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Tomba E, Tecuta L, Gardini V, Tomei G, Lo Dato E. Staging models in eating disorders: A systematic scoping review of the literature. Compr Psychiatry 2024; 131:152468. [PMID: 38460478 DOI: 10.1016/j.comppsych.2024.152468] [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: 01/11/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.
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Affiliation(s)
- E Tomba
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - L Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | - V Gardini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - G Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | - E Lo Dato
- Department of Psychology, University of Bologna, Bologna, Italy
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Marcolini F, Ravaglia A, Tempia Valenta S, Bosco G, Marconi G, De Ronchi D, Atti AR. Severe enduring anorexia nervosa (SE-AN) treatment options and their effectiveness: a review of literature. J Eat Disord 2024; 12:48. [PMID: 38654374 DOI: 10.1186/s40337-024-01006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION For nearly 20% of patients diagnosed with Anorexia Nervosa (AN), the eating disorder (ED) is prolonged and becomes long-lasting. It has been reported that patients diagnosed with Severe Enduring Anorexia Nervosa (SE-AN) have worse ED symptoms, higher rates of lifetime hospitalization, and lower psychosocial well-being compared to patients with shorter disease duration. OBJECTIVES This review aims to describe the treatments proposed to date and their effectiveness on SE-AN-related outcomes. METHODS We conducted a PubMed search for studies addressing the issue of treatment approach to SE-AN adults, that were published between 2003 and 2023, peer-reviewed, written in the English language, and available in full-text. Next, we inductively created relevant macro-themes by synthesizing the data from the included articles. RESULTS Of 251 PubMed studies, 25 articles were considered for data extraction, all published between 2003 and 2022. We identified three macro-themes. The first macro-theme, "Psychotherapy", mostly takes into consideration treatment effectiveness of cognitive behavioral therapy (CBT). Various reports determined its greater effectiveness compared to Specialist Supportive Clinical Management (SSCM), and one study proved that outpatient CBT is a valid alternative to hospitalization. The second one involves "Pharmacological Treatments". Research on dronabinol, a synthetic orexigenic cannabinoid, antipsychotics (in particular, olanzapine and haloperidol), and ketamine showed some mixed results regarding the often-complementary areas of weight gain and improvement in ED-related symptoms. Regarding the third macro-theme, "Brain Stimulation Therapies," such as Repetitive Transcranial Magnetic Stimulation (rTMS) and Deep Brain Stimulation (DBS), we found promising results in improving ED-related psychological traits (such as mood and anxiety), affective regulation, and quality of life. However, we have observed divergent results regarding outcome measures such as BMI and weight gain. CONCLUSIONS SE-AN patients are predicted to encounter both medical complications and psychological distress of increasing severity that will inevitably affect their quality of life; to our knowledge, research evidence on treatment options for SE-AN remains limited, and the methodological quality of studies is generally low. These findings denote the need to focus future research efforts on effective treatment strategies specific to long-lasting EDs.
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Affiliation(s)
- Federica Marcolini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy.
| | - Alessandro Ravaglia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Silvia Tempia Valenta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Giovanna Bosco
- Department of Clinical Nutrition, AUSL Bologna, Bologna, Italy
| | - Giorgia Marconi
- U.O. Cure Primarie, AUSL Area Vasta Romagna, Ambito di Rimini, Rimini, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Viale Pepoli 5, 40123, Bologna, Italy
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Williams M, Kingston Miller A, Lafrance A. Ayahuasca ceremony leaders' perspectives on special considerations for eating disorders. Eat Disord 2024; 32:120-139. [PMID: 37943076 DOI: 10.1080/10640266.2023.2271201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Eating disorders (EDs) are difficult conditions to resolve, necessitating novel treatments. Ayahuasca, a psychedelic plant medicine originating in Indigenous Amazonian communities, is being investigated. Aspects of ceremonial ayahuasca use (purging, dietary restrictions) appear similar to ED behaviors, raising questions about ayahuasca's suitability as an intervention for individuals with EDs. This study explored the perspectives of ayahuasca ceremony leaders on these and other considerations for ceremonial ayahuasca drinking among individuals with EDs. A qualitative content analysis of interviews was undertaken with 15 ayahuasca ceremony leaders, the majority of whom were from the West/Global North. Screening for EDs, purging and dietary restrictions, potential risks and dangers, and complementarity with conventional ED treatment emerged as categories. The findings offer ideas, including careful screening and extra support, to promote safe and beneficial ceremony experiences for ceremony participants with EDs. More research is needed to clarify the impacts of ceremony-related purging and preparatory diets. To evolve conventional models of treatment, the ED field could consider Indigenous approaches to mental health whereby ayahuasca ceremony leaders and ED researchers and clinicians collaborate in a decolonizing, bidirectional bridging process between Western and Indigenous paradigms of healing.
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Affiliation(s)
- Meris Williams
- Independent Researcher, Vancouver, British Columbia, Canada
| | - Annie Kingston Miller
- School of Rural and Northern Health, Laurentian University, Sudbury, Ontario, Canada
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Hu Y, Pan Y, Yue L, Gao X. Self-objectification and eating disorders: the psychopathological and neural processes from psychological distortion to psychosomatic illness. PSYCHORADIOLOGY 2024; 4:kkae003. [PMID: 38666139 PMCID: PMC10946225 DOI: 10.1093/psyrad/kkae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Yinying Hu
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
| | - Yafeng Pan
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang 310058, China
- The State Key Lab of Brain-Machine Intelligence, Zhejiang University, Hangzhou, Zhejaing 310058, China
| | - Liming Yue
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
| | - Xiangping Gao
- Department of Applied Psychology, School of Psychology, Shanghai Normal University, Shanghai, Shanghai 200234, China
- Shanghai Institute of Early Childhood Education, Shanghai Normal University, Shanghai, Shanghai 200234, China
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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [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: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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Dang AB, Kiropoulos L, Anderluh M, Collier D, Fernandez-Aranda F, Karwautz A, Treasure J, Wagner G, Krug I. Do risk factors differentiate DSM-5 and drive for thinness severity groups for anorexia nervosa? J Eat Disord 2024; 12:5. [PMID: 38212857 PMCID: PMC10785425 DOI: 10.1186/s40337-024-00966-5] [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: 08/19/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The current study examined whether risk factors for anorexia nervosa (AN) were related to different levels of severity based on (a) the DSM-5/body mass index (BMI) and (b) drive for thinness (DT) severity ratings. METHODS The sample comprised 153 pairs of individuals with a lifetime diagnosis AN per DSM-IV criteria and their non-ED sisters (N = 306, mean age = 26.53; mean current BMI = 20.42 kg/m2). The Oxford risk factor interview was used to establish AN-related risk factors. Individuals were categorised into the DSM-5 severity groups based on their lowest BMI, while the DT subscale from the eating disorder inventory-2 was used to classify individuals with AN into low and high DT groups. RESULTS Multinominal regression models showed similar risk factors (e.g., perfectionism, having a history of being teased about weight and shape) contributed to the development of AN using the DSM-5 and DT severity ratings. Follow-up analyses across the severity groups for both indices revealed that only childhood perfectionism was found to be more common in the extreme severe DSM-5 BMI severity group compared to the severe DSM-5 group. CONCLUSION Overall, this study found little evidence for AN risk factors being related to the DSM-5 and DT severity ratings. However, given the novelty of this study, replication of the current results is warranted.
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Affiliation(s)
- An Binh Dang
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, Australia.
