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Kiser ET, Sinclair KL, Tullos EA, Ratcliff CG. Associations between disordered eating and body focused repetitive behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1184-1191. [PMID: 35549835 DOI: 10.1080/07448481.2022.2070713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
Objective: College students with disordered eating (DE) are at increased risk of body focused repetitive behaviors (BFRBs). Both DE and BFRBs are described as impulsive and compulsive. However, the associations of impulsive DE with impulsive BFRBs and compulsive DE with compulsive BFRBs have not been examined. Methods: 191 college-aged students completed a survey of BFRBs and DE. Results: Participants who reported hair pulling were twice as likely to report clinically significant DE than those who denied hair pulling (p = .022). Participants who endorsed distressing hair pulling (p = .026), skin picking (p = .052), and nail biting (p = .094) were twice as likely to report clinically significant DE than those who were not distressed by these behaviors. Evidence did not support the association of BFRBs and DE along an impulsive/compulsive continuum. Conclusions: Results suggest that BFRBs and DE often co-occur, and the role of impulsivity and compulsivity in these behaviors is complex.
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Affiliation(s)
- Emalee T Kiser
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Kelsey L Sinclair
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
| | - Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas, USA
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2
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Zhao Z, Gobrogge K. Neurodevelopmental Model Explaining Associations between Sex Hormones, Personality, and Eating Pathology. Brain Sci 2023; 13:859. [PMID: 37371339 DOI: 10.3390/brainsci13060859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Clinical scientists have been investigating the relationships between sex hormones, personality, and eating disorders for decades. However, there is a lack of direct research that addresses whether personality mediates or moderates the relationships between sex hormones and eating pathology. Moreover, the neural mechanisms that underlie the interactive associations between these variables remain unclear. This review aims to summarize the associations between these constructs, describe a neural mechanism mediating these relationships, and offer clinical strategies for the early identification and intervention of eating disorders. The gathered evidence shows that aggressiveness, impulsivity, and obsessive-compulsiveness may mediate or moderate the relationships between sex hormones and eating pathology, but only among females. Furthermore, sex hormone receptor density in the mesocorticolimbic dopamine pathway may explain the neural mechanism of these associations. Future research should use more comprehensive personality measurements and assess the mediation and moderation effects of temperament while taking the hormone levels of women across menstrual cycles into account. Additionally, electroencephalography and functional magnetic resonance imaging should be implemented to directly assess brain activity and corroborate these findings.
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Affiliation(s)
- Ziyu Zhao
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Kyle Gobrogge
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
- Undergraduate Program in Neuroscience, College of Art & Sciences, Boston University, Boston, MA 02215, USA
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3
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McIntyre A, Kennett J, Eisenberg K, Nikolitch K, Wang T, Brunet A. Letter to the Editor: Examining weekly relationships between obsessive-compulsive and eating disorder symptoms. J Affect Disord 2023; 320:507-508. [PMID: 36206886 DOI: 10.1016/j.jad.2022.09.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Aynslie McIntyre
- Department of Psychiatry, Lady Davis Institute - Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
| | - Juliane Kennett
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Kayla Eisenberg
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Katerina Nikolitch
- Institute of Mental Health Research, The Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa, Canada; Ottawa Health Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Canada
| | - Ting Wang
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Alain Brunet
- Department of Psychiatry, McGill University, Montreal, Canada
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4
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Ahn J, Lee D, Lee JE, Jung YC. Orbitofrontal cortex functional connectivity changes in patients with binge eating disorder and bulimia nervosa. PLoS One 2022; 17:e0279577. [PMID: 36576922 PMCID: PMC9797068 DOI: 10.1371/journal.pone.0279577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
We aimed to define the shared and unshared functional neurobiological underpinnings of binge eating disorder (BED) and bulimia nervosa (BN). These disorders both involve loss of control over binge eating, but differ based on purging behavior and body image distortion. BED and BN have also been found to show differences in brain activation patterns in reward sensitivity. We enrolled 13 and 12 drug-naive and medication-free women with BED and BN, respectively, and 22 age- and sex-matched healthy controls. We performed an orbitofrontal cortex (OFC)-seeded resting-state whole brain functional connectivity (FC) analysis among the groups. In this study, BED patients exhibited significantly higher impulsivity than controls, whereas the difference in impulsivity between BN and controls was not significant. Participants with BED and BN showed weaker FC between the left lateral OFC and the right precuneus than controls. In the BED only group, the FC strength between these regions was negatively correlated with self-reported impulsivity. In both BED and BN, FC between the left lateral OFC and the right dorsolateral prefrontal cortex was weaker than that in controls. In BED, FC between the left medial OFC and the right cerebellar lobule IV was stronger than that of other groups. Our current results suggest similarities and differences between BED and BN in OFC-seeded FC with respect to reward processing. In particular, FC of the OFC in BED patients showed a significant correlation with their high impulsivity, which may reflect a decline in executive control over binge eating.
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Affiliation(s)
- Jaeun Ahn
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - DeokJong Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Jung Eun Lee
- Yonsei Empathy Psychiatric Clinic, Seoul, South Korea
| | - Young-Chul Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
- * E-mail:
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5
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Williams BM, Brown ML, Sandoval-Araujo L, Russell S, Levinson CA. Psychiatric Comorbidity Among Eating Disorders and Obsessive-Compulsive Disorder and Underlying Shared Mechanisms and Features: An Updated Review. J Cogn Psychother 2022; 36:226-246. [PMID: 35882534 DOI: 10.1891/jcpsy-d-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eating disorders (EDs) are highly comorbid with obsessive-compulsive disorder (OCD), with comorbidity rates as high as 41%. In the current review, we summarize the literature regarding the prevalence of ED-OCD comorbidity. We also identify and review the literature assessing shared features (i.e., shared characteristics or symptoms) and mechanisms (i.e., variables that may explain ED or OCD symptoms) of EDs and OCD. Potential shared features of EDs and OCD include age of onset, course of illness, obsessions, compulsions and ritualistic behaviors, and thought action fusion. Shared mechanisms that may explain ED-OCD comorbidity include genetic and neurobiological mechanisms, anxiety and fear, repetitive negative thinking, perfectionism, intolerance of uncertainty, distress tolerance, and impulsivity. Based on these shared features and mechanisms, a theoretical conceptualization of ED and OCD comorbidity is developed, and outline considerations for assessment, differential diagnosis, treatment, and future research regarding ED-OCD comorbidity are described.
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Affiliation(s)
- Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Mackenzie L Brown
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | - Luis Sandoval-Araujo
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
| | | | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY
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6
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Kolar DR, Kaurin A, Meule A, Schlegl S, Dittmer N, Voderholzer U. Interpersonal, affective and compulsive features of driven exercise in anorexia nervosa. J Affect Disord 2022; 307:53-61. [PMID: 35337926 DOI: 10.1016/j.jad.2022.03.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This preregistered (https://osf.io/g9ajb) analysis sought to integrate the current literature on trait compulsivity into maintenance models of driven exercise in anorexia nervosa (AN). We tested whether compulsivity increases the likelihood of driven exercise via interpersonal and affect-regulatory pathways. METHODS We used multilevel structural equation modeling to test the hypothesis that trait compulsivity predicts a stronger within-person link between affect-regulatory difficulties or interpersonal sensitivity and driven exercise in female adolescents and adults with AN. We used data from five assessments across inpatient treatment and 6-months follow-up of 207 adult and adolescent patients with AN (1035 datapoints). RESULTS In line with our hypotheses, patients who generally experienced more affect-regulatory difficulties or stronger interpersonal sensitivity tended to engage in driven exercise more strongly. Moreover, high levels of trait compulsivity amplified the effect of interpersonal sensitivity on driven exercise across time. Contrary to our hypotheses, the link between affect regulation and driven exercise was not moderated by compulsivity. Similar effects on general eating disorder psychopathology were found, but no cross-level moderation effect of compulsivity. LIMITATIONS Due to sample size, potential AN subtype-dependent effects were not analyzed. CONCLUSION Our results suggest that driven exercise coincides with self-reported experiences of interpersonal sensitivity and that this link varies as a function of compulsivity such that the within-person coupling is stronger among those scoring high on compulsivity. To derive clinically useful functional models of driven exercise, future studies might use intensive longitudinal data to investigate its momentary associations with affect and interpersonal sensitivity in the context of compulsive traits.
