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Meneguzzo P, Terlizzi S, Maggi L, Todisco P. The loneliness factor in eating disorders: Implications for psychopathology and biological signatures. Compr Psychiatry 2024; 132:152493. [PMID: 38696935 DOI: 10.1016/j.comppsych.2024.152493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/07/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES Eating disorders (ED) are severe psychiatric conditions. While the biological consequences of EDs are well established, including an increase in inflammatory biomarkers, the influence of psychological factors, such as loneliness, has only recently gained attention in research. Loneliness has been associated with more severe psychopathology in ED patients, while its association with inflammatory biomarkers has only been explored in the general population. For these reasons, we aimed to investigate any possible associations between psychological features, trauma, and inflammatory biomarkers with loneliness in people with ED. METHODS This study examined the interaction between loneliness, eating psychopathology, and biological markers in people with EDs. A group of 97 female patients with various diagnoses of ED was assessed for loneliness, general and eating psychopathology, traumatic history during childhood, and clinical biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and urinary-free cortisol (UFC). RESULTS The results indicated that individuals with ED who reported moderate to severe loneliness also displayed greater general psychopathology (p = 0.001), weight concerns (p = 0.007), and physical neglect during childhood (p = 0.006). Furthermore, people with higher levels of loneliness also had higher inflammatory indexes (ESR p = 0.001, CRP p = 0.027) and were positively correlated with markers of stress reaction such as UFC (p < 0.05). CONCLUSION The findings underscore the importance of considering loneliness in the assessment of individuals with an ED. We observed notable associations between loneliness and increased psychopathology (both general and specific to eating), as well as higher levels of inflammation and childhood physical neglect. Addressing loneliness may contribute to improving overall well-being and potentially support recovery. This consideration encompasses both psychological and physical factors that interplay in the clinical presentation of individuals.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Samira Terlizzi
- Eating Disorders Unit, Casa di Cura Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy.
| | - Luca Maggi
- Eating Disorders Unit, Casa di Cura Ville di Nozzano - Neomesia, Nozzano, Lucca, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
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Schuman I, Wang J, Ballard IC, Lapate RC. Waiting for it: Anorexia Risk, Future Orientation, and Intertemporal Discounting. RESEARCH SQUARE 2024:rs.3.rs-4002723. [PMID: 38585785 PMCID: PMC10996782 DOI: 10.21203/rs.3.rs-4002723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Anorexia Nervosa is a severe eating disorder characterized by food restriction in service of a future goal: thinness and weight loss. Prior work suggests abnormal intertemporal decision-making in anorexia, with more farsighted decisions observed in patients with acute anorexia. Prospective future thinking in daily life, or temporal orientation, promotes more farsighted delay discounting. However, whether temporal orientation is altered in anorexia, and underlies reduced delay discounting in this population, remains unclear. Further, because changes in delay discounting could reflect cognitive effects of an acute clinical state, it is important to determine whether reduced delay discounting is observed in subclinical, at-risk samples. We measured delay discounting behavior and temporal orientation in a large sample of never-diagnosed individuals at risk of anorexia nervosa. We found that farsighted delay discounting was associated with elevated risk for anorexia nervosa. Anorexia nervosa risk was also associated with increased future-oriented cognition. Future-oriented cognition mediated the difference in delay-discounting behavior between high and low-risk groups. These results were unrelated to subjective time perception and were independent of mood and anxiety symptomatology. These findings establish future-oriented cognition as a cognitive mechanism underlying altered intertemporal decision-making in individuals at risk of developing anorexia nervosa.
