.84), and a significant environmental correlation between PTSD symptoms and Emotional Eating (re =.30; CI:.12,.45). These findings suggest the influence of common etiology. Future research and clinical efforts should focus on developing integrated treatments.
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Affiliation(s)
- Niloofar Afari
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Marianna Gasperi
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Cara Dochat
- Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA.,San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Jennalee S Wooldridge
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Matthew S Herbert
- VA Center of Excellence for Stress and Mental Health, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Department of Mental Health, Department of Research, VA San Diego Healthcare System, San Diego, California, USA
| | - Ellen A Schur
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dedra S Buchwald
- Elson S Floyd College of Medicine, Washington State University, Spokane, Washington, USA
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22
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Fávero M, Moreira D, Abreu B, Del Campo A, Moreira DS, Sousa-Gomes V. Psychological intervention with adult victims of sexual abuse: A comprehensive review. Clin Psychol Psychother 2021; 29:62-80. [PMID: 33844370 DOI: 10.1002/cpp.2598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/09/2022]
Abstract
Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short- and long-term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult CSA survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA and demonstrates the need to conduct further research on the effectiveness of intervention.
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Affiliation(s)
- Marisalva Fávero
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Braga, Portugal
| | - Diana Moreira
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal.,Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Beatriz Abreu
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal
| | - Amaia Del Campo
- Department of Evolutionary and Educational Psychology, University of Salamanca, Salamanca, Spain
| | - Diana Sá Moreira
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal
| | - Valéria Sousa-Gomes
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Braga, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal
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Arabaci LB, Buyukbayram Arslan A, Dagli DA, Tas G. The relationship between university students' childhood traumas and their body image coping strategies as well as eating attitudes. Arch Psychiatr Nurs 2021; 35:66-72. [PMID: 33593517 DOI: 10.1016/j.apnu.2020.09.017] [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: 05/07/2019] [Revised: 05/01/2020] [Accepted: 09/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study examined the relationship between university students' childhood traumas and their body image coping strategies as well as eating attitudes. METHODS This cross-sectional, descriptive, and correlational study was conducted with 654 students who were selected from 6240 university students enrolled during the spring semester of the 2017-2018 academic year and determined using the stratified and simple random sampling method. Introductory Information Form, Childhood Trauma Questionnaire (CTQ), Body Image Coping Strategies Inventory (BICSI), and Eating Attitudes Test (EAT) were used. The reliability coefficients of the scales were 0.93, 0.82, and 0.85, respectively. The data were evaluated using number-percentage distributions and the relationships between the variables were examined using correlation analysis. RESULTS Of the students, 56.7% were female. Their mean age was 20.71 ± 1.54. The mean CTQ score (41.14 ± 15.98), BICSI score (71.33 ± 10.32; max.: 116), and EAT score (19.61 ± 14.60) were below average. The study found a low, positive correlation between the CTQ total and subscale mean scores and the BICSI avoidance subscale mean score as well as the EAT mean score (p < 0.05). CONCLUSIONS Few university students reported childhood traumas. Most students referred to positive coping using rational acceptance tendency against body image threats and problems, had low tendencies toward negative eating attitudes, and had no risk for an eating disorder. However, the students with a history of childhood trauma coped with body image threats and problems mostly using an avoidance tendency and had negative tendencies toward eating attitudes.
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Affiliation(s)
- Leyla Baysan Arabaci
- Izmir Katip Celebi University, Faculty of Health Science, Department of Mental Health and Psychiatric Nursing, Izmır, Turkey.
| | - Ayse Buyukbayram Arslan
- Izmir Katip Celebi University, Faculty of Health Science, Department of Mental Health and Psychiatric Nursing, Izmır, Turkey
| | - Dilek Ayakdas Dagli
- Izmir Katip Celebi University, Faculty of Health Science, Department of Mental Health and Psychiatric Nursing, Izmır, Turkey
| | - Gulsenay Tas
- Izmir Katip Celebi University, Faculty of Health Science, Department of Mental Health and Psychiatric Nursing, Izmır, Turkey
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24
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Scharff A, Ortiz SN, Forrest LN, Smith AR, Boswell JF. Post‐traumatic stress disorder as a moderator of transdiagnostic, residential eating disorder treatment outcome trajectory. J Clin Psychol 2021; 77:986-1003. [DOI: 10.1002/jclp.23106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Adela Scharff
- Department of Psychology University at Albany—State University of New York Albany New York USA
| | | | | | - April R. Smith
- Department of Psychology Miami University Oxford Ohio USA
| | - James F. Boswell
- Department of Psychology University at Albany—State University of New York Albany New York USA
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25