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, Australia
| | - Marija Anderluh
- University Children's Hospital, University Medical Center Ljubljana SI, Ljubljana, Slovenia
| | - David Collier
- Eating Disorders Unit and SGDP Research Centre, Institute of Psychiatry, King's College, London, UK
| | | | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gudrun Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, Australia
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Bryant E, Koemel N, Martenstyn J, Marks P, Hickie I, Maguire S. Mortality and mental health funding-do the dollars add up? Eating disorder research funding in Australia from 2009 to 2021: a portfolio analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100786. [PMID: 37693868 PMCID: PMC10485676 DOI: 10.1016/j.lanwpc.2023.100786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/01/2023] [Accepted: 04/25/2023] [Indexed: 09/12/2023]
Abstract
Background Eating Disorders (EDs) are among the deadliest of the mental disorders and carry a sizeable public health burden, however their research and treatment is consistently underfunded, contributing to protracted illness and ongoing paucity of treatment innovation. Methods We compare absolute levels and growth rates of Australian mental health research funding by illness group for the years 2009-2021, with a specific focus on eating disorders analysed at the portfolio level. Findings Actual and adjusted data obtained from Australia's three national medical research funding bodies (NHMRC, ARC and MRFF) shows eating disorders receive a disproportionately low allocation of mental health research funding despite having amongst the highest mortality rates. Forty-one category one research grants totalling $AUD28.1 million were funded for eating disorders over the period. When adjusted for inflation, this equates to $2.05 per affected individual, compared with $19.56 for depression, $32.11 for autism, and $176.19 for schizophrenia. Half of all research funded for eating disorders was 'basic' research (e.g., illness underpinning), with little investment in the development of innovative treatment models, novel therapeutics or translation, well reflected by recovery rates of less than 50% in individuals with Anorexia Nervosa. Interpretation Significant discrepancy remains between research funding dollars and disease burden associated with the mental health disorders. The extent to which eating disorders are underfunded may in part be attributable to inaccuracies in epidemiological and burden of disease data. Funding This work was in-part funded by the Australian Government Department of Health and the National Eating Disorder Research & Translation Strategy. The funder was not directly involved in informing the development of the current study.
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Affiliation(s)
- E. Bryant
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - N. Koemel
- The Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - J.A. Martenstyn
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
- School of Psychology, Faculty of Science, University of Sydney, Australia
| | - P. Marks
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
| | - I. Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia
| | - S. Maguire
- InsideOut Institute, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Australia
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Rodan SC, Bryant E, Le A, Maloney D, Touyz S, McGregor IS, Maguire S. Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:112. [PMID: 37415200 DOI: 10.1186/s40337-023-00833-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The current review broadly summarises the evidence base for pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating. METHODS This paper forms part of a Rapid Review series examining the evidence base in the field of eating disorders. This was conducted to inform the Australian National Eating Disorder Research and Translation Strategy 2021-2030. ScienceDirect, PubMed and Ovid/Medline were searched for included studies published between 2009 and 2021 in English. High-level evidence such as meta-analyses, large population studies and randomised control trials were prioritised, and grey literature excluded. Data from included studies relating to pharmacotherapy, and to adjunctive and alternative therapies in eating disorders, were synthesised and disseminated in the current review. RESULTS A total of 121 studies were identified, relating to pharmacotherapy (n = 90), adjunctive therapies (n = 21) and alternative therapies (n = 22). Some of the identified studies involved combinations of the above (e.g. adjunctive pharmacotherapy). Evidence of efficacy of interventions across all three categories was very limited with few relevant high quality clinical trials. There was a particular scarcity of evidence around effective treatments for anorexia nervosa (AN). With treatment of bulimia nervosa (BN), fluoxetine has exhibited some efficacy leading to regulatory approval in some countries. With binge eating disorder (BED), recent evidence supports the use of lisdexamfetamine. Neurostimulation interventions show some emerging efficacy in the treatment of AN, BN and BED but some, such as deep brain stimulation can be highly invasive. CONCLUSION Despite widespread use of medications, this Rapid Review has identified a lack of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of high-quality clinical trial activity and drug discovery innovation are required to better assist patients suffering from EDs.
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Affiliation(s)
- Sarah-Catherine Rodan
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia.
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
- Brain and Mind Centre, University of Sydney, Sydney, Australia.
| | - Emma Bryant
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Iain S McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Level 2, Charles Perkins Centre (D17), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
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Coales E, Hill A, Heywood-Everett S, Rabbee J, Mansfield M, Grace C, Beeton I, Traviss-Turner G. Adapting an online guided self-help intervention for the management of binge eating in adults with type 2 diabetes: The POSE-D study. Diabet Med 2023:e15082. [PMID: 36897802 DOI: 10.1111/dme.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023]
Abstract
AIMS People with type 2 diabetes (T2D) are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided self-help (GSH) is the recommended treatment for binge-eating disorder, but there is currently a lack of evidenced treatment for binge eating in individuals living with T2D. The aims of the current study were to adapt an existing evidence-based GSH intervention using the principles of co-design to make it available online, suitable for remote delivery to address binge eating specifically in adults living with T2D. The Working to Overcome Eating Difficulties GSH intervention comprises online GSH materials presented in seven sections delivered over 12 weeks, supported by a trained Guide. METHODS In order to adapt the intervention, we held four collaboration workshops with three expert patients recruited from diabetes support groups, eight healthcare professionals and an expert consensus group. We used thematic analysis to make sense of the data. RESULTS AND CONCLUSIONS The main themes included; keeping the GSH material generic, adapting Sam the central character, tailoring the dietary advice and eating diary. The length of Guidance sessions was increased to 60 min, and Guide training was focussed around working with people with diabetes.
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Affiliation(s)
- Eleanor Coales
- Leeds Institute of Health Sciences, University of Leeds, Leeds, Clarendon Way, UK
| | - Andrew Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, Clarendon Way, UK
| | - Suzanne Heywood-Everett
- Bradford District Care NHS Foundation Trust, Primary Care Wellbeing Service, Bradford, Victoria Road, Saltaire, UK
| | - Jinan Rabbee
- Leeds Institute of Health Sciences, University of Leeds, Leeds, Clarendon Way, UK
| | - Michael Mansfield
- Leeds Teaching Hospitals Trust, Leeds Centre for Diabetes and Endocrinology, St James's University Hospital, Leeds, UK
| | - Clare Grace
- Leeds Community Healthcare Trust, Chapeltown Health Centre, Leeds, Spencer Place, UK
| | - Ian Beeton
- Leeds Diabetes-UK Support Group, Leeds, St Peter's Square, UK
| | - Gemma Traviss-Turner
- Leeds Institute of Health Sciences, University of Leeds, Leeds, Clarendon Way, UK
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İnce B, Yücel B. Reducing eating disorders risk in Turkish female university students using cognitive behavioural theory: A randomized controlled feasibility trial. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Reay M, Holliday J, Stewart J, Adams J. Creating a care pathway for patients with longstanding, complex eating disorders. J Eat Disord 2022; 10:128. [PMID: 36038898 PMCID: PMC9421634 DOI: 10.1186/s40337-022-00648-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery rates for people with eating disorders are low; fewer than half recover and approximately 20% develop a longstanding eating disorder. Patients with longstanding eating disorders are often referred to as "SEED" (severe and enduing eating disorders) although this remains controversial and is not acknowledged in the British treatment guidance. This project aimed to generate recommendations for a longstanding eating disorder care pathway by identifying what proportion of patients have longstanding eating disorders and how to best identify and support them. METHODS Initially, a literature review was completed, followed by interviews with service-users who consider themselves to have longstanding eating disorders, and focus groups with staff members. The results were combined to create a definition of a longstanding eating disorder which was used to establish how many service-users could benefit from the pathway. The qualitative data was used to produce recommendations for a tailored pathway for those with longstanding eating disorders. RESULTS The results highlighted that, although "SEED" is often used, participants preferred to be referred to as "longstanding" or having no label. Qualitative analysis identified four themes in relation to supporting this population group which described how to structure the service and individualise care, as well as patients' relationship to the service, and how to build a life after eating disorder services. CONCLUSIONS Recommendations included promoting a hopeful message, focusing on quality of life and introducing peer support. Crucially, accessing the pathway should not result in being labelled "SEED", nor should it prevent access to recovery focused interventions including weight restoration. The full list of recommendations are included as well as the implications of the project and limitations.