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Affiliation(s)
- Isabel Schuman
- Department of Psychological & Brain Sciences, University of California, Santa Barbara
| | - Jingyi Wang
- Department of Psychological & Brain Sciences, University of California, Santa Barbara
| | - Ian C Ballard
- Department of Psychology, University of California, Riverside
| | - Regina C Lapate
- Department of Psychological & Brain Sciences, University of California, Santa Barbara
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3
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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Rosenbaum DL, Gillen MM, Bloomer SA. The effects of sleep on body image: examining the roles of depression, perceived stress, and anxiety. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 36977339 DOI: 10.1080/07448481.2023.2186153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/19/2022] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
Objective: Although health and wellness behaviors are associated with positive body image, research is limited regarding the relationship between sleep and positive body image. We propose that negative affective states may link sleep and body image. Specifically, we examined whether better sleep may relate to positive body image through reductions in negative affective experiences. Participants: Participants were 269 undergraduate women. Methods: Cross-sectional surveys were administered. Results: We found correlations in the expected directions between sleep, positive body image variables (i.e., body appreciation, appearance evaluation, and appearance orientation), and negative affective states (i.e., depression, anxiety, and stress). There were group differences in negative affective states and body image based on adequate sleep. Data supported indirect effects of sleep through depression on appearance evaluation, and through depression and stress on body appreciation, respectively. Conclusions: Our findings indicate sleep warrants further research attention as a wellness behavior related to more positive body image.
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Affiliation(s)
- Diane L Rosenbaum
- Psychological and Social Sciences, Abington College, Pennsylvania State University, Abington, PA, USA
| | - Meghan M Gillen
- Psychological and Social Sciences, Abington College, Pennsylvania State University, Abington, PA, USA
| | - Steven A Bloomer
- Biology, Abington College, Pennsylvania State University, Abington, PA, USA
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Kenny TE, Lewis SP. More than an outcome: a person-centered, ecological framework for eating disorder recovery. J Eat Disord 2023; 11:45. [PMID: 36949489 PMCID: PMC10032254 DOI: 10.1186/s40337-023-00768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/08/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Eating disorder recovery is a complex phenomenon. While historical understandings focused on weight and behaviours, the importance of psychological factors is now widely recognized. It is also generally accepted that recovery is a non-linear process and is impacted by external factors. Recent research suggests a significant impact of systems of oppression, though these have not yet been named in models of recovery. BODY: In this paper, we propose a research-informed, person-centered, and ecological framework of recovery. We suggest that there are two foundational tenets of recovery which apply broadly across experiences: recovery is non-linear and ongoing and there is no one way to do recovery. In the context of these tenets, our framework considers individual changes in recovery as determined by and dependent on external/personal factors and broader systems of privilege. Recovery cannot be determined by looking solely at an individual's level of functioning; one must also consider the broader context of their life in which changes are being made. To conclude, we describe the applicability of the proposed framework and offer practical considerations for incorporating this framework in research, clinical, and advocacy settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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Portingale J, Eddy S, Fuller-Tyszkiewicz M, Liu S, Giles S, Krug I. Tonight, I'm disordered eating: The effects of food delivery app use, loneliness, and mood on daily body dissatisfaction and disordered eating urges. Appetite 2023; 180:106310. [PMID: 36122621 DOI: 10.1016/j.appet.2022.106310] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/03/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022]
Abstract
With the recent proliferation of food delivery applications ('apps'; FDAs), accessing a meal is more convenient and immediate than ever. However, these apps may foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are required.