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Brewerton TD, Perlman MM, Gavidia I, Suro G, Genet J, Bunnell DW. The association of traumatic events and posttraumatic stress disorder with greater eating disorder and comorbid symptom severity in residential eating disorder treatment centers. Int J Eat Disord 2020; 53:2061-2066. [PMID: 33159362 DOI: 10.1002/eat.23401] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Traumatic events, posttraumatic stress disorder (PTSD) and related symptoms are commonly associated with eating disorders (ED). Several clinical features indicative of a more severe and complex course have been associated with traumatized ED patients, especially those with PTSD, who may be more likely admitted to residential treatment (RT). Research in this population is sparse but of increasing interest. METHOD Adult participants (96.7% female) with EDs entering RT (n = 642) at seven sites in the U.S. completed validated self-report assessments of ED, PTSD, major depression, state-trait anxiety, and quality of life. Presumptive diagnoses of DSM-5 PTSD (PTSD+) were made via the Life Events Checklist-5 and the PTSD Symptom Checklist for DSM-5. RESULTS PTSD+ occurred in 49.3% of patients. PTSD+ patients had significantly higher scores on all assessment measures (p ≤ .001), including measures of ED psychopathology, depression, state-trait anxiety, and quality of life. Those with PTSD+ had significantly higher numbers of lifetime traumatic event types, higher rates of almost all lifetime traumatic events, and a greater propensity toward binge-type EDs. DISCUSSION Results confirm that ED-PTSD+ patients in RT are more symptomatic and have worse quality of life than ED patients without PTSD+. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Timothy D. Brewerton, MD, LLC, Mt. Pleasant, South Carolina, USA.,Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA.,Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Douglas W Bunnell
- Monte Nido and Affiliates, Miami, Florida, USA.,Douglas W. Bunnell, PhD, LLC, Westport, Connecticut, USA
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26
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Groth T, Hilsenroth M, Boccio D, Gold J. Relationship between Trauma History and Eating Disorders in Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:443-453. [PMID: 33269044 PMCID: PMC7683676 DOI: 10.1007/s40653-019-00275-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Reasons for developing an eating disorder (ED) are complex, yet one plausible risk factor gaining more relevance in adolescents with EDs is childhood trauma. The current study is the first to examine the presence of childhood trauma in relation to ED symptomatology in adolescents using DSM-5 criteria. It was hypothesized that patients with more traumatic experiences also have more severe ED symptoms. 112 therapists currently treating adolescent patients diagnosed with an ED completed an online survey consisting of a DSM-5 ED symptom checklist and a childhood trauma questionnaire on a current adolescent patient whom they have seen for at least eight sessions. Children with multiple traumatic experiences and the severity of those experiences demonstrated a relationship to overall ED (r = .179, p = .059) and bulimia symptoms (r = .183, p = .054), specifically binging (r = .188, p = .047). and purging (r = .217, p = .021). In addition, logistic regression analyses indicated that adolescents high on bulimia nervosa (B = 4.694, p = .044) were more likely to have been traumatized victims of violence. Exploratory analyses support prior literature that suggest similarities between adolescents' lack of control of the experienced trauma(s) with lack of control of ED symptoms. These findings highlight the importance of exploring trauma history when treating an adolescent with an ED, especially bulimia.
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Affiliation(s)
- Taylor Groth
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Dana Boccio
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Jerold Gold
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
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27
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Brewerton TD, Lafrance A, Mithoefer MC. The potential use of N-methyl-3,4-methylenedioxyamphetamine (MDMA) assisted psychotherapy in the treatment of eating disorders comorbid with PTSD. Med Hypotheses 2020; 146:110367. [PMID: 33203569 DOI: 10.1016/j.mehy.2020.110367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/06/2023]
Abstract
Despite advances in the field, eating disorders (EDs) remain very challenging disorders to treat, especially when comorbid with posttraumatic stress disorder (PTSD). N-methyl-3,4-methylenedioxyamphetamine (MDMA)-assisted psychotherapy for treatment refractory PTSD shows great promise, with two-thirds of participants achieving full remission at 1 year or more at follow-up. PTSD is a common comorbidity associated with EDs, and patients with EDs and PTSD (ED-PTSD) are reported to have higher severities of illness, greater comorbidities, higher treatment dropouts, and poorer outcomes. We hypothesize that MDMA-assisted psychotherapy will be efficacious in the ED-PTSD population for both ED and PTSD symptoms. The rationales for and proposed mechanisms of MDMA-assisted psychotherapy for ED-PTSD are considered from neurobiological, psychological and social perspectives. MDMA is associated with unique psychopharmacological effects, including: 1) reduced fear, 2) enhanced wellbeing, 3) increased sociability/extroversion, 4) reduced self-criticism, 5) increased compassion for self/others, 6) increased interpersonal trust, and 7) alert state of consciousness. These anxiolytic and prosocial effects may counteract avoidance and hyperarousal in the context of psychotherapy for those with ED-PTSD. Other clinical features of EDs that may be amenable to MDMA-assisted psychotherapy include body image distortion, cognitive rigidity, and socio-emotional processing difficulties. To illustrate its potential, personal accounts of individuals with ED-PTSD symptoms reporting benefit from MDMA adjunctive to psychotherapy are described. In addition, the possible risks and challenges in conducting this work are addressed, and future implications of this proposal are discussed.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Timothy D. Brewerton, MD, LLC, 216 Scott Street, Mt. Pleasant, SC 29464, USA.