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Affiliation(s)
- Megan Reay
- Oxford Health NHS Foundation Trust, Oxford, UK.
| | | | | | - Joanna Adams
- The Oxford Institute for Clinical Psychology Training and Research, Oxford, UK
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13
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Ramos R, Vaz A, Rodrigues TF, Pinto-Bastos A, Brandão I, Neves A, Conceição E, Machado PPP. Severe and Enduring' Stage in Anorexia Nervosa: Comparing Eating Attitudes, Impairment and Associated Psychopathology. Front Nutr 2022; 9:867401. [PMID: 35419398 PMCID: PMC8995558 DOI: 10.3389/fnut.2022.867401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
This study aimed to assess differences in eating attitudes, impairment, and related psychopathology at treatment presentation for patients with "Non-severe and enduring Anorexia Nervosa" (illness duration of <7 years) and patients with "severe and enduring Anorexia Nervosa" (illness duration of 7 years or more). One hundred and thirty-nine patients diagnosed with Anorexia Nervosa participated in this study. Participants were interviewed with the Eating Disorder Examination (EDE) and asked to complete several questionnaires at the end of the first treatment appointment. We also explored differences at treatment presentation by considering alternative criteria to define groups, namely a composite of illness duration and clinical impairment (≥16 CIA total score). No differences were found when comparing participants based on illness duration. However, when participants were classified into a different classification scheme: "Non-severe and enduring Anorexia Nervosa" (illness duration <7 years and a CIA total score <16) vs. "severe and enduring Anorexia Nervosa" (illness duration ≥7 years and CIA total score ≥16), significant differences were found in terms of eating pathology, depressive symptomatology, psychological distress, and emotion dysregulation. Further research is needed to better understand the role of illness duration and clinical impairment in informing the course of AN.
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Affiliation(s)
- Rita Ramos
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Ana Vaz
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Tânia F. Rodrigues
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Ana Pinto-Bastos
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Brandão
- Psychiatry Department, Hospital of S. João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - António Neves
- Eating Disorders Unit, Psychiatry Department, Hospital of Santa Maria, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Eva Conceição
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
| | - Paulo P. P. Machado
- Psychotherapy and Psychopathology Research Lab - CIPsi, School of Psychology, University of Minho, Braga, Portugal
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14
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Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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15
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Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder. J Affect Disord 2021; 295:446-452. [PMID: 34507225 DOI: 10.1016/j.jad.2021.08.049] [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: 03/08/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully. METHODS Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics. RESULTS SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme. LIMITATIONS These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability. CONCLUSIONS Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.
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16
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Krug I, Arroyo MD, Giles S, Dang AB, Kiropoulos L, De Paoli T, Buck K, Treasure J, Fuller-Tyszkiewicz M. A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms. J Eat Disord 2021; 9:153. [PMID: 34809723 PMCID: PMC8607624 DOI: 10.1186/s40337-021-00508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. METHOD 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. RESULTS Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). CONCLUSION We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.
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Affiliation(s)
- Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.
| | - Mercedes Delgado Arroyo
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia.,Department of Psychiatry, University Hospital Vall de' Hebron, Barcelona, Spain
| | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - An Binh Dang
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Litza Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Tara De Paoli
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Kim Buck
- Melbourne School of Psychological Sciences, University of Melbourne Psychology Clinic, Redmond Barry, Level 7, North Melbourne, VIC, 3051, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, King's College London, London, UK
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, VIC, Australia.,Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
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17
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Stone KD, Dimitropoulos G, MacMaster FP. Food for Thought: A Dissonance Between Healthcare Utilization Costs and Research Funding for Eating Disorders in Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:197-203. [PMID: 34381512 PMCID: PMC8315219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/15/2021] [Indexed: 06/13/2023]
Abstract
In this commentary, we present the premise that, in Canada, mental illness research specific to eating disorders is underfunded, and many Canadians are suffering the consequences of this underinvestment. We highlight three critical aspects of eating disorders: 1) the increasingly common yet potentially life-threatening nature of eating disorders, with an onset usually during adolescence; 2) the challenges and costs to treating eating disorders, with a discussion of current hospital-related costs across Canada; and 3) the glaring discrepancy between the money spent on eating disorder diagnoses/treatment and the funding dollars granted for eating disorder research in Canada (i.e. only $0.70 per affected Canadian in 2018). Research funding per affected individual for other psychiatric and neurodevelopmental conditions are used as comparisons (e.g. $50.17 per affected Canadian with schizophrenia). We suggest that it is time to revolutionize treatment for individuals with eating disorders and use our resources in a more efficient and effective manner, using current neuroimaging and neuromodulation methods as promising examples. We conclude by emphasizing the need for increased research funding in the field of eating disorders in Canada, as the current research-related investments hinder progress in developing neuroscientifically-sound treatments for these populations.
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Affiliation(s)
- Kayla D Stone
- Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
| | - Frank P MacMaster
- Departments of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health Portfolio, Alberta, Canada
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18
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Syrkiewicz-Świtała M, Detyna B, Sosada N, Detyna J, Świtała R, Bitkowska A, Szkutnik J. Mobile applications and eating habits among women and men – Polish experiences. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Christian C, Williams BM, Hunt RA, Wong VZ, Ernst SE, Spoor SP, Vanzhula IA, Tregarthen JP, Forbush KT, Levinson CA. A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms. Psychol Med 2021; 51:815-824. [PMID: 31907093 DOI: 10.1017/s0033291719003817] [Citation(s) in RCA: 12] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive-behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory). METHODS We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs). RESULTS Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI. CONCLUSIONS Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.
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Affiliation(s)
- Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Valerie Z Wong
- Department of Psychology, Yale University New Haven, CT, United States of America
| | - Sarah E Ernst
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Irina A Vanzhula
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, United States of America
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
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20
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Rodríguez-Quiroga A, MacDowell KS, Leza JC, Carrasco JL, Díaz-Marsá M. Childhood trauma determines different clinical and biological manifestations in patients with eating disorders. Eat Weight Disord 2021; 26:847-857. [PMID: 32424563 DOI: 10.1007/s40519-020-00922-7] [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: 04/04/2019] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE There is a significant relationship between childhood trauma and the development of an eating disorder in adolescence or adulthood, possibly influenced by circulating levels of inflammatory parameters. The main objective is to identify and describe a subgroup of patients with eating disorders and a history of trauma in childhood or adolescence with differential clinical features. METHODS An observational study on a sample of 55 patients who met the diagnostic criteria for any DSM-5 eating disorder was carried out. Inflammatory parameters in white blood cells were examined. Patients underwent different assessments, including clinical and personality scales. RESULTS Patients with a history of trauma had higher scores in the delirious and narcissistic items of the Millon Clinical Multiaxial Inventory (MCMI-II) (p < 0.05) and a higher score in the paranoid item of the SCID-5 Personality Disorders Version (SCID-5-PD) (p < 0.05). Patients with distinguishing personality features were grouped according to the Childhood Trauma Questionnaire sexual subscale. Tumor necrosis alpha (TNF-α) showed a significant association with childhood trauma history. CONCLUSIONS There is a profile of patients with eating disorders who have increased activity in the inflammatory pathways that, if identified precociously, can benefit from specifically aimed interventions. LEVEL OF EVIDENCE Level V, observational study.