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Affiliation(s)
- Jade Portingale
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Sarah Eddy
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia; Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
| | - Shanshan Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
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Kenny TE, Trottier K, Lewis SP. Lived experience perspectives on a definition of eating disorder recovery in a sample of predominantly white women: a mixed method study. J Eat Disord 2022; 10:149. [PMID: 36224653 PMCID: PMC9558402 DOI: 10.1186/s40337-022-00670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There has recently been a push for recovery-focused research in the eating disorder (ED) field, starting with a consensus definition of recovery. One definition, in particular, proposed by Bardone-Cone et al. [21] has received considerable attention given its transdiagnostic nature and validation studies. However, no studies to date have elicited lived experience views of this definition. The goal of the current study was to examine perspectives on this definition of recovery from individuals with a past or present ED and to determine whether participant agreement with the model differed based on diagnostic history or current symptom severity. METHODS Sixty-two individuals (95.2% women; 91.9% White/European) participated in a 1-2 h interview aimed at capturing their perspectives on ED recovery. Transcripts were analyzed using qualitative content analysis and codebook thematic analysis to examine agreement with and thoughts on Bardone-Cone's definition of recovery, respectively. Chi-squared tests of independence and binary logistic regression were computed to determine whether agreement with the definition differed across diagnostic history and self-reported symptoms. RESULTS Although some participants indicated acceptance of the definition, the majority expressed concerns related to its categorical nature, proposed criteria, feasibility, language, and applications. There were no differences in acceptance based on diagnostic history or current symptom severity. CONCLUSION A single definition of recovery does not seem to fit individuals' lived ED experience. Future research may benefit from distinguishing between recovery as an individually-defined phenomenon and related constructs such as remission (i.e., loss of diagnosis or absence of clinical symptoms). A more comprehensive multi-faceted, and person-centered model of recovery may have merit in clinical settings.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
| | - Kathryn Trottier
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Stephen P Lewis
- Department of Psychology, University of Guelph, 50 Stone Road E., Guelph, ON, N1G 2W1, Canada
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Breton E, Fotso Soh J, Booij L. Immunoinflammatory processes: Overlapping mechanisms between obesity and eating disorders? Neurosci Biobehav Rev 2022; 138:104688. [PMID: 35594735 DOI: 10.1016/j.neubiorev.2022.104688] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
Obesity and eating disorders are conditions that involve eating behaviors and are sometimes comorbid. Current evidence supports alterations in immunoinflammatory processes in both obesity and eating disorders. A plausible hypothesis is that immunoinflammatory processes may be involved in the pathophysiology of obesity and eating disorders. The aim of this review is to highlight the link between obesity and eating disorders, with a particular focus on immunoinflammatory processes. First, the relation between obesity and eating disorders will be presented, followed by a brief review of the literature on their association with immunoinflammatory processes. Second, developmental factors will be discussed to clarify the link between obesity, eating disorders, and immunoinflammatory processes. Genetic and epigenetic risk factors as well as the potential roles of stress pathways and early life development will be presented. Finally, implications of these findings for future research are discussed. This review highlighted biological and developmental aspects that overlap between obesity and EDs, emphasizing the need for biopsychosocial research approaches to advance current knowledge and practice in these fields.
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Affiliation(s)
- E Breton
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada
| | - J Fotso Soh
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychology, Concordia University, Montreal, Canada
| | - L Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada; Department of Psychiatry and Addictology, University of Montreal, Montreal, Canada; Department of Psychology, Concordia University, Montreal, Canada.
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Eating Disorders and Intimate Partner Violence: The Influence of Fear of Loneliness and Social Withdrawal. Nutrients 2022; 14:nu14132611. [PMID: 35807792 PMCID: PMC9268080 DOI: 10.3390/nu14132611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
Eating disorders are vulnerability factors that increase the likelihood of intimate partner violence. However, the mechanisms underlying this relationship are unclear. Although eating disorders have been associated with increased perception and fear of loneliness, they have also been associated with increased social withdrawal resulting from decreased enjoyment of social situations and poorer social functioning. The purpose of the present study was to examine the mediating role of fear of loneliness in the relationship between the behavioural characteristics of eating disorders and intimate partner violence, as well as to explore the moderating role of social withdrawal in the relationship between fear of loneliness and intimate partner violence. The sample comprised 683 participants (78% female and 22% male) with a mean age of 21.14 years (SD = 2.72). The psychometric scales used were Eating Disorders Inventory (EDI 2), Emotional Dependency Questionnaire (EDQ), Coping Strategies Inventory (CSI) and the Violence Received, Exercised and Perceived in Youth and Adolescent Dating Relationships Scale (VREPS). The hypothesised model was tested by path analysis using maximum likelihood. The path analysis of the hypothesised model showed that inefficacy, fear of maturity, and impulsivity were the behavioural characteristics of eating disorders predominantly related to fear of loneliness. Fear of loneliness had no direct significant effect on any of the received violence variables. However, interaction effects indicated that there was a moderately significant effect of fear of loneliness on physical, psychological, and social violence received as a function of levels of social withdrawal. These findings show the need to take into account and work on fear of loneliness and social withdrawal among individuals with an eating disorder to decrease the likelihood of establishing violent intimate partner relationships. Improving interpersonal functioning and social support is key to recovery from eating disorders.