| | - Adele Lafrance
- Department of School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | - Michael C Mithoefer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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28
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Ruiz AL, Font SA. Role of childhood maltreatment on weight and weight-related behaviors in adulthood. Health Psychol 2020; 39:986-996. [PMID: 32969695 PMCID: PMC8381525 DOI: 10.1037/hea0001027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study investigated associations between child maltreatment and body mass, body weight perceptions, and weight control behaviors among men and women. METHOD Data were derived from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Multinomial logistic regression was used to investigate links between dimensions of childhood maltreatment and adult (a) classifications of body mass index (BMI), (b) discrepancies in perceived weight and actual BMI categories, and (c) normative and risky weight control behaviors. RESULTS Childhood maltreatment was highly predictive of BMI classification, weight perception discrepancies, and weight control behaviors for women. Women who reported physical abuse, sexual abuse, and neglect had increased risks for being slightly or very overweight, and among those who reported physical abuse and/or a combination of physical abuse and neglect, there is an increased likelihood of holding overweight perceptions. Finally, female victims of physical abuse, physical abuse and neglect, and of neglect only were more likely to adopt risky (e.g., diet pills or purging) versus normative (e.g., diet and exercise) weight control behaviors. CONCLUSION Results indicated that women who reported childhood maltreatment have increased risks for developing body and weight related issues, confirming research documenting female-specific effects of childhood maltreatment. For women, certain forms of maltreatment strongly predicted BMI groupings, discrepant weight perceptions, and risky weight behaviors. Taken together, findings suggest that child maltreatment is a predictor of health-related outcomes. Moreover, results highlight the importance of assessing gender-specific effects when examining outcomes related to body, weight, and dieting. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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29
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Schiltz L. Séquelles post-traumatiques à long terme rencontrées chez les enfants et adolescents victimes de violence sexuelle : implications pour l’expertise de crédibilité. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Leonidas C, Santos MAD. Eating Disorders and Female Sexuality: Current Evidence-base and Future Implications. PSICO-USF 2020. [DOI: 10.1590/1413-82712020250109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract This study aimed to examine current scientific production regarding sexuality-related issues in the context of eating disorders (ED). Searches were performed on PubMed, LILACS, CINAHL and PsycINFO, including papers published between 2008 and 2018, using the following descriptors: eating disorders, femininity, sexuality and sexual behavior. Nineteen studies were selected. Findings were systematized into two main thematic categories and showed, in general, that femininity can be a risk factor to the development of ED. Studies indicated that endorsing a gender role that is socially considered discrepant from biological sex, despite feminine or masculine, is related to ED symptomatology. Moreover, body dissatisfaction is positively correlated to sexual dysfunction. Interventions targeting prevention of ED should include sexuality-related issues by approaching probable negative consequences of adhering to female gender role social requirements and stereotypes, especially those related to body weight and body shape.
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31
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Wolf NM, Elklit A. Child Maltreatment and Disordered Eating in Adulthood: a Mediating Role of PTSD and Self-Esteem? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:21-32. [PMID: 32318225 PMCID: PMC7163900 DOI: 10.1007/s40653-018-0224-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The current study investigated relationships between different experiences of child maltreatment (CM) and disordered eating (DE) in a large population-based sample of Danish young adults. Participants completed a structured interview comprising socio-demographic, psychological and physical domains. Questions regarding CM, DE, PTSD symptoms and self-esteem were analyzed using chi-square-tests, ANOVAs, hierarchical regression, and multiple mediation analyses. Participants with a history of CM experienced higher levels of DE than non-abused individuals. PTSD symptoms and self-esteem appeared to differentially mediate the relationship between three classes of CM and DE. Whereas the relation between emotional and sexual abuse with DE was partially mediated via participants' level of PTSD symptoms and self-esteem with emotional abuse having a stronger impact on self-esteem and sexual abuse more strongly influencing PTSD symptoms, the relation between polyvictimization and DE was fully mediated by PTSD and self-esteem, mainly due to the indirect effect via PTSD.