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Affiliation(s)
- Alberto Rodríguez-Quiroga
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Gran Vía del Este 80, 28030, Madrid, Spain. .,Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.
| | - Karina S MacDowell
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Pharmacology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av. Cordoba, s/n, 28041, Madrid, Spain
| | - Juan C Leza
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Pharmacology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av. Cordoba, s/n, 28041, Madrid, Spain
| | - José Luis Carrasco
- Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Marina Díaz-Marsá
- Department of Psychiatry and Psychology, Medical School, Complutense University, Av. Séneca, 2, 28040, Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain
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21
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İnce B, Schlatter J, Max S, Plewnia C, Zipfel S, Giel KE, Schag K. Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review. J Eat Disord 2021; 9:38. [PMID: 33736708 PMCID: PMC7977597 DOI: 10.1186/s40337-021-00384-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others. METHOD A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed. RESULTS Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful. CONCLUSION Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.
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Affiliation(s)
- Başak İnce
- Department of Psychology, Haliç University, Istanbul, Turkey
| | - Johanna Schlatter
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Sebastian Max
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany.,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstraße 5, 72076, Tübingen, Germany. .,Competence Center of Eating Disorders Tübingen (KOMET), Tübingen, Germany.
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22
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McCallum LA, Alaggia R. Achieving Recovery Through Resilience: Insights From Adults in Midlife Living With Anorexia Nervosa. QUALITATIVE HEALTH RESEARCH 2021; 31:619-630. [PMID: 33349161 DOI: 10.1177/1049732320978202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite the high percentage of adults living with anorexia nervosa (AN) over the life course, there is limited understanding of what it means to be living with AN in midlife when the majority of research has focused on adolescents and young adults. As such, clinical practice for individuals in midlife is informed by a severe and enduring AN (SE-AN) framework, which assumes that recovery is not necessarily feasible past young adulthood. This study used constructivist grounded theory methodology to understand the experiences of adults in midlife living with AN. In-depth analyses of 19 participant narratives in midlife show that individuals face barriers to seeking help or remaining in recovery; however, midlife can also act as a significant catalyst toward recovery. Subsequently, there is merit in revisiting the utility of the SE-AN framework in the context of life course theory and exploring resilience-informed approaches in supporting recovery from AN.
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Affiliation(s)
- Leslie A McCallum
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ramona Alaggia
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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23
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Kotilahti E, West M, Isomaa R, Karhunen L, Rocks T, Ruusunen A. Treatment interventions for Severe and Enduring Eating Disorders: Systematic review. Int J Eat Disord 2020; 53:1280-1302. [PMID: 32488936 DOI: 10.1002/eat.23322] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Approximately 20% of people with Anorexia Nervosa (AN) and 10% with Bulimia Nervosa (BN) will eventually develop a long-standing illness. Although there is no set definition for Severe and Enduring eating Disorder (SE-ED), the common criteria relate to a long duration of the disorder and a number of unsuccessful treatment attempts. Research evidence for treatment of SE-ED remains limited, thus the objective of this systematic review was to describe different treatment interventions and their effects on SE-ED-related outcomes. METHOD A systematic search for quantitative treatment studies of adult participants with SE-ED was conducted in June 2019 (PROSPERO, CRD42018115802) with no restriction on eating disorder type. Altogether, 2,938 studies were included for title and abstract screening. RESULTS After systematic searches and article screening, 23 studies (3 randomized controlled trials, 3 open-label studies, 8 naturalistic follow-up studies, 8 case series and case studies, and 1 partially blinded pilot study) were included in the analysis and data extraction. Methodological quality of the included studies was generally low. Inpatient treatment programs (n = 5) were effective in short-term symptom reduction, but long-term results were inconsistent. Outpatient and day-hospital treatment programs (n = 5) seemed promising for symptom reduction. Drug interventions (n = 5) showed some benefits, especially as adjuvant therapies. Brain stimulation (n = 6) led to improvements in depressive symptoms. Other treatments (n = 2) produced mixed results. DISCUSSION This is the first systematic review to examine all of the different treatment interventions that have been studied in SE-ED. The results will inform future interventions in research and clinical practice.
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Affiliation(s)
- Emilia Kotilahti
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Madeline West
- Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Rasmus Isomaa
- Department of Social Services and Health Care, Finland.,Faculty of Education and Welfare Studies, Åbo Akademi University, Åbo, Finland
| | - Leila Karhunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Tetyana Rocks
- Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Anu Ruusunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Deakin University, Food & Mood Centre, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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Hanly F, Torrens-Witherow B, Warren N, Castle D, Phillipou A, Beveridge J, Jenkins Z, Newton R, Brennan L. Peer mentoring for individuals with an eating disorder: a qualitative evaluation of a pilot program. J Eat Disord 2020; 8:29. [PMID: 32626579 PMCID: PMC7329554 DOI: 10.1186/s40337-020-00301-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse. METHODS To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment. RESULTS Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. CONCLUSIONS Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population. TRIAL REGISTRATION Australian and New Zealand Clinical Trials registration number - ACTRN12617001412325 - Date of registration - 05/10/2017 (Retrospectively registered).
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Affiliation(s)
- Freya Hanly
- School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC Australia
| | | | - Narelle Warren
- School of Social Sciences, Monash University, Melbourne, VIC Australia
| | - David Castle
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
| | - Andrea Phillipou
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
- Department of Mental Health, Austin Health, Melbourne, VIC Australia
| | | | - Zoe Jenkins
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, VIC Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC Australia
| | - Richard Newton
- Department of Psychiatry, Monash University, Melbourne, Victoria Australia
- Peninsula Health, Frankston, Victoria Australia
| | - Leah Brennan
- School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC Australia
- Centre for Eating, Weight and Body Image, Melbourne, VIC Australia
- School of Psychology and Public Health, La Trobe University, Wodonga, VIC Australia
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25
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Lindstedt K, Forss E, Elwin M, Kjellin L, Gustafsson SA. Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction. Child Adolesc Psychiatry Ment Health 2020; 14:16. [PMID: 32391079 PMCID: PMC7196214 DOI: 10.1186/s13034-020-00323-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 04/15/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up. METHODS Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms. RESULTS Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment. CONCLUSIONS The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.
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Affiliation(s)
- Katarina Lindstedt
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emma Forss
- grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Marie Elwin
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Kjellin
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- grid.15895.300000 0001 0738 8966University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Abstract
OBJECTIVE Approximately 20% of patients with anorexia nervosa develop severe and enduring anorexia nervosa (SE-AN), manifest by decades-long illnesses. At certain points, demoralized and/or based on judicious appraisals of the seeming futility of further professional treatment to radically alter their course, some SE-AN patients decide that "enough is enough" and opt out of intensive treatment. This article considers courses and treatment options available at these stages for patients, families, and clinicians. METHODS The author uses clinical illustrations, Socratic questioning, and available literature to explore questions of treatment strategies with patients struggling with SE-AN. RESULTS SE-AN patients have frequently received care in varieties of medical, psychiatric, and specialized eating disorders inpatient, residential, partial hospital, and outpatient treatment settings. Patients may reject further high-intensity treatment for judicious or capricious reasons, but may still accept lower intensity treatments. Some may reject any and all offers of treatment. Clinicians' treatment recommendations, not always coinciding with patients' wishes, are influenced by numbers of clinical, social, and professional pressures, including those from families, treatment settings, regulatory bodies, and payors. CONCLUSIONS When managing patients with decades-long disease and multiple comorbidities, clinicians must be realistic about the low odds of effecting cure and adjust treatment expectations accordingly. For patients with SE-AN, a variety of low-intensity treatment approaches, at times extending to palliative and hospice care, may be useful. Clinicians should always strive to provide humane comfort and support, as closely aligned to patients' judicious wishes as realistically possible.