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Investigation of Loneliness and Social Support in Patients with Eating Disorders: A Case-Control Study. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Loneliness and, to a lesser degree, social support are considered under-researched topics in the literature on eating disorders (ED). This study attempted to expand the relevant body of research by examining loneliness in combination with social support in ED patients and in healthy controls (HC). Binge-eating problems, emotional eating, resilience, anxiety, and depression symptoms were also assessed. Thirty-two patients with ED and twenty-nine HC completed the following measures: UCLA Loneliness Scale, Social Support Questionnaire—Short Form, Binge Eating Scale, Emotional Eating Scale, Connor–Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and the Eating Disorder Examination Questionnaire. Eating-disorder patients showed higher levels of loneliness and lower levels of social support—both in terms of perceived availability and satisfaction—than HC. Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) subgroups did not differ significantly on either of these variables. In ED patients, loneliness was only correlated with Social Support Satisfaction (negatively) and depressive symptomatology (positively). Patients with ED appear to be lonelier and less satisfied with their social support compared to HC. We found similar levels of loneliness and social support between AN, BN, and BED sufferers. Decreased social support satisfaction and elevated symptoms of depression could account for ED patients’ high levels of loneliness.
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McNamara N, Wakefield JRH, Cruwys T, Potter A, Jones BA, McDevitt S. The link between family identification, loneliness, and symptom severity in people with eating disorders. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2022. [DOI: 10.1002/casp.2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Niamh McNamara
- Department of Psychology Nottingham Trent University Nottingham UK
| | | | - Tegan Cruwys
- Research School of Psychology The Australian National University Canberra Australian Capital Territory Australia
| | - Adam Potter
- Department of Psychology Nottingham Trent University Nottingham UK
| | - Bethany A. Jones
- Department of Psychology Nottingham Trent University Nottingham UK
| | - Sara McDevitt
- Department of Psychiatry University College Cork Cork Ireland
- Consultant Child & Adolescent Psychiatrist Health Services Executive Dublin Ireland
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Wade TD, Allen K, Crosby RD, Fursland A, Hay P, McIntosh V, Touyz S, Schmidt U, Treasure J, Byrne S. Outpatient therapy for adult anorexia nervosa: Early weight gain trajectories and outcome. EUROPEAN EATING DISORDERS REVIEW 2020; 29:472-481. [PMID: 32838476 DOI: 10.1002/erv.2775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/10/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. METHOD Participants (n = 120) were randomised to one of three outpatient therapies. RESULTS Four latent classes were identified; two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m2 at initial assessment, and both gained significantly more weight over the 13 sessions compared to the other two classes. The third and fourth classes (middle, stable and low, stable) had an initial BMI of 16.44 and 15.31, respectively, and neither gained weight over the first 13 sessions. Compared to the other three classes, the higher, rapid class (N = 19, 16%) showed a significantly greater BMI increase over the first 13 sessions of therapy and a significantly higher rate of remission at end of treatment and 12-month follow-up (18-22 months post-randomisation). CONCLUSIONS The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Karina Allen
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research and the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Anthea Fursland
- Centre for Clinical Interventions, Perth, Western Australia, Australia.,Western Australia Eating Disorders Outreach & Consultation Service, Perth, Western Australia, Australia
| | - Phillipa Hay
- School of Medicine & Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
| | - Virginia McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Stephen Touyz
- School of Psychology, Sydney University, Sydney, New South Wales, Australia
| | - Ulrike Schmidt
- Department of Psychological Medicine, Kings College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| | - Susan Byrne
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
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Wade TD, Lock J. Developing consensus on the definition of remission and recovery for research. Int J Eat Disord 2020; 53:1204-1208. [PMID: 31469436 DOI: 10.1002/eat.23165] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current research investigated whether a consensus among professional eating disorder researchers existed for definitions of remission and recovery that could be used in research. METHOD Membership of the Eating Disorder Research Society and attendees at the 2018 annual meeting in Sydney were invited to participate in this investigation. Two surveys were conducted with 62 and 122 respondents, respectively. The first survey used a mix of forced choice yes/no or scaled responses. The second survey was a free response to the question "which definitions of recovery do you favor?" RESULTS A majority consensus emerged about three issues. First, it was agreed that it was important to develop a standard definition of recovery for research purposes. Second, recovery needed to be evident over a 12-month period, with remission evident over a 3- to 12-month period. Third, recovery and remission required the absence of diagnostic criteria in addition to the presence of functional recovery. DISCUSSION Consensus is apparent in the field. We suggest that future research seeks to: (a) validate the most commonly researched definition of remission and recovery across different eating disorders using a standardized battery of assessments, and (b) better understand differences in self-assessed and psychometrically assessed recovery.