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Affiliation(s)
- D R Kolar
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - A Kaurin
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany
| | - A Meule
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - S Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - N Dittmer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - U Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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7
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Lyvers M, Sweetnam T, Thorberg FA. Alexithymia, rash impulsiveness, and reward sensitivity in relation to symptoms of exercise dependence in physically active young adults. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1981747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Michael Lyvers
- School of Psychology, Bond University, Gold Coast, Australia
| | - Taylor Sweetnam
- School of Psychology, Bond University, Gold Coast, Australia
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8
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Merinuk N, Varcoe SC, Kelly PJ, Robinson LD. The role of rash-impulsivity, emotional dysregulation and reward drive in comorbid disordered eating and substance use disorders. ADVANCES IN DUAL DIAGNOSIS 2021. [DOI: 10.1108/add-01-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Substance use disorder (SUD) frequently co-occurs with other psychological conditions, such as eating disorders (EDs). Psychological factors such as emotional dysregulation, rash impulsivity (RI) and reward sensitivity (RS) play a role in the etiology of each disorder, yet little is known about the combined effects of these on comorbid SUDs and EDs or disordered eating behaviours (DEBs). This study aims to examine the role of these psychological factors in comorbid DEBs and SUDs among individuals in treatment for SUDs. The role of gender is tested as a moderator.
Design/methodology/approach
A cross-sectional self-report survey was completed by 131 participants attending Australian residential substance use treatment centres. A binomial logistic regression analysis was performed to examine the effects of emotional dysregulation, RI and RS on comorbid DEB and SUD. Further, moderation analyses were used to examine the moderating effect for gender on the relationship between these three personality variables and comorbidity.
Findings
The most commonly reported primary substance of use was alcohol (43.5%), followed by amphetamines (38.6%). Findings showed that emotional dysregulation and RI were significantly related to an increase in comorbidity likelihood; however, RS was not. Gender moderated the relationship between comorbidity and RI only.
Originality/value
The significant positive relationship found between RI and comorbidity for females only was a novel finding for the current study. Further research is needed to develop an understanding of the etiology of comorbidity.
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9
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Claes L, Buelens T, Depestele L, Dierckx E, Schoevaerts K, Luyckx K. Obsessive-compulsive symptoms in female patients with an eating disorder with or without impulsive non-suicidal self-injury. EUROPEAN EATING DISORDERS REVIEW 2021; 29:663-669. [PMID: 33880819 DOI: 10.1002/erv.2836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/16/2021] [Accepted: 04/06/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIMS In the present study, we investigated differences in obsessive-compulsive (OC) symptoms in patients with an eating disorder (ED) with or without recent/lifetime impulsive non-suicidal self-injury (NSSI). We included 429 female inpatients with an ED, of whom 31.9% engaged in recent impulsive NSSI and 56.4% in lifetime impulsive NSSI. MATERIALS They filled out the Eating Disorder Evaluation Scale, the Self-Injury Questionnaire-Treatment Related and the Padua Inventory-Revised (OC symptoms). METHODS AND RESULTS Patients with anorexia nervosa, binge-eating/purging type (AN-BP) and bulimia nervosa (BN) engaged more frequently in recent/lifetime impulsive NSSI compared to patients with anorexia nervosa, restrictive-type (AN-R). Two MANCOVAs with OC symptoms as dependent variables, and ED subtypes and recent/lifetime impulsive NSSI as independent variables controlling for age and body mass index showed the main effects of ED subtypes and recent/lifetime impulsive NSSI. Patients with AN-BP reported significantly more impulses (i.e., being afraid of losing control over motor behaviours) compared to patients with AN-R and BN. ED patients with impulsive recent/lifetime NSSI scored significantly higher on all OC scales compared to patients without NSSI. DISCUSSION AND CONCLUSION In sum, the presence of recent/lifetime impulsive NSSI in patients with an ED seems to be related to more severe OC symptoms. Hence, this comorbidity needs to be addressed in psychotherapy, such as in transdiagnostic cognitive behavioural therapy for EDs.
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Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Tinne Buelens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Lies Depestele
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Psychiatric Hospital Alexianen Zorggroep Tienen, Tienen, Belgium
| | - Eva Dierckx
- Psychiatric Hospital Alexianen Zorggroep Tienen, Tienen, Belgium.,Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
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10
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Todisco P, Meneguzzo P, Garolla A, Antoniades A, Vogazianos P, Tozzi F. Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study. Eat Weight Disord 2021; 26:869-877. [PMID: 32430886 DOI: 10.1007/s40519-020-00916-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 05/02/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs). METHODS 320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient. RESULTS Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037). DISCUSSION Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings. LEVEL OF EVIDENCE III, cohort or case-control analytic studies.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | - Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy. .,Department of Neuroscience, University of Padova, via Giustiniani 2, 35128, Padova, Italy.
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University Cyprus, Engomi, Cyprus
| | - Federica Tozzi
- Research and Development, Stremble Ventures, Limassol, Cyprus
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11
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Sassover E, Weinstein A. Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view. J Behav Addict 2020; 11. [PMID: 32997646 PMCID: PMC9295215 DOI: 10.1556/2006.2020.00055] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/18/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior disorder (CSBD) has been a long debated issue. While formerly the discussion was about whether to regard CSBD as a distinctive disorder, the current debate is dealing with the classification of this phenomenon. One of the prominent voices in this field considers CSBD as a behavioral addiction and proposes CSBD to be called and diagnosed as sexual addiction (SA). This present debate paper will review the existing evidence supporting this view and it will argue against it. RESULTS We have found that a great deal of the current literature is anecdotal while empirical evidence is insufficient. First, the reports about the prevalence of CSBD are contradictory. Additionally, the field mainly suffers from inconsistent defining criteria of CSBD and a consensus which symptoms should be included. As a result, the empirical evidence that does exist is mostly about some symptoms individually and not on the disorder as a whole construct. CONCLUSIONS We conclude that currently, there is not enough data supporting CSBD as a behavioral addiction. Further research has to be done, examining CSBD phenomenology as a whole construct and based on a homogeneous criterion.