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Cury MEG, Berberian A, Scarpato BS, Kerr-Gaffney J, Santos FH, Claudino AM. Scrutinizing Domains of Executive Function in Binge Eating Disorder: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:288. [PMID: 32362845 PMCID: PMC7181673 DOI: 10.3389/fpsyt.2020.00288] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/24/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cognitive deficits are implicated in theoretical explanatory models for binge eating disorder (BED). Furthermore, evidence suggest that alterations in executive function may underlie symptoms in BED. The current systematic review and meta-analysis provides an update on executive functioning in individuals with BED. METHODS Literature searches (up to November 2019) were conducted in electronic databases combining binge eating or BED with executive functions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines was used. Studies of any design comparing adults with BED with those without BED in executive function domains were selected. Methodological quality of studies was based on the Newcastle-Ottawa scale. RESULTS Of 1,983 citations identified, 28 case-control studies met inclusion criteria for this review. Six meta-analyses that examined four domains (decision-making, cognitive flexibility, inhibitory control, and working memory) were conducted. The only meta-analysis to show a significant difference in executive functioning between BED and obese controls was working memory (SMD = 0.32, 95% IC: -0.60, -0.03; p = 0.028), with an effect size of small magnitude. Qualitative inspection of the literature indicated mixed findings for control inhibition, decision making and cognitive flexibility in individuals with BED compared to controls (obese or normal weight). In addition, people with BED showed poorer problem solving performance, but similar planning abilities to obese controls. CONCLUSIONS Individuals with BED were found to show worse performance on working memory tasks compared to obese individuals without the disorder. The findings did not provide definitive evidence of alterations in other aspects of executive functioning. Interest in executive functioning in people with BED is increasing but is limited by insufficient data from small studies with varied methodology. Future studies should focus on using similar tests and outcome measures, in order to enable more pertinent comparisons across studies.
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Affiliation(s)
- Maria Elisa Gisbert Cury
- Eating Disorders Program (PROATA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Arthur Berberian
- Interdisciplinary Laboratory of Clinical Neurosciences (LiNC), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Bruno Sini Scarpato
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Flavia H Santos
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Angélica Medeiros Claudino
- Eating Disorders Program (PROATA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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28
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Steding J, Boehm I, King JA, Geisler D, Ritschel F, Seidel M, Doose A, Jaite C, Roessner V, Smolka MN, Ehrlich S. Goal-directed vs. habitual instrumental behavior during reward processing in anorexia nervosa: an fMRI study. Sci Rep 2019; 9:13529. [PMID: 31537862 PMCID: PMC6753148 DOI: 10.1038/s41598-019-49884-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022] Open
Abstract
Previous studies have proposed that altered reward processing and elevated cognitive control underlie the etiology of anorexia nervosa (AN). A newly debated notion suggests altered habit learning and an overreliance on habits may contribute to the persistence of AN. In weight-recovered AN patients, we previously found neuroimaging-based evidence for unaltered reward processing, but elevated cognitive control. In order to differentiate between state versus trait factors, we here contrast the aforementioned hypotheses in a sample of acutely underweight AN (acAN) patients. 37 acAN patients and 37 closely matched healthy controls (HC) underwent a functional MRI while performing an established instrumental motivation task. We found no group differences with respect to neural responses during the anticipation or receipt of reward. However, the behavioral response data showed a bimodal distribution, indicative for a goal-directed (gAN) and a habit-driven (hAN) patient subgroup. Additional analyses revealed decreased mOFC activation during reward anticipation in hAN, which would be in line with a habit-driven response. These findings provide a new perspective on the debate regarding the notion of increased goal-directed versus habitual behavior in AN. If replicable, the observed dissociation between gAN and hAN might help to tailor therapeutic approaches to individual patient characteristics.
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Affiliation(s)
- Julius Steding
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Arne Doose
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, TU Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany. .,Translational Developmental Neuroscience Section, Department of Child and Adolescent Psychiatry, Eating Disorders Research and Treatment Center, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.
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A randomized trial exploring mindfulness and gratitude exercises as eHealth-based micro-interventions for improving body satisfaction. COMPUTERS IN HUMAN BEHAVIOR 2019. [DOI: 10.1016/j.chb.2019.01.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Kristmannsdottir G, Keski-Rahkonen A, Kuusinen KL. Changes in the sense of agency: Implications for the psychotherapy of bulimia nervosa- A case study. J Clin Psychol 2019; 75:1415-1428. [PMID: 30980392 DOI: 10.1002/jclp.22787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A sense of agency is a transtheoretical concept that increases our understanding of important processes in psychotherapy. Agency can be described in terms of how strongly the person believes that she can have an impact on her problematic experiences and behaviors. In this case study, a patient's sense of agency in relation to symptoms of bulimia nervosa was assessed during 3 years of psychotherapy. Five distinct phases of agency in relation to eating disorder symptoms were identified: A false sense of agency or no agency at all, a weak sense of agency, a nascent sense of agency, a wavering sense of agency, and a strong sense of agency. A better understanding of patient agency can facilitate adapting approaches and methods best suited for the patient's capacity for change throughout treatment.
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Crucianelli L, Serpell L, Paloyelis Y, Ricciardi L, Robinson P, Jenkinson P, Fotopoulou A. The effect of intranasal oxytocin on the perception of affective touch and multisensory integration in anorexia nervosa: protocol for a double-blind placebo-controlled crossover study. BMJ Open 2019; 9:e024913. [PMID: 30878983 PMCID: PMC6429868 DOI: 10.1136/bmjopen-2018-024913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Anorexia nervosa (AN) is an eating disorder characterised by restriction of energy intake, fears of gaining weight and related body image disturbances. The oxytocinergic system has been proposed as a pathophysiological candidate for AN. Oxytocin is a neuropeptide involved in bodily processes (eg, breast feeding) and in the onset of social behaviours (eg, bonding). Studies investigating the effect of intranasal oxytocin (IN-OT) in AN showed that it can improve attentional bias for high-calorie food and fat bodies stimuli, and related stress. However, less is known about the effect of IN-OT on bodily awareness and body image distortions, key features of the disorder linked to its development, prognosis and maintenance. Here, we aim to investigate the effect of IN-OT on the perception of affective, C-tactile-optimal touch, known to be impaired in AN and on multisensory integration processes underlying a body ownership illusion (ie, rubber hand illusion). For exploratory purposes, we will also investigate the effect of IN-OT on another interoceptive modality, namely cardiac awareness and its relationship with affective touch. DESIGN, METHODS AND ANALYSIS Forty women with AN and forty matched healthy controls will be recruited and tested in two separate sessions; self-administering IN-OT (40 IU) or placebo, intranasally, in a pseudo-randomised manner. The data from this double-blind, placebo-controlled, cross-over study will be analysed using linear mixed models that allow the use of both fixed (treatment levels) and random (subjects) effects in the same analysis. To address our main hypotheses, separate analyses will be run for the affective touch task, where the primary outcome dependent variable will be the pleasantness of the touch, and for the rubber hand illusion, where we will investigate multisensory integration quantified as subjective embodiment towards the rubber hand. In the latter, we will manipulate the synchronicity of touch and the size of the hand. ETHICS AND DISSEMINATION Ethics approval has been obtained by National Research Ethics Service NRES Committee London (Queen's Square Committee, ref number 14/LO/1593). The results will be disseminated through conference presentations and publication in peer-reviewed journals.