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Affiliation(s)
- Nele Marie Wolf
- National Center of Psychotraumatology, University of Southern Denmark, Odense, Denmark
- Present Address: Alexianer Center of Psychotraumatology, Michaelshovener Str. 11, 50999 Cologne, Germany
| | - Ask Elklit
- National Center of Psychotraumatology, University of Southern Denmark, Odense, Denmark
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32
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Trottier K. Posttraumatic stress disorder predicts non‐completion of day hospital treatment for bulimia nervosa and other specified feeding/eating disorder. EUROPEAN EATING DISORDERS REVIEW 2020; 28:343-350. [DOI: 10.1002/erv.2723] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/02/2019] [Accepted: 12/23/2019] [Indexed: 12/17/2022]
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33
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Smith S, Woodside DB. Characterizing Treatment-Resistant Anorexia Nervosa. Front Psychiatry 2020; 11:542206. [PMID: 33488410 PMCID: PMC7819894 DOI: 10.3389/fpsyt.2020.542206] [Citation(s) in RCA: 8] [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: 03/11/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background: The issue of treatment resistance in eating disorder care is controversial. Prior research has identified multiple failed treatment attempts as a common criterion for severe and enduring anorexia nervosa, but little is known about patients who have multiple failed treatment attempts. This study was designed to compare the clinical and demographic characteristics of eating disorder patients with multiple, incomplete inpatient admissions to those with good outcomes. Understanding if these patient populations differ at initial admissions has implications for the prediction and characterization of inpatient eating disorder treatment resistance. Methods: This study analyzed existing data from a specialist inpatient eating disorder program at a large Canadian teaching hospital collected between 2000 and 2016. Treatment resistance was defined as two or more incomplete admissions and no complete admissions in the study period. Data were available on 37 patients who met this criteria, and 38 patients who had completed their first admission and remained well (defined as a BMI > 18.5 with no binging or purging behavior) 1 year after discharge. Variables of interest included age, weight, diagnoses, duration of illness, eating disorder psychopathology, eating disorder behavioral frequencies and depressive symptoms at the time of index inpatient admissions. Statistical analyses consisted of Mann-Whitney U tests, Chi-square tests, and a logistic regression. Results: In our main bivariate analyses, patients with multiple incomplete admissions were characterized by more severe eating disorder psychopathology and depressive symptoms at admission as well as an increased prevalence of the binge purge subtype of anorexia nervosa. In our exploratory multivariate analyses controlling for diagnostic subtype and depressive symptoms, severity of eating disorder psychopathology did not remain significant. No statistically significant difference in body mass index (BMI) or frequencies of eating disorder behaviors were found. A trend toward a longer duration of illness did not meet statistical significance. Conclusions: This study found that patients considered resistant to inpatient eating disorder treatment differ from those with good outcomes at initial admission. These results suggest that while treatment-resistant anorexia nervosa may be related to severe and enduring anorexia nervosa, it may also be a different concept that warrants additional research.
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Affiliation(s)
- Sarah Smith
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - D Blake Woodside
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University Health Network, Toronto, ON, Canada
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Rai T, Mainali P, Raza A, Rashid J, Rutkofsky I. Exploring the Link Between Emotional Child Abuse and Anorexia Nervosa: A Psychopathological Correlation. Cureus 2019; 11:e5318. [PMID: 31598427 PMCID: PMC6777933 DOI: 10.7759/cureus.5318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 01/08/2023] Open
Abstract
Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.
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Affiliation(s)
- Tehrima Rai
- Pediatrics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Pranita Mainali
- Psychiatry, Washington DC VA Medical Center, Washington DC, USA
| | - Ali Raza
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Junaid Rashid
- Medicine and Histopathology, California Instititute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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35
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Farina B, Liotti M, Imperatori C. The Role of Attachment Trauma and Disintegrative Pathogenic Processes in the Traumatic-Dissociative Dimension. Front Psychol 2019; 10:933. [PMID: 31080430 PMCID: PMC6497769 DOI: 10.3389/fpsyg.2019.00933] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Epidemiological, clinical, and neurobiological studies of the last 30 years suggest that traumatic attachments during the early years of life are associated to specific psychopathological vulnerabilities based on dissociative pathogenic processes. It has been observed that the dissociative pathogenic processes caused by these traumatic attachments either may contribute to the genesis of well-defined mental disorders (e.g., dissociative disorders) or may variably occur in many other diagnostic categories, complicating their clinical pictures and worsening their prognosis. For this reason, we proposed to define the dimension of psychopathological outcomes linked to traumatic attachments and dissociative pathogenic processes as the "traumatic-dissociative" dimension (TDD). The clinical complexity of the TDD requires specific training to enable mental health professionals to recognize the signs of traumatic developments and to implement specific treatment strategies. The present article aims to review some crucial points about the clinical meaning and treatment strategies of the TDD, the dissociative pathogenic processes characterizing the TDD, as well as of the role of attachment trauma in the TDD. We also focused on the clinical and theoretical evidence suggesting that dissociation and dis-integration may be considered two different processes but highly correlated. The usefulness of clinical reasoning in terms of psychopathological dimensions, instead of distinct diagnostic categories, as well as several therapeutic implications of these issues was finally discussed.