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Affiliation(s)
- Eli Sassover
- Department of Behavioral Science, Ariel University, Science Park, Ariel, Israel
- Department of Behavioral Science and Integrative Brain and Cognition Center, Ariel University, Ariel, Israel
| | - Aviv Weinstein
- Department of Behavioral Science, Ariel University, Science Park, Ariel, Israel
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12
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Soidla K, Akkermann K. Perfectionism and impulsivity based risk profiles in eating disorders. Int J Eat Disord 2020; 53:1108-1119. [PMID: 32378245 DOI: 10.1002/eat.23285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The categorical classification of eating disorders (ED) has several limitations, for example, high symptom variability within the diagnosis and limited predictive validity for treatment response. An alternative is classifying individuals with ED based on personality traits, which can reflect underlying etiological mechanisms. We aimed to find latent profiles based on facets of maladaptive and adaptive perfectionism, impulsivity and ED symptoms. METHOD The sample comprised of 274 women-164 had an ED diagnosis and 110 were controls. Two separate latent profile analyses were performed-one on the mixed sample (controls and individuals with ED) and the other on the sample of individuals with ED only. RESULTS We identified a five-class model to be the best fit for the mixed sample. The classes were: (a) moderately impulsive, (b) high functioning, (c) purely perfectionistic, (d) emotionally dysregulated, (e) behaviorally dysregulated. Among the individuals with ED, a four-class solution was found to be the best fit. The classes were very similar in their response patterns on indicator variables to response patterns observed in the mixed sample, except the emotionally and behaviorally dysregulated classes that formed into one class. DISCUSSION In addition to the well-known high-functioning, overcontrolled and undercontrolled classes, two to three undercontrolled classes (moderately impulsive, behaviorally, and emotionally dysregulated class) emerged. Those classes differentiated on perfectionism and impulsivity levels as well as on ED symptom severity and psychiatric comorbidities-all of which may influence maintenance of ED, appropriate treatment choice and therefore treatment response.
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Affiliation(s)
- Kärol Soidla
- Institute of Psychology, University of Tartu, Näituse, Estonia
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13
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Monell E, Clinton D, Birgegård A. Self-directed behaviors differentially explain associations between emotion dysregulation and eating disorder psychopathology in patients with or without objective binge-eating. J Eat Disord 2020; 8:17. [PMID: 32377341 PMCID: PMC7193412 DOI: 10.1186/s40337-020-00294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 04/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emotion dysregulation and negative self-directed behaviors are key characteristics of eating disorders (EDs), but their interaction in relation to ED psychopathology is insufficiently explored, and empirically robust and clinically relevant models are needed. METHODS This study examined whether the association between emotion dysregulation and ED psychopathology was mediated by different negative self-directed behaviors in 999 ED patients divided into two sub-samples based on absence or presence of objective binge-eating episodes (OBE). Several simple and extended mediation models were examined using the Difficulties in Emotion Regulation Scale (DERS) as independent variable, the Structural Analysis of Social Behavior (SASB) as mediator, and the Eating Disorder Examination Questionnaire (EDE-Q) as dependent variable. RESULTS An associational pathway was found where higher emotion dysregulation was associated with more negative self-directed behaviors, which in turn was associated with higher ED psychopathology. Self-directed behaviors of importance differed between patient groups. In participants without OBE, lower self-love and higher self-attack were influential, whereas in participants with OBE, lower self-affirmation and higher self-blame were influential. CONCLUSIONS Self-directed behaviors may help to explain the association between emotion dysregulation and ED psychopathology. Our findings have both theoretical and clinical implications that are pathology-specific. Addressing specific self-directed behaviors could be an important way of helping patients deal with their emotions in relation to ED psychopathology.
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Affiliation(s)
- Elin Monell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Clinton
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute for Eating Disorders, Oslo, Sweden
| | - Andreas Birgegård
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, SE-11364 Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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14
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Claes L, Vandereycken W, Vertommen H. Family environment of eating disordered patients with and without self-injurious behaviors. Eur Psychiatry 2020; 19:494-8. [PMID: 15589709 DOI: 10.1016/j.eurpsy.2004.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Revised: 06/28/2004] [Accepted: 08/25/2004] [Indexed: 10/26/2022] Open
Abstract
AbstractObjective.– The family environment is known to be an important contributor to the course of psychiatric disorders. In this study, we examined the family context of eating disordered (ED) patients with and without self-injurious behaviors (SIB).Method.– A Dutch adaptation of the Family Environment Scale ‘Sci Eng 57(9-B):1997;5927’ was completed by 131 ED patients of whom 47% showed at least one form of SIB (e.g., cutting, burning, hair pulling, etc.).Results– Results showed a significant difference in family environment between patients with and without SIB. The family environment of self-injuring ED patients was less cohesive, expressive and socially oriented, and more conflictual and disorganized than the family environment of those without SIB. No significant differences in perceived family environment were found with respect to the number or form of SIB and the subtype of ED. Neither did we find a significant interaction effect between ED subtype and presence/absence of SIB.
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Affiliation(s)
- Laurence Claes
- Department of Psychology, Catholic University of Leuven, Tiensestraat 102, 3000 Leuven, Belgium.
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15
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Allen KJD, Sammon MM, Fox KR, Stewart JG. Emotional Response Inhibition: A Shared Neurocognitive Deficit in Eating Disorder Symptoms and Nonsuicidal Self-Injury. Brain Sci 2020; 10:E104. [PMID: 32075254 PMCID: PMC7071419 DOI: 10.3390/brainsci10020104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 01/18/2023] Open
Abstract
Eating disorder (ED) symptoms often co-occur with non-suicidal self-injury (NSSI). This comorbidity is consistent with evidence that trait negative urgency increases risk for both of these phenomena. We previously found that impaired late-stage negative emotional response inhibition (i.e., negative emotional action termination or NEAT) might represent a neurocognitive mechanism for heightened negative urgency among people with NSSI history. The current study evaluated whether relations between negative urgency and ED symptoms similarly reflect deficits in this neurocognitive process. A total of 105 community adults completed an assessment of ED symptoms, negative urgency, and an emotional response inhibition task. Results indicated that, contrary to predictions, negative urgency and NEAT contributed independent variance to the prediction of ED symptoms, while controlling for demographic covariates and NSSI history. Worse NEAT was also uniquely associated with restrictive eating, after accounting for negative urgency. Our findings suggest that difficulty inhibiting ongoing motor responses triggered by negative emotional reactions (i.e., NEAT) may be a shared neurocognitive characteristic of ED symptoms and NSSI. However, negative urgency and NEAT dysfunction capture separate variance in the prediction of ED-related cognitions and behaviors, distinct from the pattern of results we previously observed in NSSI.
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Affiliation(s)
| | - M. McLean Sammon
- Department of Psychology, Oberlin College, Oberlin, OH 44074-1024, USA;
| | - Kathryn R. Fox
- Department of Psychology, University of Denver, Denver, CO 80210-4638, USA;
| | - Jeremy G. Stewart
- Department of Psychology, Queen’s University, Kingston, ON K7L 3N6, Canada
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16
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Verschueren M, Claes L, Palmeroni N, Bogaerts A, Gandhi A, Moons P, Luyckx K. Eating Disorder Symptomatology in Adolescent Boys and Girls: Identifying Distinct Developmental Trajectory Classes. J Youth Adolesc 2019; 49:410-426. [PMID: 31761965 DOI: 10.1007/s10964-019-01174-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
Eating disorder symptomatology is highly prevalent in adolescence and is regarded one of the most important precursors of clinical eating disorders. The present longitudinal study examined the development of eating disorder symptomatology in adolescents over two years. At Time 1,528 high school students filled out self-report questionnaires (50.5% female; Mage = 15 years). Multivariate latent growth curve modeling and latent class growth analyses were performed to model latent trajectories and to identify latent trajectory classes. Stable trajectories of drive for thinness and body dissatisfaction were found, whereas bulimia and BMI increased over time. Important gender differences pointed to girls experiencing more eating disorder symptoms at each time point. Additionally, more diverse trajectory classes were found in girls than in boys. Finally, classes with the most eating disorder symptoms also experienced the most problems in identity development, internalizing symptoms, and the least effortful control. The present study underscores the importance of identifying vulnerable adolescents that experience greater eating disorder symptomatology, as they also seem to experience the worst psychosocial development.