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Affiliation(s)
- Laura Crucianelli
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Yannis Paloyelis
- Department of Neuroimaging Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Lucia Ricciardi
- Cardiovascular Sciences Research Centre, St George’s Hospital, London, UK
| | - Paul Robinson
- Barnet Enfield and Haringey Mental Health Trust, London, UK
- Faculty of Medical Sciences, University College London, London, UK
| | - Paul Jenkinson
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hatfield, UK
| | - Aikaterini Fotopoulou
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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The use of a positive mood induction video-clip to target eating behaviour in people with bulimia nervosa or binge eating disorder: An experimental study. Appetite 2018; 133:400-404. [PMID: 30529607 DOI: 10.1016/j.appet.2018.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022]
Abstract
Recent theoretical models and empirical research have indicated that momentary negative affect increases the likelihood of binge eating episodes for individuals with bulimia nervosa and binge eating disorder. However, relatively little research has explored the potential for positive mood to serve a protective effect in reducing the likelihood of overeating behaviour in bulimia nervosa and binge eating disorder. The current study included 30 women with bulimia nervosa or binge eating disorder in a within-subjects crossover design. Following exposure to a video designed to induce food craving, we found that a positive mood vodcast was associated with significantly lower levels of negative mood and food consumption in a taste test meal, when compared to a neutral vodcast (p = 0.002). These findings support a role for decreasing negative mood in reducing the likelihood of binge eating behaviour in women with bulimia nervosa and binge eating disorder.
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Abstract
PURPOSE OF REVIEW The neurohormone oxytocin (OXT) impacts food intake as well as cognitive, emotional, and social functioning-all of which are central to eating disorder (ED) pathology across the weight spectrum. Here, we review findings on endogenous OXT levels and their relationship to ED pathology, the impact of exogenous OXT on mechanisms that drive ED presentation and chronicity, and the potential role of genetic predispositions in the OXT-ED link. RECENT FINDINGS Current findings suggest a role of the OXT system in the pathophysiology of anorexia nervosa. In individuals with bulimia nervosa, endogenous OXT levels were comparable to those of healthy controls, and exogenous OXT reduced food intake. Studies in other ED are lacking. However, genetic studies suggest a broad role of the OXT system in influencing ED pathology. Highlighting findings on why OXT represents a potential biomarker of and treatment target for ED, we advocate for a systematic research approach spanning the entire ED spectrum.
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Brockmeyer T, Friederich HC, Schmidt U. Advances in the treatment of anorexia nervosa: a review of established and emerging interventions. Psychol Med 2018; 48:1228-1256. [PMID: 28889819 DOI: 10.1017/s0033291717002604] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a disabling, deadly and costly mental disorder. Until recently, treatment recommendations were based on expert opinion and limited evidence. The aim of this systematic review is to synthesise recent evidence on established and emerging AN treatments and to forecast trends for future developments. METHODS We systematically review trials of established treatments and associated process outcome studies from the last 5 years, published since a previous review in this journal. 'Established' treatments were those that are widely used in AN, recommended by guidelines and/or have been tested in at least one large randomised controlled trial. Secondly, we summarise emerging treatments for AN, i.e. those that have only been (or are currently being) tested in proof-of concept, feasibility or pilot trials. RESULTS We identified 19 published trials of established treatments (15 of high or moderate quality), mostly assessing psychological therapies (n = 17). We also found 11 published trials of emerging treatments, and a total of 34 registered, as yet unpublished trials. Promising emerging treatments include cognitive remediation therapy, exposure therapy and non-invasive neuromodulation. CONCLUSIONS Evidence generation on the treatment of AN has dramatically accelerated, with our understanding of the role of family-based approaches for adolescents more nuanced and a range of psychological approaches available for the treatment of adults. Evidence on emerging treatments and from forthcoming trials suggests that there is a shift towards more targeted brain-based interventions. Future studies need to focus on elucidating mechanisms of action of treatments and what works best for whom.
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Affiliation(s)
- T Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - H-C Friederich
- Department of Psychosomatic Medicine and Psychotherapy,LVR Clinic,Medical Faculty of the Heinrich-Heine-University Düsseldorf,Düsseldorf,Germany
| | - U Schmidt
- Section of Eating Disorders,Department of Psychological Medicine,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
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Brown A, Jenkinson R, Coakes J, Cockfield A, O'Brien T, Hall L. Pathways to Recovery: development and evaluation of a cognitive-behavioural therapy in-patient treatment programme for adults with anorexia nervosa. BJPsych Bull 2018; 42:95-101. [PMID: 29761754 PMCID: PMC6048735 DOI: 10.1192/bjb.2017.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Aims and methodA cognitive-behavioural therapy in-patient treatment model for adults with severe anorexia nervosa was developed and evaluated, and outcomes were compared with the previous treatment model and other published outcomes from similar settings. RESULTS This study showed the Pathways to Recovery outcomes were positive in terms of improvements in body mass index and psychopathology.Clinical implicationsAdults with anorexia nervosa can achieve good outcomes despite longer illness duration and comorbidities.Declaration of interestA.B., A.C. and L.H. work at The Retreat where the Pathways to Recovery were developed.
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36
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Chamberlain SR, Stochl J, Redden SA, Grant JE. Latent traits of impulsivity and compulsivity: toward dimensional psychiatry. Psychol Med 2018; 48:810-821. [PMID: 28805173 PMCID: PMC5699644 DOI: 10.1017/s0033291717002185] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The concepts of impulsivity and compulsivity are commonly used in psychiatry. Little is known about whether different manifest measures of impulsivity and compulsivity (behavior, personality, and cognition) map onto underlying latent traits; and if so, their inter-relationship. METHODS A total of 576 adults were recruited using media advertisements. Psychopathological, personality, and cognitive measures of impulsivity and compulsivity were completed. Confirmatory factor analysis was used to identify the optimal model. RESULTS The data were best explained by a two-factor model, corresponding to latent traits of impulsivity and compulsivity, respectively, which were positively correlated with each other. This model was statistically superior to the alternative models of their being one underlying factor ('disinhibition') or two anticorrelated factors. Higher scores on the impulsive and compulsive latent factors were each significantly associated with worse quality of life (both p < 0.0001). CONCLUSIONS This study supports the existence of latent functionally impairing dimensional forms of impulsivity and compulsivity, which are positively correlated. Future work should examine the neurobiological and neurochemical underpinnings of these latent traits; and explore whether they can be used as candidate treatment targets. The findings have implications for diagnostic classification systems, suggesting that combining categorical and dimensional approaches may be valuable and clinically relevant.
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Affiliation(s)
- S. R. Chamberlain
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
- Cambridge and Peterborough NHS Foundation
Trust, Cambridge, UK
| | - J. Stochl
- Department of Psychiatry,
University of Cambridge, Cambridge,
UK
- Cambridge and Peterborough NHS Foundation
Trust, Cambridge, UK
- Department of Kinanthropology,
Charles University in Prague, Prague,
Czech Republic
| | - S. A. Redden
- Department of Psychiatry & Behavioral
Neuroscience, University of Chicago,
Chicago, USA
| | - J. E. Grant
- Department of Psychiatry & Behavioral
Neuroscience, University of Chicago,
Chicago, USA
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37
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Turton R, Cardi V, Treasure J, Hirsch CR. Modifying a negative interpretation bias for ambiguous social scenarios that depict the risk of rejection in women with anorexia nervosa. J Affect Disord 2018; 227:705-712. [PMID: 29179140 DOI: 10.1016/j.jad.2017.11.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND A heightened sensitivity to social rejection might contribute towards the interpersonal difficulties and symptoms that characterise Anorexia Nervosa (AN). This paper examines the effect of Cognitive Bias Modification for Interpretation biases (CBM-I) training on a negative interpretation bias for ambiguous social scenarios that involve the risk of rejection and eating behaviour. METHOD Women with AN received a single session of CBM-I training to develop a more benign interpretational style or a control condition (which included 50:50 negative and benign resolutions). To measure participant's interpretation bias for social stimuli, a sentence completion task was used pre and post-training (a near-transfer outcome measure). A test meal was given after the training and salivary cortisol (stress) levels were measured as far-transfer outcome measures. RESULTS CBM-I training led to a significant reduction in a negative interpretation bias in both conditions. No effect on eating behaviour or stress was found, which may be expected as the training conditions did not significantly differ in interpretation bias change. LIMITATIONS The control condition may have inadvertently reduced a negative interpretation bias as it involved listening to benign resolutions to ambiguous social scenarios for 50% of the trials. CONCLUSIONS It is possible to modify a negative interpretation bias for social stimuli. To clarify the effect of CBM-I training on AN symptomatology, repeated, more intensive, and ecologically-valid training interventions may be required. This is because any change in eating behaviour may not be immediate, particularly in a population with a low body mass index and long-illness durations.