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Affiliation(s)
- Benedetto Farina
- Department of Human Sciences, European University of Rome, Rome, Italy
- Traumatic Treatment Unit, Centro Clinico De Sanctis, Rome, Italy
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36
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Gregertsen EC, Mandy W, Kanakam N, Armstrong S, Serpell L. Pre-treatment patient characteristics as predictors of drop-out and treatment outcome in individual and family therapy for adolescents and adults with anorexia nervosa: A systematic review and meta-analysis. Psychiatry Res 2019; 271:484-501. [PMID: 30551081 DOI: 10.1016/j.psychres.2018.11.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/09/2023]
Abstract
Understanding variables predicting drop-out or unfavourable outcome following treatment for anorexia nervosa (AN) may help to improve upon intervention efforts. However, the current literature has demonstrated sparse and inconsistent significant findings. The current systematic review and meta-analysis summarised the evidence base examining baseline predictors of drop-out and outcome in AN treatment. A literature search was conducted to identify research investigating predictors of drop-out and outcome in individuals treated for AN. Four online databases were searched, and predictors were organised by category and dependent variable (outcome versus drop-out). 27 studies were included. Lower motivation, lower BMI, and having the binge-purge subtype of AN predicted drop-out. Greater ED pathology and poorer motivation predicted poorer outcome. Clinical recommendations include taking particular care during assessment stages to identify patients at risk of drop-out and/or poor outcome based on their clinical profile and level of motivation for recovery. At-risk patients should be receiving tailored treatment to enhance engagement and reduce risk of drop-out. In conclusion, there's some evidence that motivation, BMI, subtype, and ED pathology predicts drop-out and/or outcome in individual and family-based therapy for AN amongst adolescents and adults; however, research incorporating carefully designed multi-site studies is required to further examine these findings.
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Affiliation(s)
- Eva C Gregertsen
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - William Mandy
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | | | | | - Lucy Serpell
- Department of Clinical, Educational, and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, London, UK
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37
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Statement of removal. Health Care Women Int 2018; 39:1316. [PMID: 29485357 DOI: 10.1080/07399332.2018.1443108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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38
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Malecki J, Rhodes P, Ussher J. Childhood trauma and anorexia nervosa: from body image to embodiment. Health Care Women Int 2018; 39:936-951. [PMID: 30152723 DOI: 10.1080/07399332.2018.1492268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Contemporary understandings of anorexia nervosa are framed by the body-image paradigm. The body-image framework considers that women's bodily experiences are reflected through distorted mental images of their bodies or disordered thinking and behavior around food and eating. Body image has come to symbolize all that can go wrong with women's relationships with their bodies, food, and eating. The problem with this approach is its failure to consider the experience of women who have survived childhood abuse. Women's bodily disturbances are not easily discernible through objective measures because they lie within the inner subjective realm of the embodied 'self' and embodied emotional experience. Consideration of the different ways that women inhabit their bodies informs this paper's examination of the conceptual framework of embodiment as an alternative to the body-image paradigm.
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Affiliation(s)
- Jennifer Malecki
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Paul Rhodes
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Jane Ussher
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
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Hicks White AA, Pratt KJ, Cottrill C. The relationship between trauma and weight status among adolescents in eating disorder treatment. Appetite 2018; 129:62-69. [PMID: 29969660 DOI: 10.1016/j.appet.2018.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
A relationship between trauma and eating disorders in adolescence is well established, though less is known about how different types of trauma, apart from childhood sexual abuse, associate with eating disorders. The purpose of this study is to describe the prevalence of various trauma types in a clinical sample of adolescents presenting at an outpatient eating disorder treatment facility (N = 182). Thirty-five percent of the sample reported experiencing one or more traumatic events during their lifetime. Bullying was the most prevalent type of trauma (10%), followed by significant death/loss (9%), and sexual abuse (8%). Adolescents with any trauma exposure had higher body mass index (BMI), BMI percentile, and percent expected body weight (%EBW) compared to those without any trauma exposure. Specifically, patients who were exposed to bullying and domestic violence reported a significantly higher %EBW than those who were not exposed. On average, adolescents exposed to bullying had a %EBW that was 7 percentage points higher than their non-exposed peers. Patients with bulimia nervosa were more likely to report trauma exposure than those with other eating disorder diagnosis. Providers working with adolescents diagnosed with eating disorders of all weight statuses should consider assessing for past and current trauma, including bullying and exposure to domestic violence. Trauma informed approaches to eating disorder treatment are needed to avoid potentially activating or exacerbating trauma related distress for adolescents in eating disorder treatment.
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Affiliation(s)
- Ashley A Hicks White
- The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA.
| | - Keeley J Pratt
- Human Development and Family Science, The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA
| | - Casey Cottrill
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatrics, The Ohio State University, 410 W 10th Avenue, Columbus, OH, 43210, USA
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Calugi S, Franchini C, Pivari S, Conti M, El Ghoch M, Dalle Grave R. Anorexia nervosa and childhood sexual abuse: Treatment outcomes of intensive enhanced cognitive behavioural therapy. Psychiatry Res 2018; 262:477-481. [PMID: 28927864 DOI: 10.1016/j.psychres.2017.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/25/2017] [Accepted: 09/11/2017] [Indexed: 09/30/2022]
Abstract
Sexual abuse has been widely studied as a risk factor in anorexia nervosa, but data on its influence on treatment outcomes are scarce. Hence, we compared short- and long-term outcomes of inpatient enhanced cognitive-behavioural therapy (CBT-E) in patients with anorexia nervosa who had and had not suffered sexual abuse. Eighty-one patients were recruited, and body mass index (BMI), Eating Disorder Examination, Brief Symptom Inventory, and Work and Social Adjustment Scale scores were recorded before and after treatment, and at 6- and 12-month follow-ups. Twenty patients (24.7%) reported experiencing childhood sexual abuse before anorexia nervosa onset, while 61 (75.3%) reported none. Both groups displayed similar characteristics before treatment, and similarly large increases in BMI, eating-disorder, general psychopathology, and work and social functioning from baseline to 12-month follow-up. Based on these findings, childhood sexual abuse does not appear to compromise outcomes in patients with anorexia nervosa treated via intensive CBT-E.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy.