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Affiliation(s)
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Nina Palmeroni
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Annabel Bogaerts
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Amarendra Gandhi
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
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17
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Sagiv E, Hadlaczky G, Sheetrit N, Gur E, Horesh N, Gvion Y. The Fear of Losing-Nonsuicidal Self-Injury as a Protective Mechanism in Eating Disorders. Front Psychiatry 2019; 10:825. [PMID: 31803081 PMCID: PMC6873791 DOI: 10.3389/fpsyt.2019.00825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/18/2019] [Indexed: 01/01/2023] Open
Abstract
Background: This study examined the moderating role of loss aversion (LA) on the relationship between impulsivity, nonsuicidal self-injury (NSSI), suicidal attempts, and ideations among Eating Disorder (ED) patients. Methods: Data was collected on 81 ED patients and 37 healthy controls. ED patients were divided into 2 groups: 25 AN-Rs, 56 AN-BPs and BNs. Measurements of trait impulsivity, LA, NSSI, suicide attempts, and suicide ideations were collected. Results: The rate of attempting suicide was highest in the AN-BP/BN (34.8%), lower in the AN-Rs (8%), and the lowest in the controls (2.7%). Suicide ideation was also higher in AN-BP/BN compared to both AN-R and controls. NSSI was higher in the AN-BP/BN group compared to both AN-R and control groups. LA scores were lower among participants with EDs compared to controls. BMI and depression were positively associated with suicide ideation and NSSI. Impulsivity was associated to suicide attempt and suicide ideation. Contrary to our hypothesis, LA scores were positively correlated with NSSI and SI. A stepwise regression revealed that contradictory to our hypothesis, higher LA predicted NSSI prevalence severity of NSSI and suicide ideation. Limitations: (1) Cross-sectional design; (2) Relatively small sample size of clinical subjects and only female participants; (3) Heterogeneity of treatment status. Conclusions: EDs are associated with lower levels of LA compared to general population. Although high LA is considered a protective factor against "high damage" decisions, it may serve as a facilitator of lower risk decisions which help the individual soothe and communicate his or her own suffering such as NSSI.
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Affiliation(s)
- Eran Sagiv
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Gergö Hadlaczky
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Noga Sheetrit
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Eitan Gur
- The Eating Disorders Department, Sheba Medical Center, Ramat Gan, Israel
| | - Netta Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Yari Gvion
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychology, Academic College Tel Aviv–Yaffo, Yaffo, Israel
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18
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Thompson-Memmer C, Glassman T, Diehr A. Drunkorexia: A new term and diagnostic criteria. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:620-626. [PMID: 30285556 DOI: 10.1080/07448481.2018.1500470] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/11/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
Individuals who restrict their caloric intake and/or exercise excessively to mitigate the calories from alcohol consumption may suffer from an eating disorder, substance abuse disorder, or both. While the term "drunkorexia" has been used in both academic articles and popular culture, issues persist with respect to diagnosing and treating this condition. Classifying the behavior as a subcategory of Other Specified Feeding and Eating Disorders (OSFED) would provide patients with an increased likelihood of receiving insurance coverage for this condition. A consistent definition of this behavior and a more medically accurate/appropriate term-such as "alcoholimia"-are both needed to advance treatment and prevention efforts.
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Affiliation(s)
| | | | - Aaron Diehr
- Southern Illinois University , Carbondale , Illinois , USA
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19
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Bénard M, Bellisle F, Kesse-Guyot E, Julia C, Andreeva VA, Etilé F, Reach G, Dechelotte P, Tavolacci MP, Hercberg S, Péneau S. Impulsivity is associated with food intake, snacking, and eating disorders in a general population. Am J Clin Nutr 2019; 109:117-126. [PMID: 30596882 DOI: 10.1093/ajcn/nqy255] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background Impulsivity is a psychological trait linked to health issues such as obesity. However, few studies have explored the relation between impulsivity, dietary intake, and eating disorders (EDs) in a general population. Objective The aim of this cross-sectional study was to assess whether impulsivity was associated with energy intake, food-group consumption, snacking, and risk of EDs. Design In 2014, 51,368 adult participants from the NutriNet-Santé Study completed the 11th version of the Barratt Impulsiveness Scale (BIS-11), which assesses impulsivity. Food-group consumption and diet quality were evaluated by using ≥3 self-reported 24-h dietary records (n = 35,830), whereas snacking behavior was evaluated by an ad hoc question (n = 48,562). Risk of EDs was assessed with the Sick-Control-One-Fat-Food Questionnaire (SCOFF), and categories of ED (restrictive, bulimic, hyperphagic, and other types of EDs) were determined with the Expali algorithm (n = 48,824). Logistic and linear regressions were used to analyze the associations between impulsivity and energy intake, food-group consumption, diet quality, snacking, and risk of EDs, taking into account sociodemographic and lifestyle factors. Results Positive associations were found between impulsivity and consumption of alcoholic beverages and appetizers, whereas negative associations were found for fruit and vegetables, meat and poultry, processed meat, dairy products, milk-based desserts, and starchy foods. Impulsivity was positively associated with energy intake and negatively associated with diet quality. Impulsivity was also positively associated with snacking (OR: 3.32; 95% CI: 2.99, 3.68) and risk of EDs (OR: 3.02; 95% CI: 2.74, 3.33). The strongest associations were found for bulimic disorders (OR: 4.38; 95% CI: 3.66, 5.23) and hyperphagic disorders (OR: 2.91; 95% CI: 2.56, 3.31). Conclusion Impulsivity was associated with food intakes, snacking, and risk of EDs and could be taken into account in the promotion of healthy eating behavior. This study was registered at clinicaltrials.gov as NCT03335644.
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Affiliation(s)
- Marc Bénard
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France
| | - France Bellisle
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France
| | - Chantal Julia
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France.,Public Health Department, Avicenne Hospital, Bobigny, France
| | - Valentina A Andreeva
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France
| | - Fabrice Etilé
- Paris School of Economics and INRA, UMR1393 Paris-Jourdan Economic Sciences (PjSE), Paris, France
| | - Gérard Reach
- Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital, Bobigny, France
| | - Pierre Dechelotte
- Nutrition Department, Rouen University Hospital and INSERM U1073, Rouen, France
| | - Marie-Pierre Tavolacci
- Rouen University Hospital, Clinical Investigation Center 1404 and Normandie University, UNIROUEN, INSERM U1073, Rouen, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France.,Public Health Department, Avicenne Hospital, Bobigny, France
| | - Sandrine Péneau
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), French National Institute for Health and Medical Research (INSERM) U1153, French National Institute for Agricultural Research (INRA) U1125, National Conservatory for Arts and Crafts (CNAM), Paris 13 University, Bobigny, France
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20
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Ay R, Aytas O. The relationship between eating attitudes and distress tolerance in obsessive compulsive disorder. ARCH CLIN PSYCHIAT 2018. [DOI: 10.1590/0101-60830000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rukiye Ay
- Malatya Training and Research Hospital, Turkey
| | - Ozgur Aytas
- Malatya Training and Research Hospital, Turkey
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21
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Pak KN, Wonderlich J, le Grange D, Engel SG, Crow S, Peterson C, Crosby RD, Wonderlich SA, Fischer S. The moderating effect of impulsivity on negative affect and body checking. Compr Psychiatry 2018; 86:137-142. [PMID: 30145404 PMCID: PMC8666955 DOI: 10.1016/j.comppsych.2018.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/18/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
This study examined the moderating effects of different aspects of trait impulsivity on trajectories of negative affect prior to and following body checking in the natural environment in women with anorexia nervosa (AN). Body checking is a compulsive behavior that may maintain the cycle of eating disordered behavior through negative reinforcement. Previous studies regarding the relationship of negative affect to body checking have been inconsistent, making it unclear how negative affect functions as an antecedent to this behavior in the natural environment. We hypothesized that individual differences in trait impulsivity may influence body checking in response to negative affect. Negative urgency (NU) (the tendency to act rashly under distress) and (lack of) perseverance (the tendency to give up on goal directed behavior) may be unique facets of impulsivity that play a role in body checking. Women with AN (n = 82) completed a self-report measure of impulsivity and used ecological momentary assessment (EMA) to record negative affect and body checking for two weeks. Results indicated that women with low (lack of) perseverance experienced a greater increase in negative affect than those with high (lack of) perseverance prior to and following body checking. Overall, results indicate that individual differences in trait impulsivity moderated the relationship of negative affect to body checking in women with AN.