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Affiliation(s)
- Robert Turton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
| | - Valentina Cardi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
| | - Colette R Hirsch
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
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38
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Kim YR. Medical complications and management of eating disorders. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2018. [DOI: 10.5124/jkma.2018.61.3.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea
- Institute of Eating Disorders and Mental Health, Inje University, Seoul, Korea
- Institute for Gender Research, Seoul National University, Seoul, Korea
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39
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Turton R, Nazar BP, Burgess EE, Lawrence NS, Cardi V, Treasure J, Hirsch CR. To Go or Not to Go: A Proof of Concept Study Testing Food-Specific Inhibition Training for Women with Eating and Weight Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 26:11-21. [PMID: 29098749 DOI: 10.1002/erv.2566] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 11/11/2022]
Abstract
Inefficient food-specific inhibitory control is a potential mechanism that underlies binge eating in bulimia nervosa and binge eating disorder. Go/no-go training tools have been developed to increase inhibitory control over eating impulses. Using a within-subjects design, this study examined whether one session of food-specific go/no-go training, versus general inhibitory control training, modifies eating behaviour. The primary outcome measure was food consumption on a taste test following each training session. Women with bulimia nervosa and binge eating disorder had small non-significant reductions in high-calorie food consumption on the taste test following the food-specific compared with the general training. There were no effects on eating disorder symptomatic behaviour (i.e. binge eating/purging) in the 24 h post-training. The training task was found to be acceptable by the clinical groups. More research is needed with larger sample sizes to determine the effectiveness of this training approach for clinical populations. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Robert Turton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bruno P Nazar
- Department of Psychiatry and Mental Health, Federal University of Rio de Janeiro, Institute of Psychiatry (IPUB-UFRJ), Rio de Janeiro, Brazil
| | - Emilee E Burgess
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.,Mental Health and Addictions Services, Nova Scotia Health Authority, Halifax, Canada
| | | | - Valentina Cardi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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40
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Abstract
PURPOSE OF REVIEW The objective of this paper is to review the role that hedonic factors, emotions and self-regulation systems have over eating behaviours from animal models to humans. RECENT FINDINGS Evidence has been found to suggest that for some high-risk individuals, obesity/binge eating may develop as an impulsive reaction to negative emotions that over time becomes a compulsive habit. Animal models highlight the neural mechanisms that might underlie this process and suggest similarities with substance use disorders. Emotional difficulties and neurobiological factors have a role in the aetiology of eating and weight disorders. Precise treatments targeted at these mechanisms may be of help for people who have difficulties with compulsive overeating.
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Affiliation(s)
- Robert Turton
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Rayane Chami
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK
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41
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Broomfield C, Stedal K, Touyz S, Rhodes P. Labeling and defining severe and enduring anorexia nervosa: A systematic review and critical analysis. Int J Eat Disord 2017; 50:611-623. [PMID: 28444828 DOI: 10.1002/eat.22715] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE With anorexia nervosa (AN) having various presentations, attention has been directed towards particularly durable forms of the condition in both research and clinical contexts. A major hindrance in terms of advancing the field is the inconsistent labeling and defining of this subgroup. This has two implications; first, the inconsistent recruitment of participants when researching this sample, and second, the misdiagnosing of patients who may or may not have a durable course of the disease. The current research had the purpose of providing an overview of the current labels and criteria used for defining cases of severe and enduring AN, and critically analysing the implications of these findings. METHOD In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science and Scopus) in order to identify 32 records that met the standards stipulated by the criteria. Data extraction included explicit labeling, the definition or criteria used to describe the subgroup, along with participant age and study design. RESULTS It was found that the terms chronic and severe and enduring were the most commonly used adjectives when referring to this subgroup. In terms of criteria, illness duration and the number of previously failed treatment attempts were the most common defining features within the literature. DISCUSSION It is the aim of the authors to inspire further research into what is the most appropriate label and defining features for the subgroup in order to facilitate a better approach and outcome for the individuals affected.
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Affiliation(s)
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål
| | - Stephen Touyz
- Department of Psychology, University of Sydney, Sydney, Australia
| | - Paul Rhodes
- Department of Psychology, University of Sydney, Sydney, Australia
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42
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Effects of a food-specific inhibition training in individuals with binge eating disorder-findings from a randomized controlled proof-of-concept study. Eat Weight Disord 2017; 22:345-351. [PMID: 28271453 DOI: 10.1007/s40519-017-0371-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/10/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Impulsivity might contribute to the development and maintenance of obesity and eating disorders. Patients suffering from binge eating disorder (BED) show an impulsive eating pattern characterized by regular binge eating episodes. Novel behavioral interventions increasing inhibitory control could improve eating behavior in BED. We piloted a novel food-specific inhibition training in individuals with BED. METHODS N = 22 BED patients according to SCID-I were randomly assigned to three sessions of a training or control condition. In both conditions, pictures of high-caloric food items were presented in peripheral vision on a computer screen while assessing gaze behavior. The training group had to suppress the urge to turn their gaze towards these pictures (i.e., to perform antisaccades). The control group was allowed to freely explore the pictures. We assessed self-reported food craving, food addiction, and wanting/liking of food pictures pre- and post-intervention. RESULTS Twenty participants completed the study. The training proved to be feasible and acceptable. Patients of the training group significantly improved inhibitory control towards high-caloric food stimuli. Both groups reported a significantly lower number of binge eating episodes in the last four weeks after termination of the study. No changes were found in food craving, food addiction, liking, and wanting ratings. CONCLUSIONS A food-specific inhibition training could be a useful element in the treatment of BED and other eating disorders; however, larger efficacy studies in patient samples are needed to investigate the efficacy of this and similar training approaches.
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The effects of intranasal oxytocin on smoothie intake, cortisol and attentional bias in anorexia nervosa. Psychoneuroendocrinology 2017; 79:167-174. [PMID: 28288443 DOI: 10.1016/j.psyneuen.2017.01.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by severe malnutrition as well as intense fear and anxiety around food and eating with associated anomalies in information processing. Previous studies have found that the neuropeptide, oxytocin, can influence eating behaviour, lower the neurobiological stress response and anxiety among clinical populations, and alter attentional processing of food and eating related images in AN. METHODOLOGY Thirty adult women with AN and twenty-nine healthy comparison (HC) women took part in the current study. The study used double blind, placebo controlled, crossover design to investigate the effects of a single dose of intranasal oxytocin (40 IU) on a standard laboratory smoothie challenge, and on salivary cortisol, anxiety, and attentional bias towards food images before and after the smoothie challenge in AN and HC participants. Attentional bias was assessed using a visual probe task. RESULTS Relative to placebo intranasal oxytocin reduced salivary cortisol and altered anomalies in attentional bias towards food images in the AN group only. The oxytocin-induced reduction in attentional avoidance of food images correlated with oxytocin induced reduction in salivary cortisol in the AN group before the smoothie challenge. Intranasal oxytocin did not significantly alter subjective feelings of anxiety or intake during the smoothie challenge in the AN or HC groups. CONCLUSIONS Intranasal oxytocin may moderate the automated information processing biases in AN and reduce neurobiological stress. Further investigation of the effects of repeated administration of oxytocin on these processes as well as on eating behaviour and subjective anxiety would be of interest.