| | - Cecilia Franchini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Silvia Pivari
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
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Afifi TO, Sareen J, Fortier J, Taillieu T, Turner S, Cheung K, Henriksen CA. Child maltreatment and eating disorders among men and women in adulthood: Results from a nationally representative United States sample. Int J Eat Disord 2017; 50:1281-1296. [PMID: 28990206 PMCID: PMC5698735 DOI: 10.1002/eat.22783] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Child maltreatment is associated with an increased likelihood of having mood disorders, anxiety disorders, post-traumatic stress disorder, substance use disorders, and personality disorders, but far less is known about eating disorders. The objective of the current study was to examine the associations between child maltreatment, including harsh physical punishment, physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, and exposure to intimate partner violence, and eating disorders in adulthood among men and women. METHOD Data were from the National Epidemiologic Survey on Alcohol and Related Conditions wave 3 (NESARC-III) collected in 2012-2013. The sample was nationally representative of the United States adult population (N = 36,309). Lifetime eating disorders (anorexia nervosa [AN], bulimia nervosa [BN], and binge-eating disorder [BED]) were assessed using diagnostic and statistical manual of mental disorders, fifth edition (DSM-5) criteria and the alcohol use disorder and associated disabilities interview schedule-5 (AUDADIS-5). RESULTS The prevalence of any lifetime eating disorder was 1.7% (0.8% among men and 2.7% among women). All child maltreatment types were associated with AN, BN, and BED with notable differences among men and women. Overall, the types of child maltreatment with the strongest relationships with any eating disorder were sexual abuse and physical neglect among men and sexual abuse and emotional abuse among women. DISCUSSION Clinicians should be mindful that child maltreatment experiences are associated with increased odds of eating disorders including AN, BED, and BN. Such relationships are significant among men and women although notable gender differences in these relationships exist. Abstract word count = 248.
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Affiliation(s)
- Tracie O. Afifi
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Jitender Sareen
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada
| | - Janique Fortier
- Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Tamara Taillieu
- Applied Health Sciences Program, University of ManitobaManitobaR3E 0W5Canada
| | - Sarah Turner
- Department of PsychiatryUniversity of ManitobaManitobaR3E 0W5Canada,Department of Community Health SciencesUniversity of ManitobaManitobaR3E 0W5Canada
| | - Kristene Cheung
- Department of PsychologyUniversity of ManitobaManitobaR3E 0W5Canada
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Update on Psychological Trauma, Other Severe Adverse Experiences and Eating Disorders: State of the Research and Future Research Directions. Curr Psychiatry Rep 2017. [PMID: 28624866 DOI: 10.1007/s11920-017-0806-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This paper provides an updated review of the literature on the relationship between psychological trauma exposure, other severe adverse experiences, and eating disorders. RECENT FINDINGS Trauma exposure and other severe adverse experiences (e.g., emotional abuse) in both childhood and adulthood are associated with eating disorders. The relationship between traumatic and other adverse experiences and eating disorders appears to be mediated by emotional and behavioral dysregulation, as well as by cognitive factors such as self-criticism. Biological vulnerabilities may also be relevant to this relationship. Overall, the literature is limited by predominantly cross-sectional designs. There is clear evidence of a correlational relationship between trauma exposure and other severe adverse events, and eating disorders. Both risk and maintenance factor hypotheses have been put forth; however, prospective research testing these hypotheses remains limited. Future research should use prospective designs and focus on trauma-related symptoms (rather than trauma exposure) in order to advance research on risk and maintaining factors for eating disorders and inform treatment directions.
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Molendijk ML, Hoek HW, Brewerton TD, Elzinga BM. Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychol Med 2017; 47:1402-1416. [PMID: 28100288 DOI: 10.1017/s0033291716003561] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Meta-analyses have established a high prevalence of childhood maltreatment (CM) in patients with eating disorders (EDs) relative to the general population. Whether the prevalence of CM in EDs is also high relative to that in other mental disorders has not yet been established through meta-analyses nor to what extent CM affects defining features of EDs, such as number of binge/purge episodes or age at onset. Our aim is to provide meta-analyses on the associations between exposure to CM (i.e. emotional, physical and sexual abuse) on the occurrence of all types of EDs and its defining features. METHOD Systematic review and meta-analyses. Databases were searched until 4 June 2016. RESULTS CM prevalence was high in each type of ED (total N = 13 059, prevalence rates 21-59%) relative to healthy (N = 15 092, prevalence rates 1-35%) and psychiatric (N = 7736, prevalence rates 5-46%) control groups. ED patients reporting CM were more likely to be diagnosed with a co-morbid psychiatric disorder [odds ratios (ORs) range 1.41-2.46, p < 0.05] and to be suicidal (OR 2.07, p < 0.001) relative to ED subjects who were not exposed to CM. ED subjects exposed to CM also reported an earlier age at ED onset [effect size (Hedges' g) = -0.32, p < 0.05], to suffer a more severe form of the illness (g = 0.29, p < 0.05), and to binge-purge (g = 0.31, p < 0.001) more often compared to ED patients who did not report any CM. CONCLUSION CM, regardless of type, is associated with the presence of all types of ED and with severity parameters that characterize these illnesses in a dose dependent manner.
