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Barone E, Carfagno M, Marafioti N, Bello R, Arsenio E, Marone L, Volpicelli A, Cascino G, Monteleone AM. Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis. Compr Psychiatry 2024; 134:152515. [PMID: 38968746 DOI: 10.1016/j.comppsych.2024.152515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/14/2024] [Accepted: 06/29/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators. METHODS Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators. RESULTS In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals. DISCUSSION The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.
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Affiliation(s)
- Eugenia Barone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Niccolò Marafioti
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Marone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Volpicelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
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Brewerton TD, Kopland MCG, Gavidia I, Suro G, Perlman MM. A network analysis of eating disorder, PTSD, major depression, state-trait anxiety, and quality of life measures in eating disorder patients treated in residential care. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 39289909 DOI: 10.1002/erv.3136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/10/2024] [Accepted: 09/07/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND The network approach in the eating disorder (ED) field has confirmed important links between EDs and posttraumatic stress disorder (PTSD) symptoms. However, studies including comorbid symptoms are scarce, which limits our understanding of potentially important connections. We hypothesised that anxiety, depression and poor quality of life (QOL) would provide a more complete picture of central, maintaining factors. METHODS Network analysis using R was performed in 2178 adult ED patients (91% female) admitted to residential treatment. Assessments included the ED Examination Questionnaire (EDEQ), the Eating Disorders Inventory (EDI-2), the PTSD Checklist for DSM-5 (PTSD clusters (PCL-5)), the Patient Health Questionnaire (PHQ-9), the Spielberger State-Trait Anxiety Scale (STAI), and the ED QOL Scale (EDQOL), which measure symptoms of EDs, PTSD, major depression, state-trait anxiety, and QOL, respectively. RESULTS EDI-2 ineffectiveness showed the highest centrality (expected influence) followed by EDI-2 interoceptive awareness, STAI state anxiety, EDEQ shape concern, EDQOL psychological subscale, and PTSD cluster D (hyperarousal) symptoms. Eating Disorder Quality of Life psychological and physical-cognitive subscales and PHQ-9 major depressive, STAI state anxiety and PCL-5 PTSD cluster E (negative alterations in mood and cognition) symptoms showed the highest bridge expected influence, suggesting their interactive role in maintaining ED-PTSD comorbidity. CONCLUSIONS This is the first network analysis of the interaction between ED and PTSD symptoms to include the comorbid measures of depression, anxiety, and QOL in a large clinical sample of ED patients. Our results indicate that several symptom clusters are likely to maintain ED-PTSD comorbidity and may be important targets of integrated treatment.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
- Timothy D. Brewerton, MD, LLC, Mt. Pleasant, SC, USA
- Monte Nido and Affiliates, Miami, FL, USA
| | - Maren C G Kopland
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
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Fasolato R, De Felice M, Barbui C, Bertani M, Bonora F, Castellazzi M, Castelli S, Cristofalo D, Dall'Agnola RB, Ruggeri M, Signoretto B, Bonetto C. Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study. J Eat Disord 2024; 12:138. [PMID: 39261959 PMCID: PMC11389446 DOI: 10.1186/s40337-024-01103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. METHODS Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. RESULTS Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. CONCLUSIONS This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.