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Wildes JE, Forbush KT, Hagan KE, Marcus MD, Attia E, Gianini LM, Wu W. Characterizing severe and enduring anorexia nervosa: An empirical approach. Int J Eat Disord 2017; 50:389-397. [PMID: 27991694 PMCID: PMC5386793 DOI: 10.1002/eat.22651] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/07/2022]
Abstract
Targeted approaches for the treatment of severe and enduring anorexia nervosa (SE-AN) have been recommended, but there is no consensus definition of SE-AN to inform research and clinical practice. This study aimed to take initial steps toward developing an empirically based definition of SE-AN by characterizing associations among putative indicators of severity and chronicity in eating disorders. Patients with AN (N = 355) completed interviews and questionnaires at treatment admission and discharge; height and weight were assessed to calculate body mass index (BMI). Structural equation mixture modeling was used to test whether associations among potential indicators of SE-AN (illness duration, treatment history, BMI, binge eating, purging, quality-of-life) formed distinct subgroups, a single group with one or more dimensions, or a combination of subgroups and dimensions. A three-factor (dimensional), two-profile (categorical) mixture model provided the best fit to the data. Factor 1 included eating disorder behaviors; Factor 2 comprised quality-of-life domains; Factor 3 was characterized by illness duration, number of hospitalizations, and admission BMI. Profiles differed on eating disorder behaviors and quality-of-life, but not on indicators of chronicity or BMI. Factor scores, but not profile membership, predicted outcome at discharge from treatment. Data suggest that patients with AN can be classified on the basis of eating disorder behaviors and quality-of-life, but there was no evidence for a chronic subgroup of AN. Rather, indices of chronicity varied dimensionally within each class. Given that current definitions of SE-AN rely on illness duration, these findings have implications for research and clinical practice.
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Affiliation(s)
- Jennifer E. Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | | | - Kelsey E. Hagan
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Marsha D. Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Loren M. Gianini
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Wei Wu
- Department of Psychology, University of Kansas, Lawrence, KS, USA
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45
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Westwood H, Stahl D, Mandy W, Tchanturia K. The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis. Psychol Med 2016; 46:1809-1827. [PMID: 27109830 DOI: 10.1017/s0033291716000581] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.
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Affiliation(s)
- H Westwood
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - D Stahl
- Department of Biostatistics,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - W Mandy
- University College London,Research Department of Clinical, Educational and Health Psychology,London,UK
| | - K Tchanturia
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
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46
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Shih PAB, Woodside DB. Contemporary views on the genetics of anorexia nervosa. Eur Neuropsychopharmacol 2016; 26:663-73. [PMID: 26944296 PMCID: PMC4801707 DOI: 10.1016/j.euroneuro.2016.02.008] [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: 08/05/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Anorexia nervosa (AN) is a serious mental illness characterized by severe dietary restriction that leads to high rates of morbidity, chronicity, and mortality. Unfortunately, effective treatment is lacking and few options are available. High rates of familial aggregation and significant heritability suggested that the complex etiology of AN is affected by both genetic and environmental factors. In this paper, we review studies that reported common and rare genetic variation that influence susceptibility of AN through candidate gene studies, genome-wide association studies, and sequencing-based studies. We also discuss gene expression, methylation, imaging genetics, and pharmacogenetics to demonstrate that these studies have collectively advanced our knowledge of how genetic variation contributes to AN susceptibility and clinical course. Lastly, we highlight the importance of gene by environment interactions (G×E) and share our enthusiasm for the use of nutritional genomic approaches to elucidate the interaction among nutrients, metabolic intermediates, and genetic variation in AN. A deeper understanding of how nutrition alters genome stability, how genetic variation influences uptake and metabolism of nutrients, and how response to food components affects disordered eating, will lead to personalized dietary interventions and effective nutraceutical and pharmacological treatments for AN.
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Affiliation(s)
- Pei-an Betty Shih
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive #0664, La Jolla, CA 92093-0664, USA.
| | - D Blake Woodside
- Inpatient Eating Disorders Service, Toronto General Hospital, Canada; Department of Psychiatry, University of Toronto, Canada.
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47
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Treasure J. Applying evidence-based management to anorexia nervosa. Postgrad Med J 2016; 92:525-31. [PMID: 26944338 DOI: 10.1136/postgradmedj-2015-133282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/11/2016] [Indexed: 12/28/2022]
Abstract
AIM This paper considers how the three principles of evidence based practice (clinical expertise, scientific evidence, and patient preference) can be applied to the complexity of treatment for anorexia nervosa AN. METHOD A narrative review of the evidence of these three domains is presented. Clinical cases are used to illustrate how the formulation and management can be put into practice at different stages of illness. RESULTS The management of anorexia nervosa is complex. First, individuals with the illness do not regard the manifestations of the illness as a source of concern rather they are embraced and integrated into their identity. This contrasts to the reaction of other people who are terrified by the overt signs of ill health. Thus engagement into treatment is problematic. Second, the core symptom restricted eating, produces malnutrition which impacts on brain, body, and the social network. Thus a mixture of psychological and physical problems gradually accumulates over the course of the illness. This means that the treatment targets increase over time. CONCLUSION Thus treatment has to work with motivation and readiness to change and tackle the various domains of ill health.
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48
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Turton R, Bruidegom K, Cardi V, Hirsch CR, Treasure J. Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 61:132-55. [DOI: 10.1016/j.neubiorev.2015.12.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 11/12/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022]
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49
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Brockmeyer T, Hamze Sinno M, Skunde M, Wu M, Woehning A, Rudofsky G, Friederich HC. Inhibitory Control and Hedonic Response towards Food Interactively Predict Success in a Weight Loss Programme for Adults with Obesity. Obes Facts 2016; 9:299-309. [PMID: 27701173 PMCID: PMC5644782 DOI: 10.1159/000447492] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/01/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Low inhibitory control and strong hedonic response towards food are considered to contribute to overeating and obesity. Based on previous research, the present study aimed at examining the potentially crucial interplay between these two factors in terms of long-term weight loss in people with obesity. METHODS BMI, inhibitory control towards food, and food liking were assessed in obese adults prior to a weight reduction programme (OPTIFAST® 52). After the weight reduction phase (week 13) and the weight loss maintenance phase (week 52), participants' BMI was re-assessed. RESULTS Baseline BMI, inhibitory control and food liking alone did not predict weight loss. As hypothesised, however, inhibitory control and food liking interactively predicted weight loss from baseline to week 13 and to week 52 (albeit the latter effect was less robust). Participants with low inhibitory control and marked food liking were less successful in weight reduction. CONCLUSION These findings underscore the relevance of the interplay between cognitive control and food reward valuation in the maintenance of obesity.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- *Dr. Timo Brockmeyer, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany,
| | - Maria Hamze Sinno
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mandy Skunde
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mudan Wu
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- Department of Psychology, College of Education, Shanghai Normal University, Shanghai, China
| | - Annika Woehning
- Department of Endocrinology, Metabolism and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Gottfried Rudofsky
- Department of Endocrinology, Metabolism and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- Department of Internal Medicine, Medizinische Klinik, Kantonsspital Olten, Olten, Switzerland
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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50
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Touyz S, Hay P. Severe and enduring anorexia nervosa (SE-AN): in search of a new paradigm. J Eat Disord 2015; 3:26. [PMID: 26236477 PMCID: PMC4521346 DOI: 10.1186/s40337-015-0065-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Stephen Touyz
- School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Centre for Health Research School of Medicine, University of Western Sydney, Sydney, Australia
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