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Affiliation(s)
- M L Molendijk
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, Columbia University, New York, USA
| | - T D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - B M Elzinga
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
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Trottier K, Monson CM, Wonderlich SA, Olmsted MP. Initial Findings From Project Recover: Overcoming Co-Occurring Eating Disorders and Posttraumatic Stress Disorder Through Integrated Treatment. J Trauma Stress 2017; 30:173-177. [PMID: 28398626 DOI: 10.1002/jts.22176] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 11/06/2022]
Abstract
This pilot study is the initial investigation of an integrated cognitive behavioral therapy (CBT) for co-occurring eating disorders (ED) and posttraumatic stress disorder (PTSD). Following a course of intensive hospital-based ED treatment focused on ED behavioral symptom interruption, 10 individuals with ED-PTSD received 16 sessions of CBT that focused on maintaining improvements in ED symptoms outside of the hospital environment and integrated cognitive processing therapy for PTSD. We hypothesized that the treatment would be associated with significant improvements in PTSD symptoms, depression, and anxiety, as well as sustained improvements in ED symptomatology. There were statistically significant improvements in clinician-rated PTSD symptoms (gav = 4.58), depression (gav = 1.37), and anxiety (gav = 1.00). As expected, there was no statistically significant change in ED cognitions (gav = .28). Reliable change analyses revealed that only 1 participant experienced deterioration in ED cognitions over the course of the integrated treatment. Of the 9 participants who were remitted from behavioral ED symptoms at the end of intensive treatment/beginning of the integrated treatment, 8 remained behaviorally remitted at poststudy treatment, which is encouraging given the high rate of rapid relapse following intensive ED treatment. Findings from this study provide preliminary support for the efficacy of an integrated CBT for ED-PTSD.
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Affiliation(s)
- Kathryn Trottier
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Candice M Monson
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA.,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Marion P Olmsted
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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45
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Tolosa-Sola I, Gunnard K, Giménez Muniesa C, Casals L, Grau A, Farré JM. Body dissatisfaction and eating disorder symptomatology: Which factors interfere with sexuality in women with eating disorders? J Health Psychol 2017; 24:1526-1535. [PMID: 28810426 DOI: 10.1177/1359105317695425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Body dissatisfaction is a relevant aspect in both eating disorders and sexuality. Using Stice's model, this study aimed to evaluate the relationship between these variables in eating disorder patients compared with healthy controls. Statistically significant correlations between body dissatisfaction and sexuality were found in the whole sample. The clinical group had higher rates of body dissatisfaction and sexual impairment. Within the clinical group, the participants with a greater drive for thinness showed higher sexual dysfunctions. These results suggest that sexuality should be systematically explored in eating disorders. Higher rates of drive for thinness may be associated with greater sexual impairment.
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Affiliation(s)
| | | | | | | | - Antoni Grau
- 3 Institut de Trastorns Alimentaris (ITA), Spain
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Trottier K, Monson CM, Wonderlich SA, MacDonald DE, Olmsted MP. Frontline clinicians' perspectives on and utilization of trauma-focused therapy with individuals with eating disorders. Eat Disord 2017; 25:22-36. [PMID: 27463764 DOI: 10.1080/10640266.2016.1207456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With this study, we sought to survey clinicians regarding their perspectives and use of concurrent or integrated psychotherapy for co-occurring eating disorders (EDs) and posttraumatic stress disorder. We conducted a quantitative survey of 184 frontline ED clinicians to investigate whether, and to what extent, they view concurrent EDs and trauma-focused therapy as clinically important. We also assessed clinicians' specific concerns regarding concurrent EDs and trauma-focused treatment, as well as barriers to implementation of an evidence-based concurrent treatment. On the whole, clinicians reported that addressing trauma-related symptoms in individuals with EDs is highly important and should be administered concurrently. Although clinicians reported anticipating many important benefits of concurrent treatment, they also reported anticipating several potential negative side effects, and they reported a number of perceived barriers to implementation. Clinicians working in hospital settings anticipated more complications, expected fewer benefits, and perceived more barriers to the administration of concurrent treatment.