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Affiliation(s)
- K. Naomi Pak
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA,Corresponding author. (K.N. Pak)
| | - Joseph Wonderlich
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA
| | - Daniel le Grange
- University of California San Francisco, 3333 California Street, Box 0503, LH Suite 245, San Francisco, CA 94143-0503, USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Scott Crow
- University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Carol Peterson
- University of Minnesota, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences, 120 8th Street South, Fargo, ND 58103, USA
| | - Sarah Fischer
- George Mason University, 4400 University Drive, Fairfax, VA 22032, USA
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22
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Steward T, Mestre-Bach G, Vintró-Alcaraz C, Agüera Z, Jiménez-Murcia S, Granero R, Fernández-Aranda F. Delay Discounting of Reward and Impulsivity in Eating Disorders: From Anorexia Nervosa to Binge Eating Disorder. EUROPEAN EATING DISORDERS REVIEW 2018; 25:601-606. [PMID: 29057603 DOI: 10.1002/erv.2543] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 12/16/2022]
Abstract
Evidence points to eating disorder patients displaying altered rates of delay discounting (one's degree of preference for immediate rewards over larger delayed rewards). Anorexia nervosa (AN) patients are believed to have an increased capacity to delay reward, which reflects their ability to override the drive to eat. Contrarily, binge eating disorder (BED) patients are associated with a reduced predisposition to delay gratification. Here, we investigated monetary delay discounting and impulsivity in 80 adult women with EDs (56 AN and 24 BED), diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria, and 80 healthy controls. AN-restrictive (AN-R) subtype patients showed less steep discounting rates than BED and AN-bingeing/purging subtype patients. Compared with healthy controls and AN-R patients, BED and AN-bingeing/purging patients presented higher delay discounting and positive and negative urgency levels. Our findings suggest that restriction in AN-R patients is associated with disproportionate self-control, whereas bingeing behaviours could be more driven by emotional states and impulsivity traits. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Trevor Steward
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | - Gemma Mestre-Bach
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | | | - Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autónoma de Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Spain.,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Spain
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23
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Hunt TK, Forbush KT, Hagan KE, Chapa DA. Do emotion regulation difficulties when upset influence the association between dietary restraint and weight gain among college students? Appetite 2017; 114:101-109. [DOI: 10.1016/j.appet.2017.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 01/30/2017] [Accepted: 03/20/2017] [Indexed: 11/26/2022]
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24
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Lavender JM, Goodman EL, Culbert KM, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Le Grange D, Crow SJ, Peterson CB. Facets of Impulsivity and Compulsivity in Women with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:309-313. [PMID: 28387426 DOI: 10.1002/erv.2516] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 02/21/2017] [Accepted: 03/06/2017] [Indexed: 01/26/2023]
Abstract
This study sought to investigate independent associations of impulsivity and compulsivity with eating disorder (ED) symptoms. Women (N = 81) with full or subthreshold Diagnostic and Statistical Manual of Mental Disorders IV anorexia nervosa (AN) completed a semi-structured interview and self-report questionnaires. Multiple regression analyses were conducted using ED symptoms as dependent variables and facets of impulsivity and compulsivity as predictor variables (controlling for body mass index and AN diagnostic subtype). For impulsivity facets, lack of perseverance was uniquely associated with eating concern, shape concern and restraint, whereas negative urgency was uniquely associated with eating concern and frequency of loss of control eating; neither sensation seeking nor lack of premeditation was uniquely associated with any ED variables. Compulsivity was uniquely associated with restraint, eating concern and weight concern. Results support independent associations of impulsivity and compulsivity with ED symptoms in adults with AN, suggesting potential utility in addressing both impulsive and compulsive processes in treatment. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Jason M Lavender
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Erica L Goodman
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
| | - Kristen M Culbert
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Stephen A Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.,The Emily Program, St. Paul, MN, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.,The Emily Program, St. Paul, MN, USA
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25
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Thompson C, Park S. Barriers to access and utilization of eating disorder treatment among women. Arch Womens Ment Health 2016; 19:753-60. [PMID: 26971265 DOI: 10.1007/s00737-016-0618-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
Anorexia, bulimia, and other specified feeding or eating disorders (OSFED) are psychiatric disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). One difference of eating disorders compared to other psychiatric disorders is the physical effects of the disease. Although anorexia is easier to physically detect than bulimia and OSFED, many women remain undiagnosed and untreated. Even if an eating disorder is recognized by the individual, barriers to clinical diagnosis and treatment persist. This study examines the barriers to treatment among women with anorexia, bulimia, and OSFED using Andersen's Behavioral Model. The physical, psychological, and personality trait differences among the eating disorder subgroups may affect treatment utilization and access.
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Affiliation(s)
- Carly Thompson
- Department of Public Policy, Indiana University-Purdue University Fort Wayne, 2101 E. Coliseum Blvd. Neff Hall 260 D, Fort Wayne, IN, 46805, USA.
| | - Sinyoung Park
- Department of Public Policy, Indiana University-Purdue University Fort Wayne, 2101 E. Coliseum Blvd. Neff Hall 260 D, Fort Wayne, IN, 46805, USA
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26
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A systematic review of the relationship between eating, weight and inhibitory control using the stop signal task. Neurosci Biobehav Rev 2016; 64:35-62. [PMID: 26900651 DOI: 10.1016/j.neubiorev.2016.02.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/26/2016] [Accepted: 02/13/2016] [Indexed: 11/24/2022]
Abstract
Altered inhibitory control (response inhibition, reward-based inhibition, cognitive inhibition, reversal learning) has been implicated in eating disorders (EDs) and obesity. It is unclear, however, how different types of inhibitory control contribute to eating and weight-control behaviours. This review evaluates the relationship between one aspect of inhibitory control (a reactive component of motor response inhibition measured by the stop signal task) and eating/weight in clinical and non-clinical populations. Sixty-two studies from 58 journal articles were included. Restrained eaters had diminished reactive inhibitory control compared to unrestrained eaters, and showed greatest benefit to their eating behaviour from manipulations of inhibitory control. Obese individuals may show less reactive inhibitory control but only in the context of food-specific inhibition or after executive resources are depleted. Of the limited studies in EDs, the majority found no impairment in reactive inhibitory control, although findings are inconsistent. Thus, altered reactive inhibitory control is related to some maladaptive eating behaviours, and hence may provide a therapeutic target for behavioural manipulations and/or neuromodulation. However, other types of inhibitory control may also contribute. Methodological and theoretical considerations are discussed.