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Affiliation(s)
- Rachele Fasolato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Mariangela De Felice
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariaelena Bertani
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Federica Bonora
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariasole Castellazzi
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Silvia Castelli
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosa Bruna Dall'Agnola
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Benedetta Signoretto
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Elwyn R, Williams M, Smith E, Smith S. Two identical twin pairs discordant for longstanding anorexia nervosa and OSFED: lived experience accounts of eating disorder and recovery processes. J Eat Disord 2024; 12:127. [PMID: 39223672 PMCID: PMC11367789 DOI: 10.1186/s40337-024-01078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Research into the risk of anorexia nervosa (AN) has examined twin pairs to further the understanding of the contributions of genetics, trait inheritance, and environmental factors to eating disorder (ED) development. Investigations of twin experiences of EDs have been biologically-based and have not considered the qualitative, phenomenological aspects of twin experiences. A gap in the literature exists regarding understanding of discordant twins with EDs. This research was developed in response, with the aim to deepen understanding of AN in discordant twins and to create novel ideas for further research and testing. The case studies presented in this article provide lived experience insights of two identical discordant twin pairs: one twin pair discordant for longstanding AN and one twin pair discordant for 'atypical' AN (the twin with AN has recovered). The perspectives and experiences of each co-twin (one with AN and one without) explore a number of factors that may have contributed to twin discordance in these cases, and how each twin has responded to the impact of AN in their lives. Through use of first-person accounts in case study presentation, this article centres social justice values of lived experience leadership and involvement in research. This article aims to extend current knowledge and understanding of EDs in discordant twins, particularly regarding risk for ED development, ED duration, diagnosis and treatment, and recovery processes.
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Affiliation(s)
- Rosiel Elwyn
- Neuroscience and Psychiatry, Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Kells MR, Davis HA, Patarinski AGG, Wildes JE. Trauma exposure proximity associated with eating disorder diagnosis in women with food insecurity. Appetite 2024; 203:107653. [PMID: 39218037 DOI: 10.1016/j.appet.2024.107653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/16/2024] [Accepted: 08/29/2024] [Indexed: 09/04/2024]
Abstract
Trauma exposure is a risk factor for both food insecurity (FI) and increased eating disorder (ED) pathology. The purpose of this study was to explore the relation between trauma and ED diagnosis in a sample of women experiencing FI. A cross-sectional analysis of surveys from 99 women with self-reported FI (54% White; mean [SD] age = 40.26 [14.33] years) in the United States was employed. Participants completed online surveys including the Life Events Checklist (LEC) questionnaire, General Anxiety Disorder-7, Patient Health Questionnaire-9, and an interview comprised of the Household Food Security Survey Module (HFSSM) and Eating Disorder Diagnostic Interview (EDDI). LEC traumatic events were weighted by proximity: events experienced directly were weighted by a factor of 3, witnessed by 2, learned about by 1, and summed to a total weighted score. ED diagnosis in the past 12 months was assessed via the EDDI using DSM-5 diagnostic criteria. A binary logistic regression model tested associations between weighted trauma score, FI, and ED diagnosis. Weighted trauma score significantly predicted any ED diagnosis (OR = 1.039, p = .016), but FI severity did not (OR = .746, p = .101). These results suggest trauma proximity predicts ED diagnosis beyond that of FI severity and may be an important component of the association between FI and ED pathology. Future work may consider evaluating longitudinal symptoms of trauma and trauma severity in relation to FI.
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Affiliation(s)
- Meredith R Kells
- University of Rochester Medical Center, School of Nursing, Rochester, NY, USA; The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA.
| | - Heather A Davis
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA; Virginia Polytechnic Institute and State University, Department of Psychology, USA
| | | | - Jennifer E Wildes
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, USA