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Affiliation(s)
- Kathryn Trottier
- a Department of Psychiatry , University Health Network , Toronto , Ontario , Canada.,b Department of Psychiatry , University of Toronto , Toronto , Ontario , Canada
| | - Candice M Monson
- c Department of Psychology , Ryerson University , Toronto , Ontario , Canada
| | - Stephen A Wonderlich
- d Neuropsychiatric Research Institute & Department of Clinical Neuroscience , University of North Dakota , Fargo , North Dakota , USA
| | - Danielle E MacDonald
- a Department of Psychiatry , University Health Network , Toronto , Ontario , Canada.,c Department of Psychology , Ryerson University , Toronto , Ontario , Canada
| | - Marion P Olmsted
- a Department of Psychiatry , University Health Network , Toronto , Ontario , Canada.,b Department of Psychiatry , University of Toronto , Toronto , Ontario , Canada
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47
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Associations between adverse childhood experiences and clinical characteristics of eating disorders. Sci Rep 2016; 6:35761. [PMID: 27804994 PMCID: PMC5090200 DOI: 10.1038/srep35761] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/03/2016] [Indexed: 11/10/2022] Open
Abstract
Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively.
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Roux H, Ali A, Lambert S, Radon L, Huas C, Curt F, Berthoz S, Godart N. Predictive factors of dropout from inpatient treatment for anorexia nervosa. BMC Psychiatry 2016; 16:339. [PMID: 27716113 PMCID: PMC5045614 DOI: 10.1186/s12888-016-1010-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with severe Anorexia Nervosa (AN) whose condition is life-threatening or who are not receiving adequate ambulatory care are hospitalized. However, 40 % of these patients leave the hospital prematurely, without reaching the target weight set in the treatment plan, and this can compromise outcome. This study set out to explore factors predictive of dropout from hospital treatment among patients with AN, in the hope of identifying relevant therapeutic targets. METHODS From 2009 to 2011, 180 women hospitalized for AN (DSM-IV diagnosis) in 10 centres across France were divided into two groups: those under 18 years (when the decision to discharge belongs to the parents) and those aged 18 years and over (when the patient can legally decide to leave the hospital). Both groups underwent clinical assessment using the Morgan & Russell Global Outcome State questionnaire and the Eating Disorders Examination Questionnaire (EDE-Q) for assessment of eating disorder symptoms and outcome. Psychological aspects were assessed via the evaluation of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Socio-demographic data were also collected. A number of factors identified in previous research as predictive of dropout from hospital treatment were tested using stepwise descending Cox regressions. RESULTS We found that factors predictive of dropout varied according to age groups (being under 18 as opposed to 18 and over). For participants under 18, predictive factors were living in a single-parent family, severe intake restriction as measured on the "dietary restriction" subscale of the Morgan & Russell scale, and a low patient-reported score on the EDE-Q "restraint concerns" subscale. For those over 18, dropout was predicted from a low depression score on the HADS, low level of concern about weight on the EDE-Q subscale, and lower educational status. CONCLUSION To prevent dropout from hospitalization for AN, the appropriate therapeutic measures vary according to whether patients are under or over 18 years of age. Besides the therapeutic adjustments required in view of the factors identified, the high dropout rate raises the issue of resorting more frequently to compulsory care measures among adults.
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Affiliation(s)
- H. Roux
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - A. Ali
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - S. Lambert
- Service d’Addictologie, CHU Nantes, Paris, France
| | - L. Radon
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - C. Huas
- Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - F. Curt
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France
| | - S. Berthoz
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014 Paris, France ,Faculté de Médecine, Université Paris Descartes, Paris, France ,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679 Paris, France ,Université Paris Descartes, Paris, France ,Université Paris Sud, Villejuif, France ,UVSQ, Villejuif, France ,Université Paris-Saclay, Villejuif, France
| | - Nathalie Godart
- Département de Psychiatrie, Institut Mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France. .,Faculté de Médecine, Université Paris Descartes, Paris, France. .,Center of Research in Epidemiology and Population Health, INSERM U1018, Paris Sud University, 97 Bd de Port-Royal, F-75679, Paris, France. .,Université Paris Descartes, Paris, France. .,Université Paris Sud, Villejuif, France. .,UVSQ, Villejuif, France. .,Université Paris-Saclay, Villejuif, France.
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Engh Kraft L, Rahm G, Eriksson UB. School Nurses Avoid Addressing Child Sexual Abuse. J Sch Nurs 2016; 33:133-142. [DOI: 10.1177/1059840516633729] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an available person prepared to listen. The aim of the study was to explore the ability of the school nurses to detect and support sexually abused children. It is a secondary analysis of focus group interviews with school nurses. Thematic analysis was performed. Results showed that the school nurses avoided addressing CSA due to arousal of strong emotions, ambivalence, and a complicated disclosure process. In order to detect CSA and support abused children, attentiveness of sexual abuse as a possible cause of physical and mental ill-health is crucial.
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Affiliation(s)
- Lisbet Engh Kraft
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - GullBritt Rahm
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
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50
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Childhood maltreatment and pre-pregnancy obesity: a comparison of obese, overweight, and normal weight pregnant women. Arch Womens Ment Health 2016; 19:355-65. [PMID: 26386682 DOI: 10.1007/s00737-015-0573-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 09/13/2015] [Indexed: 10/25/2022]
Abstract
Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95% CI 1.48-47.03; obesity: OR = 6.31, 95% CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95% CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms.
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