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Affiliation(s)
- Tracey D Wade
- Discipline of Psychology, College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - James Lock
- Discipline of Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Bardone-Cone AM, Miller AJ, Thompson KA, Walsh EC. Predicting a comprehensive operationalization of eating disorder recovery: Examining self-concept, personality, and negative affect. Int J Eat Disord 2020; 53:987-996. [PMID: 32343432 DOI: 10.1002/eat.23281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Our goal was to examine potential predictors of a comprehensive operationalization of eating disorder recovery, characterized by physical, behavioral, and cognitive recovery, focusing on constructs related to self-concept, personality, and negative affect. METHOD Participants were women with a history of an eating disorder who provided data via survey and interview at two time points separated by about 7-8 years and who met criteria for an eating disorder diagnosis at baseline (N = 36). RESULTS Logistic regression models revealed that self-esteem was a significant predictor of recovery status (OR = 1.12, p = .039) such that individuals with higher self-esteem at baseline demonstrated significantly greater odds of being in full recovery at follow-up. However, when self-esteem was considered in a set along with baseline imposter phenomenon and anxiety, no single construct emerged as a significant unique predictor of recovery in logistic regression analyses. DISCUSSION These results highlight the potential importance of self-esteem in relation to recovery, with clinical implications related to bolstering self-esteem as part of eating disorder treatment. Future research should continue to explore predictors using a comprehensive operationalization of eating disorder recovery in larger, more diverse samples to optimally identify factors associated with achieving recovery.
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Affiliation(s)
- Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alexandra J Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine A Thompson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily C Walsh
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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DeSocio JE. Challenges in diagnosis and treatment of comorbid eating disorders and mood disorders. Perspect Psychiatr Care 2019; 55:494-500. [PMID: 30729521 DOI: 10.1111/ppc.12355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/28/2018] [Accepted: 01/06/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This paper explores complex challenges in diagnosis and treatment of patients with comorbid eating disorders and mood disorders. An integrative review of the literature examines overlapping symptoms, phenotypes, neural circuits, and genetic factors for these disorders. A case study illustrates how the integration of knowledge from research and practice can inform a diagnostic formulation and multifaceted treatment plan. CONCLUSIONS Patients with complex clinical presentations inspire a search for research and clinical literature that helps build the neuroscience foundations of advanced practice. PRACTICE IMPLICATIONS Sharing clinical challenges and processes of discovery is a form of scholarship that promotes the evolution of advanced psychiatric nursing practice.