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27
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Van Autreve S, De. Baene W, Baeken C, van Heeringen K, Vancayseele N, Vervaet M. Differential Neural Correlates of Set-Shifting in the Bingeing-Purging and Restrictive Subtypes of Anorexia Nervosa: An fMRI Study. EUROPEAN EATING DISORDERS REVIEW 2016; 24:277-85. [PMID: 26856396 DOI: 10.1002/erv.2437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/05/2015] [Accepted: 01/09/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Sara Van Autreve
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences; Ghent University; Belgium
| | - Wouter De. Baene
- Department of Experimental Psychology, Faculty of Psychology and Educational Sciences; Ghent University; Belgium
- Department of Cognitive Neuropsychology; Tilburg University; The Netherlands
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences; Ghent University; Belgium
| | - Kees van Heeringen
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences; Ghent University; Belgium
| | - Nikita Vancayseele
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences; Ghent University; Belgium
| | - Myriam Vervaet
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences; Ghent University; Belgium
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Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender. Child Psychiatry Hum Dev 2016; 47:43-52. [PMID: 25776344 DOI: 10.1007/s10578-015-0543-1] [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] [Indexed: 10/23/2022]
Abstract
The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.
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Kingston DA. Hypersexuality Disorders and Sexual Offending. SEXUAL OFFENDING 2016. [DOI: 10.1007/978-1-4939-2416-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Are There Differences in Central Coherence and Set Shifting Across the Subtypes of Anorexia Nervosa?: A Systematic Review. J Nerv Ment Dis 2015; 203:774-80. [PMID: 26421969 DOI: 10.1097/nmd.0000000000000366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Anorexia nervosa (AN) has been associated with weaknesses in central coherence and set shifting. In this line, it has been proposed to directly address these neuropsychological features in treatment (e.g., cognitive remediation therapy). It is not clear, however, whether the 2 subtypes of AN, the restricting (AN-R) and bingeing/purging (AN-BP) type, have the same amount of problems in these domains. A systematic search of the literature was conducted, using the databases Web of Science and PubMed, looking for studies on the comparison of AN-R and AN-BP in performing central coherence/set-shifting tasks. Notably, very few authors describe the results of a direct comparison of the performance of patients with AN-R and AN-BP. In summary, the available indications for possible group differences are not strong enough to draw definitive conclusions.
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Gender differences in the relationship between impulsivity and disordered eating behaviors and attitudes. Eat Behav 2015; 18:120-4. [PMID: 26042919 DOI: 10.1016/j.eatbeh.2015.05.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/12/2015] [Accepted: 05/13/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated relationships among gender, impulsivity and disordered eating in healthy college students. METHOD Participants (N=1223) were healthy, undergraduate men (28.5%) and women (71.5%), who completed the Barratt Impulsiveness Scale - Version 11 (BIS-11) and a four-factor version of the Eating Attitudes Test (EAT-16). RESULTS As predicted, mean scores on all four EAT-16 factors were significantly higher for women than for men. Attentional impulsivity was related to poorer self-perception of body shape, more dieting, and a greater preoccupation with food for the sample as a whole. Moreover, motor impulsivity was related to poorer self-perceptions of body shape and a greater preoccupation with food. However, no gender differences emerged in the relationship between impulsivity and disordered eating attitudes. DISCUSSION This study elucidates the role of impulsivity in disordered eating behaviors among non-clinical college students. For both women and men, attentional and motor impulsivity were related to disordered eating attitudes and behaviors. Overall, these findings suggest that different facets of impulsivity are related to disordered eating attitudes and behaviors in a non-clinical college population.
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Claes L, Islam MA, Fagundo AB, Jimenez-Murcia S, Granero R, Agüera Z, Rossi E, Menchón JM, Fernández-Aranda F. The Relationship between Non-Suicidal Self-Injury and the UPPS-P Impulsivity Facets in Eating Disorders and Healthy Controls. PLoS One 2015; 10:e0126083. [PMID: 25993565 PMCID: PMC4439129 DOI: 10.1371/journal.pone.0126083] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/30/2015] [Indexed: 11/18/2022] Open
Abstract
In the present study, we investigated the association between Non-Suicidal Self-Injury (NSSI) and the UPPS-P impulsivity facets in eating disorder patients and healthy controls. The prevalence of NSSI in eating disorder (ED) patients ranged from 17% in restrictive anorexia nervosa (AN-R) patients to 43% in patients with bulimia nervosa (BN). In healthy controls (HC), the prevalence of NSSI was 19%. Eating disorder patients from the binge eating/purging type showed significantly more NSSI compared to restrictive ED and HC participants. Binge-eating/purging ED patients also scored significantly higher on Negative/Positive Urgency, Lack of Premeditation and Lack of Perseverance compared to HC and restrictive ED patients. Comparable findings were found between ED patients and HC with and without NSSI; ED patients and HC with NSSI scored significantly higher in four of the five UPPS-P dimensions compared to participants without NSSI; Sensation Seeking was the exception. Finally, the presence of NSSI in HC/ED patients was particularly predicted by low levels of Perseverance. Therefore, the treatment of ED patients with NSSI certainly needs to focus on the training of effortful control.
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Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Mohammed A. Islam
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Ana B. Fagundo
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Elisa Rossi
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - José M. Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- * E-mail:
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Facets of impulsivity interactively predict body fat and binge eating in young women. Appetite 2015; 87:352-7. [DOI: 10.1016/j.appet.2015.01.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 12/30/2014] [Accepted: 01/06/2015] [Indexed: 11/21/2022]
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Cooper JL, O'Shea AE, Atkinson MJ, Wade TD. Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample. Int J Eat Disord 2014; 47:630-9. [PMID: 24659541 DOI: 10.1002/eat.22278] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/20/2014] [Accepted: 03/11/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating. METHOD Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors. RESULTS The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter. DISCUSSION The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.
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Affiliation(s)
- Jane L Cooper
- School of Psychology, Flinders University, Adelaide, South Australia
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Boone L, Claes L, Luyten P. Too strict or too loose? Perfectionism and impulsivity: the relation with eating disorder symptoms using a person-centered approach. Eat Behav 2014; 15:17-23. [PMID: 24411744 DOI: 10.1016/j.eatbeh.2013.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/03/2013] [Accepted: 10/09/2013] [Indexed: 11/28/2022]
Abstract
Although both perfectionism (i.e. personal standards perfectionism and evaluative concerns perfectionism) and impulsivity have been shown to be implicated in eating disorders, no previous studies have examined the interplay between both personality dimensions in their association with eating disorder symptoms. This is the first study to investigate the relationship between empirically derived personality subtypes based on perfectionism and impulsivity and eating disorder symptoms (i.e., dietary restraint, and concerns over eating, weight and shape). Cluster analysis was used to establish naturally occurring combinations of perfectionism and impulsivity in adolescent boys and girls (N=460; M age=14.2 years, SD=.90). Evidence was obtained for four personality profiles: (1) a resilient subtype (low on perfectionism and impulsivity), (2) pure impulsivity subtype (high on impulsivity only), (3) pure perfectionism subtype (high on perfectionism only), and (4) combined perfectionism/impulsivity subtype (high on both perfectionism and impulsivity). Participants in these four clusters showed differences in terms of eating disorder symptoms in that participants with a combination of high perfectionism and high impulsivity (rather than the presence of one of these two characteristics alone) had the highest levels of ED symptoms. These findings shed new light on extant theories concerning ED.