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Amiri S, Sabzehparvar M. Childhood maltreatment and the risk of eating disorders: a meta-analysis of observational studies. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024:10.1007/s40211-024-00505-3. [PMID: 39196489 DOI: 10.1007/s40211-024-00505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 07/01/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis is to examine the relationship between childhood maltreatment as a variable of exposure and eating disorders as an outcome. METHODS PubMed, Web of Science, and Google Scholar were searched to find manuscripts related to the current research. The search was conducted up until October 2023 and limited to the English language. An odds ratio (OR) based on the random effects method was used to combine studies. One subgroup analysis was performed based on the type of eating disorder and another based on the type of childhood maltreatment. RESULTS Thirty eligible studies were recognized for this research. Childhood maltreatment was associated with a rate of eating disorders of more than double: OR 2.37 with 95% confidence interval (CI) 1.84-3.06 (P < 0.001; I2 = 92.6%). Childhood maltreatment was associated with anorexia nervosa (OR 1.89, 95% CI 1.47-2.42; Z = 5.03; P < 0.001; I2 = 0%), bulimia nervosa (OR 2.64, 95% CI 1.34-5.17; Z = 2.82; P = 0.005; I2 = 93.1%), and binge eating disorder (OR 1.76, 95% CI 1.38-2.26; Z = 4.52; P < 0.001; I2 = 80.2%). CONCLUSION The findings of this research showed that childhood maltreatment significantly increases the risk of eating disorders. Therefore, in understanding the mechanisms related to eating disorders, it is necessary to pay attention to the issue of the childhood living environment and the traumatic experiences of that time.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Mahtab Sabzehparvar
- Department of General psychology, Faculty of Literature, humanities and social sciences, Science and Research branch, Islamic Azad University, Tehran, Iran
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Day S, Hay P, Basten C, Byrne S, Dearden A, Goldstein M, Hannigan A, Heruc G, Houlihan C, Roberts M, Tannous WK, Thornton C, Valentine N, Mitchison D. Posttraumatic stress disorder (PTSD) and complex PTSD in eating disorder treatment-seekers: Prevalence and associations with symptom severity. J Trauma Stress 2024; 37:672-684. [PMID: 38637955 DOI: 10.1002/jts.23047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/20/2024]
Abstract
Although childhood trauma and posttraumatic stress disorder (PTSD) have been well-researched in eating disorder epidemiology, prevalence rates are unavailable for complex PTSD (CPTSD). Under recently introduced ICD-11 criteria, individuals with CPTSD have both PTSD symptoms and additional disturbances in self-organization (DSO). Using ICD-11 criteria, this study aimed to determine the prevalence of PTSD and DSO symptoms, diagnostic rates of PTSD and CPTSD, and childhood trauma exposure in eating disorder treatment-seekers. Participants (N = 217) were individuals attending residential, partial hospitalization, and outpatient services who completed measures of eating disorder- and trauma-related symptoms and childhood adverse experiences. One third of participants reported PTSD symptoms, and over half reported DSO symptoms, with probable ICD-11 diagnostic rates of 3.8% for PTSD and 28.4% for CPTSD. CPTSD was significantly more prevalent than PTSD and more common in higher levels of care. Both PTSD and DSO symptom severity were positively correlated with eating disorder symptoms and impairment, rs = .285-.642. DSO symptom severity was a significant and unique explanatory factor of eating disorder severity and impairment. The findings highlight the prevalence of CPTSD in eating disorder populations and the association between DSO symptoms and eating psychopathology independent of PTSD symptoms. Implications are discussed for adjunct treatment approaches for individuals with comorbid eating disorders and PTSD or CPTSD.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Penrith, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, Sydney, Australia
| | | | - Susan Byrne
- School of Psychology, University of Western Australia, Perth, Australia
- The Swan Centre, Perth, Australia
| | - Amanda Dearden
- Queensland Eating Disorder Service, Indooroopilly, Australia
| | - Mandy Goldstein
- School of Medicine, Western Sydney University, Penrith, Australia
- everyBody Psychology & Wellbeing, Bondi Junction, Australia
| | - Amy Hannigan
- Queensland Eating Disorder Service, Indooroopilly, Australia
| | | | - Catherine Houlihan
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Marion Roberts
- Department of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
- Nurture Psychology, Auckland, New Zealand
| | - W Kathy Tannous
- School of Business, Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | | | - Deborah Mitchison
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