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Tomba E, Tecuta L, Crocetti E, Squarcio F, Tomei G. Residual eating disorder symptoms and clinical features in remitted and recovered eating disorder patients: A systematic review with meta-analysis. Int J Eat Disord 2019; 52:759-776. [PMID: 31169332 DOI: 10.1002/eat.23095] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE In psychiatry, the presence of residual symptoms after treatment is linked to the definitions of remission and recovery. To identify the presence of residual eating disorder (ED) symptoms and associated non-ED clinical features in remitted and recovered EDs, the current systematic review with meta-analysis was performed. METHOD A systematic review was conducted on residual ED symptoms and non-ED clinical features including comorbid psychopathology, neurophysiological functioning, cognitive functioning, and quality of life in ED patients considered remitted or recovered. To examine residual ED symptoms, meta-analyses were performed while considering age, study quality, remission, and recovery criteria strictness as moderators. Sensitivity, publication bias, and heterogeneity analyses were also conducted. RESULTS The 64 studies selected for the systematic review underscored the presence of residual ED symptoms in anorexia nervosa (AN) and bulimia nervosa (BN), and impairments and deficits in the additional features examined. From the 64 studies, 31 were selected regarding residual ED symptoms in AN for meta-analysis. Large effect sizes indicated that remitted/recovered AN patients reported significantly lower body mass index (Hedges' g = -0.62[-0.77, -0.46]) and significantly greater symptomatology in terms of ED examination-questionnaire (Hedges'g = 0.86 [0.48,1.23]) and ED inventory (Hedges' g = 0.94[0.64,1.24]) than healthy controls, independently of remission and recovery criteria strictness, age, and study quality. DISCUSSION The presence of residual ED symptoms in AN is quantitatively supported, whereas the presence of residual ED symptoms in BN should be further investigated. Data on binge-eating disorder are missing. Future research should use consistent, multicomponent, and standardized comparable indicators of recovery.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | - Fabio Squarcio
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Giuliano Tomei
- Oxford Health NHS Foundation Trust, Department of Psychiatry, University of Oxford, Oxford, UK
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Sala M, Egbert AH, Lavender JM, Goldschmidt AB. Affect, reward, and punishment in anorexia nervosa: a narrative overview. Eat Weight Disord 2018; 23:731-737. [PMID: 30288725 PMCID: PMC7479630 DOI: 10.1007/s40519-018-0588-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/26/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is a serious psychiatric disorder that is difficult to treat and often follows a protracted course. A number of theoretical models have been proposed for the etiology and maintenance of AN. Two domains that have received substantial attention in the literature on AN are affect and reward/punishment processes. However, despite an overlap in the nature and implications of these processes, studies of AN addressing these constructs have typically investigated them independently. PURPOSE The purpose of this narrative review is to integrate the literature on the role of affect, reward, and punishment in AN. METHOD We provide a focused narrative overview of the literature relating to the affect, reward, and punishment in AN via a synthesis of recent reviews and meta-analyses. RESULTS We first describe several prominent affect and reward/punishment-based conceptualizations of AN, followed by a brief overview of the existing empirical literature in these domains. CONCLUSION We provide a critical discussion of the disparate nature of these literatures in AN, including associated limitations. We then conclude with an extensive discussion of directions for future research that integrate the study of affect and reward/punishment processes in AN. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75206, USA.
| | - Amy H Egbert
- Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Jason M Lavender
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
| | - Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Weight Control and Diabetes Research Center/The Miriam Hospital, Providence, RI, USA
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Garcia D, Granjard A, Lundblad S, Archer T. A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients. PeerJ 2017; 5:e3801. [PMID: 28929023 PMCID: PMC5600947 DOI: 10.7717/peerj.3801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence) necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients' life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. METHOD A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. RESULTS A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but only the past positive and present hedonistic time dimensions predicted life satisfaction among patients. CONCLUSION Anorexia patients were less satisfied with life despite being more conscientious, social, and agreeable than controls. Moreover, compared to controls, patients had an unbalanced time perspective: a dark view of the past (i.e., high past negative), a restrained present (i.e., low present hedonistic) and an apocalyptic view of the future (i.e., high present fatalistic). It is plausible to suggest that, therapeutic interventions should focus on empowering patients to cultivate a sentimental and positive view of the past (i.e., high past positive) and the desire to experience pleasure without concern for future consequences (i.e., high present hedonistic) so that they can make self-directed and flexible choices for their own well-being. Such interventions might have effects on life satisfaction beyond the patients' temperamental disposition.