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Affiliation(s)
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, UK
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Litwack SD, Mitchell KS, Sloan DM, Reardon AF, Miller MW. Eating disorder symptoms and comorbid psychopathology among male and female veterans. Gen Hosp Psychiatry 2014; 36:406-10. [PMID: 24815590 PMCID: PMC4287387 DOI: 10.1016/j.genhosppsych.2014.03.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/13/2014] [Accepted: 03/19/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms have gone mostly unexamined among veterans. The current study assessed rates of bulimia nervosa (BN) and binge eating disorder (BED) symptoms and diagnoses and their associations with common comorbidities among male and female veterans. METHOD Participants were US military veterans who screened positive for trauma histories and/or a probable Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) posttraumatic stress disorder (PTSD) diagnosis (n=499). Symptoms of PTSD were assessed using the Clinician-Administered PTSD Scale, and symptoms of EDs, mood, and substance use disorders were assessed using the Structured Clinical Interview for the DSM-IV. RESULTS Lifetime rates of BN and BED diagnoses were comparable to civilian populations, and a considerable range of lifetime and current BN and BED symptoms were identified. In multivariate models, PTSD and depression severity were most consistently associated with BN and BED symptom severity, with depression most strongly associated with EDs for women. CONCLUSIONS Findings highlight the importance of screening for ED symptoms among male and female veterans, particularly those that present with PTSD and depression symptomatology. Future examinations of the temporal order of such relationships and the degree to which ED symptoms and associated symptoms impact veteran functioning are warranted.
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Affiliation(s)
| | - Karen S. Mitchell
- VA Boston Healthcare System,VA National Center for PTSD,Department of Psychiatry, Boston University School of Medicine
| | - Denise M. Sloan
- VA Boston Healthcare System,VA National Center for PTSD,Department of Psychiatry, Boston University School of Medicine
| | | | - Mark W. Miller
- VA Boston Healthcare System,VA National Center for PTSD,Department of Psychiatry, Boston University School of Medicine
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Hard exercise, affect lability, and personality among individuals with bulimia nervosa. Eat Behav 2013; 14:413-9. [PMID: 24183126 PMCID: PMC3832258 DOI: 10.1016/j.eatbeh.2013.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 06/30/2013] [Accepted: 07/15/2013] [Indexed: 11/24/2022]
Abstract
The current study explores the personality traits of compulsivity (e.g., sense of orderliness and duty to perform tasks completely) and restricted expression (e.g., emotion expression difficulties) as potential moderators of the relation between affect lability and frequency of hard exercise episodes in a sample of individuals with bulimic pathology. Participants were 204 adult females recruited in five Midwestern cities who met criteria for threshold or subthreshold bulimia nervosa (BN). Compulsivity was found to significantly moderate the relation between affect lability and number of hard exercise episodes over the past 28 days, such that among those with high compulsivity, level of affect lability was associated with the number of hard exercise episodes; whereas, among those with low compulsivity, affect lability was not associated with the number of hard exercise episodes. The same pattern of findings emerged for restricted expression; however, this finding approached, but did not reach statistical significance. As such, it appears that affect lability is differentially related to hard exercise among individuals with BN depending upon the level of compulsivity and, to a more limited extent, restricted expression. These results suggest that, for individuals with BN with either compulsivity or restricted expression, focusing treatment on increasing flexibility and/or verbal expression of emotions may help in the context of intense, fluctuating affect.
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Sutoh C, Nakazato M, Matsuzawa D, Tsuru K, Niitsu T, Iyo M, Shimizu E. Changes in self-regulation-related prefrontal activities in eating disorders: a near infrared spectroscopy study. PLoS One 2013; 8:e59324. [PMID: 23527162 PMCID: PMC3602060 DOI: 10.1371/journal.pone.0059324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/13/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to clarify the symptomatology of the eating disorders examining the prefrontal function and activity associated with self-regulation among participants with or without eating disorders. METHODS Ten patients with anorexia nervosa, fourteen with bulimia nervosa, and fourteen healthy control participants performed two cognitive tasks assessing self-regulatory functions, an auditorily distracted word fluency task and a rock-paper-scissors task under the measurements on prefrontal oxyhemoglobin concentration with near infrared spectroscopy. The psychiatric symptoms of patient groups were assessed with several questionnaires. RESULTS Patients with bulimia nervosa showed decreased performances and prefrontal hyper activation patterns. Prefrontal activities showed a moderate negative correlation with task performances not in the patient groups but only in the healthy participants. The prefrontal activities of the patient groups showed positive correlations with some symptom scale aspects. CONCLUSIONS The decreased cognitive abilities and characteristic prefrontal activation patterns associated with self-regulatory functions were shown in patients with bulimia nervosa, which correlated with their symptoms. These findings suggest inefficient prefrontal self-regulatory function of bulimia nervosa that associate with its symptoms.
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Affiliation(s)
- Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University Chiba Chuo, Chiba, Japan.
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Stulz N, Hepp U, Gächter C, Martin-Soelch C, Spindler A, Milos G. The severity of ADHD and eating disorder symptoms: a correlational study. BMC Psychiatry 2013; 13:44. [PMID: 23375103 PMCID: PMC3566966 DOI: 10.1186/1471-244x-13-44] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorders (ADHD) and eating disorders (ED) share several clinical features. Research on the association between ADHD and ED is still quite sparse and findings are ambiguous. METHODS Correlations between the severity of ADHD key features (Barratt Impulsiveness Scale, and Attention Deficit/Hyperactivity Disorder-Self-Rating questionnaire) and the severity of specific ED symptoms (Structured Interview for Anorexia and Bulimia Nervosa) were examined in 32 female patients diagnosed with ED. RESULTS Most correlations between the severity of ADHD features and the severity of ED symptoms were low (r<0.30) and did not reach statistical significance. The only exception was a statistically significant, but counterintuitive association between impulsivity and the avoidance of fattening food. CONCLUSIONS The findings in this small sample suggest a weak link between the severity of ADHD key features and the severity of single ED symptoms in female patients with ED. The role of ADHD features for the development, maintenance, and treatment of EDs seems to be intricate and requires further study.
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Affiliation(s)
| | - Urs Hepp
- Psychiatric Services Aargau AG, Haselstrasse 1, CH-5401, Baden, Switzerland
| | - Céline Gächter
- Cantonal Hospital Aarau, Tellstrasse 15, CH-5001, Aarau, Switzerland
| | - Chantal Martin-Soelch
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
| | - Anja Spindler
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
| | - Gabriella Milos
- Department of Psychiatry, University Hospital Zurich, Culmannstrasse 8, CH-8091, Zurich, Switzerland
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Claes L, Fernández-Aranda F, Jimenez-Murcia S, Botella C, Casanueva FF, de la Torre R, Fernández-Real JM, Frühbeck G, Tinahones FJ, Vilarrasa N, Montserrat-Gil de Bernabé M, Granero R, Agüera Z, Sancho C, Muehlenkamp J, Menchón JM. Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions. PERSONALITY AND INDIVIDUAL DIFFERENCES 2013. [DOI: 10.1016/j.paid.2012.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mitchell KS, Mazzeo SE, Schlesinger MR, Brewerton TD, Smith BN. Comorbidity of partial and subthreshold ptsd among men and women with eating disorders in the national comorbidity survey-replication study. Int J Eat Disord 2012; 45:307-15. [PMID: 22009722 PMCID: PMC3297686 DOI: 10.1002/eat.20965] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The comorbidity of posttraumatic stress disorder (PTSD) and eating disorders (EDs) is high among women but has been understudied in men. Little is known about the association between partial or subthreshold PTSD and EDs among women or men. METHOD This study included PTSD and ED data from male (n = 2,382) and female (n = 3,310) National Comorbidity Survey-Replication study participants. RESULTS The vast majority of women and men with anorexia nervosa, bulimia nervosa (BN), and binge eating disorder (BED) reported a history of interpersonal trauma. Rates of PTSD were significantly higher among women and men with BN and BED. Subthreshold PTSD was more prevalent than threshold PTSD among women with BN and women and men with BED. DISCUSSION Interpersonal forms of trauma, PTSD, and subthreshold/partial PTSD, were prevalent among men and women with EDs. Findings highlight the importance of assessing for trauma and PTSD in ED patients.
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Affiliation(s)
- Karen S Mitchell
- National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division, VA Boston Healthcare System, Boston, Massachusetts 02130, USA.