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Affiliation(s)
- Danilo Garcia
- Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Network for Empowerment and Well-Being, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Alexandre Granjard
- Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden
| | - Suzanna Lundblad
- Psychiatry Affective, Anorexia & Bulimia Clinic for Adults, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Trevor Archer
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Network for Empowerment and Well-Being, Sweden
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Patel K, Tchanturia K, Harrison A. An Exploration of Social Functioning in Young People with Eating Disorders: A Qualitative Study. PLoS One 2016; 11:e0159910. [PMID: 27458808 PMCID: PMC4961427 DOI: 10.1371/journal.pone.0159910] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/11/2016] [Indexed: 11/19/2022] Open
Abstract
Previous research indicates adults with eating disorders (EDs) report smaller social networks, and difficulties with social functioning, alongside demonstrating difficulties recognising and regulating emotions in social contexts. Concurrently, those recovered from the illness have discussed the vital role offered by social support and interaction in their recovery. To date, little is known about the social skills and social networks of adolescents with EDs and this study aimed to conduct focus groups to explore the social functioning of 17 inpatients aged 12-17. Data were analysed using thematic analysis and six core themes were identified: group belonging, self-monitoring, social sensitivity, impact of hospitalisation, limited coping strategies and strategies for service provision. Key areas for service provision were: management of anxiety, development and/or maintenance of a social network and development of inter and intrapersonal skills. The most salient finding was that adolescents with EDs reported social difficulties which appeared to persist over and above those typically experienced at this point in the lifespan and therefore a key area for future focus is the development of appropriate coping strategies and solutions to deal with these reported difficulties.
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Affiliation(s)
- Krisna Patel
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Harrison
- Regent’s University London, Faculty of Humanities, Arts and Social Sciences, School of Psychotherapy and Psychology, London, United Kingdom
- Ellern Mede Service for Eating Disorders, London, United Kingdom
- * E-mail:
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Forrest LN, Bodell LP, Witte TK, Goodwin N, Bartlett ML, Siegfried N, Eddy KT, Thomas JJ, Franko DL, Smith AR. Associations between eating disorder symptoms and suicidal ideation through thwarted belongingness and perceived burdensomeness among eating disorder patients. J Affect Disord 2016; 195:127-35. [PMID: 26895090 DOI: 10.1016/j.jad.2016.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/14/2016] [Accepted: 02/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicidal ideation is relatively common among people with eating disorders (EDs). The Interpersonal-Psychological Theory of Suicide holds that suicidal ideation has two proximal causes: thwarted belongingness and perceived burdensomeness. It is unknown which ED symptoms are positively associated with suicidal ideation, and whether thwarted belongingness and perceived burdensomeness explain those associations. METHOD We tested two parallel mediation models to determine whether current and lifetime ED symptoms were positively related to suicidal ideation through thwarted belongingness and perceived burdensomeness among ED patients (n=98), controlling for current depression. In each model, ED symptoms and depression were predictors, thwarted belongingness and perceived burdensomeness were mediators, and suicidal ideation was the outcome. RESULTS The first model included current symptoms; current body dissatisfaction (ab=0.04, 95% CI [0.01, 0.06]) and fasting (ab=0.12, 95% CI [0.01, 0.22]) were indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. The second model included lifetime symptoms; lifetime fasting (ab=0.18, 95% CI [0.07, 0.29]) was indirectly related to increased suicidal ideation through higher burdensomeness, controlling for depression. LIMITATIONS The sample size prevented the use of latent variables for thwarted belongingness and perceived burdensomeness, and the cross-sectional data prevented testing for bidirectional relations among ED symptoms, thwarted belongingness, perceived burdensomeness, and suicidal ideation. CONCLUSIONS Results underscore the importance of exploring transdiagnostic ED symptoms, including body dissatisfaction and fasting in particular, that may intensify burdensomeness and thereby contribute to suicidal ideation over and above depressive symptoms in this high-risk population.
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Affiliation(s)
- Lauren N Forrest
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States
| | - Lindsay P Bodell
- University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, United States
| | - Tracy K Witte
- Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL 36849, United States
| | - Natalie Goodwin
- Eating Recovery Center of Washington, 1231 116th Ave NE, Bellevue, WA 98004, United States
| | - Mary L Bartlett
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Nicole Siegfried
- Castlewood Treatment Center, 2807 Greystone Commercial Blvd #36, Birmingham, AL 35242, United States
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114, United States; Bouvé College of Health Sciences and Department of Counseling and Applied Educational Psychology, Northeastern University, 123 Behrakis Health Sciences Center, Boston, MA 02115, United States
| | - April R Smith
- Department of Psychology, Miami University, 90 N. Patterson Dr., Oxford, OH 45056, United States.
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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Doris E, Westwood H, Mandy W, Tchanturia K. A Qualitative Study of Friendship in Patients with Anorexia Nervosa and Possible Autism Spectrum Disorder. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/psych.2014.511144] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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