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Rodríguez-Ruiz S, Guerra PM, Moreno S, Fernández MC, Vila J. Heart Rate Variability Modulates Eye-Blink Startle in Women With Bulimic Symptoms. J PSYCHOPHYSIOL 2012. [DOI: 10.1027/0269-8803/a000064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of the present study was to examine the modulatory influence of heart rate variability (HRV), an index of autonomic regulation, on eye-blink startle in women with bulimic symptoms. Twenty-four women with bulimic symptoms and 24 control women underwent a psychophysiological test to assess their HRVs during a rest period. They then underwent 20 trials designed to measure their startle motor reflexes while viewing pictures of food and pleasant, neutral, and unpleasant pictures. Women with bulimic symptoms and low HRV had larger startle magnitudes while viewing the pictures than women with both bulimic symptoms and high HRV and control women. A negative relationship between HRV and startle magnitude while viewing food pictures was also found in this group. These findings suggest that poor autonomic regulation, indicated by low HRV, plays a modulatory influence in women with bulimic symptoms.
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Affiliation(s)
| | | | | | | | - Jaime Vila
- Faculty of Psychology, University of Granada, Spain
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44
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Claes L, Müller A, Norré J, Van Assche L, Wonderlich S, Mitchell JE. The relationship among compulsive buying, compulsive internet use and temperament in a sample of female patients with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2011; 20:126-31. [PMID: 21710571 DOI: 10.1002/erv.1136] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 04/21/2011] [Accepted: 04/27/2011] [Indexed: 12/13/2022]
Abstract
The aim of the present study was to investigate the association among compulsive buying (CB), compulsive internet use (CIU) and reactive/regulative temperament in a sample of 60 female patients with eating disorders. All patients were assessed by means of the Compulsive Buying Scale, the CIU scale, the Eating Disorder Inventory-2, the Behavioral Inhibition System/Behavioral Activation System scales, the Dimensional Assessment of Personality Pathology and the effortful control scale of the Adult Temperament Questionnaire. The results showed a positive association between CB and CIU, both categorized as impulse control disorders, not otherwise specified. Both CB and CIU showed significantly positive correlations with emotional lability, excitement seeking and lack of effortful control (more specifically lack of inhibitory and lack of activation control). The implication of these findings for the treatment of both disorders will be discussed.
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Affiliation(s)
- Laurence Claes
- Department of Psychology, Catholic University of Leuven, Leuven, Belgium.
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Fujimori A, Wada Y, Yamashita T, Choi H, Nishizawa S, Yamamoto H, Fukui K. Parental bonding in patients with eating disorders and self-injurious behavior. Psychiatry Clin Neurosci 2011; 65:272-9. [PMID: 21507134 DOI: 10.1111/j.1440-1819.2011.02192.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The goal of the study was to investigate the correlations among parental bonding patterns, eating disorders (ED) and self-injurious behavior (SIB). METHODS The subjects were 80 patients with ED who were divided into two groups based on those that had (n = 25) and had not engaged in SIB at least once in the last month. The patients and 120 healthy control subjects were evaluated using the Eating Disorder Inventory and the Parental Bonding Instrument. RESULTS On the Parental Bonding Instrument, the ED + SIB group showed significantly lower paternal care compared with the ED/no SIB and control groups. On the Eating Disorder Inventory, the ED + SIB group showed higher body dissatisfaction, and increased maturity fear compared with the other two groups. The total scores and perfectionism and interoceptive awareness differed significantly among the three groups. CONCLUSION ED + SIB patients had a more severe ED pathology than ED/no SIB patients, and also felt that they had received low paternal care during childhood. Therefore, paternal care may be linked to severe ED pathology.
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Affiliation(s)
- Akihito Fujimori
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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46
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Olfactory and gustatory sensitivity in adults with attention-deficit/hyperactivity disorder. ACTA ACUST UNITED AC 2011; 3:53-60. [DOI: 10.1007/s12402-010-0052-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 12/26/2010] [Indexed: 11/25/2022]
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47
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Altman SE, Shankman SA. What is the association between obsessive–compulsive disorder and eating disorders? Clin Psychol Rev 2009; 29:638-46. [DOI: 10.1016/j.cpr.2009.08.001] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 08/03/2009] [Accepted: 08/10/2009] [Indexed: 11/24/2022]
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48
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Beck I, Smits DJ, Claes L, Vandereycken W, Bijttebier P. Psychometric evaluation of the behavioral inhibition/behavioral activation system scales and the sensitivity to punishment and sensitivity to reward questionnaire in a sample of eating disordered patients. PERSONALITY AND INDIVIDUAL DIFFERENCES 2009. [DOI: 10.1016/j.paid.2009.04.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Davies H, Liao PC, Campbell IC, Tchanturia K. Multidimensional self reports as a measure of characteristics in people with eating disorders. Eat Weight Disord 2009; 14:e84-91. [PMID: 19934641 DOI: 10.1007/bf03327804] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study used multidimensional self report assessments to measure perfectionism, impulsivity and obsessive compulsive characteristics in females with anorexia nervosa (AN), bulimia nervosa (BN) and in matched healthy controls (HC). The Frost Multidimensional Perfectionism Scale (FMPS), Barrett Impulsivity Scale (BIS) and Obsessive Compulsive Inventory-Revised (OCI-R) scale were completed by 107 participants (AN=30, BN=26, HC=51), in parallel with clinical measures. Results show that people with AN have the highest scores on the dimensions of the FMPS as well as on the overall score; the AN and BN groups have the highest scores on the dimensions and on the overall score of the OCI-R; on the BIS, the AN and BN groups have the highest scores on the attention subscale, but there are no group differences on the overall BIS scores. In relation to the FMPS, the global score, and the subscales 'concern over mistakes' and 'doubts about actions' are all highly correlated with both eating pathology (Eating Disorder Examination Questionnaire, EDE-Q) and low global functioning (Structured Clinical Interview for DSM IV, SCID). The subscale 'obsessing' on the OCI-R shows a strong correlation with eating pathology. The overall score and also the subscales of the BIS do not show strong correlations with eating pathology or poor global functioning. In conclusion, therapies should seek to address these specific areas which are highly correlated with eating disorder pathology.
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Affiliation(s)
- H Davies
- Eating Disorders Unit, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AF, UK.
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Boisseau CL, Thompson-Brenner H, Eddy KT, Satir DA. Impulsivity and personality variables in adolescents with eating disorders. J Nerv Ment Dis 2009; 197:251-9. [PMID: 19363381 PMCID: PMC4094306 DOI: 10.1097/nmd.0b013e31819d96c0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Impulsivity among individuals with eating disorders (EDs) is associated with severe comorbidities and poor treatment outcome. However, research investigating the construct of impulsivity in EDs is limited. The objectives of the present study were to characterize multiple dimensions of impulsivity in adolescents with EDs; determine if differences in impulsivity were associated with ED diagnosis and/or broader personality traits; and explore the relationship between impulsivity and etiologically significant variables. Experienced clinicians from a practice-research network provided data on ED symptoms, impulsive characteristics, personality pathology, The Diagnostic and Statistical Manual of Mental Disorders comorbidity, and family and developmental history for 120 adolescent patients with EDs. Three distinct types of impulsivity were identified: general, acting out, and aggressive/destructive. The impulsivity types showed specific relationships to ED diagnosis, broader personality factors, individual histories of adverse (traumatic) events, and family histories of externalizing disorders, supporting the importance of taking, assessing, and addressing impulsivity in ED research and treatment.
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Affiliation(s)
- Christina L Boisseau
- Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, Massachusetts 02215, USA.
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