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Jobin A, Gingras F, Beaupré J, Legendre M, Bégin C. Clinical Relevance of Food Addiction in Higher Weight Patients across the Binge Eating Spectrum. Behav Sci (Basel) 2024; 14:645. [PMID: 39199041 PMCID: PMC11351699 DOI: 10.3390/bs14080645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/16/2024] [Accepted: 07/25/2024] [Indexed: 09/01/2024] Open
Abstract
Food addiction (FA) is associated with greater severity on many eating-related correlates when comorbid with binge eating disorder (BED) but no study has established this relation across the whole spectrum of binge eating, i.e., from no BED to subthreshold BED to BED diagnosis. This study aims to examine the effect of the presence of FA on the severity of eating behaviors and psychological correlates in patients without BED, subthreshold BED or BED diagnosis. Participants (n = 223) were recruited at a university center specialized in obesity and eating disorder treatment and completed a semi-structured diagnostic interview and questionnaires measuring eating behaviors, emotional regulation, impulsivity, childhood interpersonal trauma, and personality traits. They were categorized by the presence of an eating disorder (no BED, subthreshold BED, or BED) and the presence of FA. Group comparisons showed that, in patients with BED, those with FA demonstrated higher disinhibition (t(79) = -2.19, p = 0.032) and more maladaptive emotional regulation strategies (t(43) = -2.37, p = 0.022) than participants without FA. In patients with subthreshold BED, those with FA demonstrated higher susceptibility to hunger (t(68) = -2.55, p = 0.013) and less cooperativeness (t(68) = 2.60, p = 0.012). In patients without BED, those with FA demonstrated higher disinhibition (t(70) = -3.15, p = 0.002), more maladaptive emotional regulation strategies (t(53) = -2.54, p = 0.014), more interpersonal trauma (t(69) = -2.41, p = 0.019), and less self-directedness (t(70) = 2.14, p = 0.036). We argue that the assessment of FA provides relevant information to complement eating disorder diagnoses. FA identifies a subgroup of patients showing higher severity on many eating-related correlates along the binge eating spectrum. It also allows targeting of patients without a formal eating disorder diagnosis who would still benefit from professional help.
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Affiliation(s)
- Alycia Jobin
- School of Psychology, Université Laval, Quebec City, QC G1V 0A6, Canada; (A.J.); (F.G.); (J.B.); (M.L.)
- Centre d’Expertise Poids, Image et Alimentation (CEPIA), Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Félicie Gingras
- School of Psychology, Université Laval, Quebec City, QC G1V 0A6, Canada; (A.J.); (F.G.); (J.B.); (M.L.)
- Centre d’Expertise Poids, Image et Alimentation (CEPIA), Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Juliette Beaupré
- School of Psychology, Université Laval, Quebec City, QC G1V 0A6, Canada; (A.J.); (F.G.); (J.B.); (M.L.)
- Centre d’Expertise Poids, Image et Alimentation (CEPIA), Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Maxime Legendre
- School of Psychology, Université Laval, Quebec City, QC G1V 0A6, Canada; (A.J.); (F.G.); (J.B.); (M.L.)
- Centre d’Expertise Poids, Image et Alimentation (CEPIA), Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Catherine Bégin
- School of Psychology, Université Laval, Quebec City, QC G1V 0A6, Canada; (A.J.); (F.G.); (J.B.); (M.L.)
- Centre d’Expertise Poids, Image et Alimentation (CEPIA), Université Laval, Quebec City, QC G1V 0A6, Canada
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Kopland MCG, Vrabel K, Landt MSO', Hoffart A, Johnson SU, Giltay EJ. Network dynamics of self-compassion, anxiety, and depression during eating disorder therapy. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 39003600 DOI: 10.1002/erv.3121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 06/04/2024] [Accepted: 06/23/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Recovery processes during residential treatment for eating disorders, especially in patients with a history of maltreatment, are insufficiently understood. This study aimed to explore the temporal relationships among comorbid factors, including depression, anxiety, and self-compassion, with the influence of childhood maltreatment. METHOD Using Dynamic Time Warp (DTW), weekly scores from the Symptom Checklist-5, Eating Disorder Examination, and Self-Compassion Scale were analysed over 12 weeks. The study generated undirected and directed networks to identify influential symptoms in a transdiagnostic sample, comparing patients with and without childhood maltreatment. RESULTS The study included 124 patients with eating disorders (ED) (97% women), mean age of 30.9 years (SD = 9.7, range 18-61 years). Diagnoses included anorexia nervosa (26%), bulimia nervosa (38%), and other specified feeding and eating disorders (36%). The directed DTW network showed that hopelessness, worrying, and restlessness had the highest out-strength, predicting changes in self-compassion and ED behaviour. In maltreatment cases, hopelessness and low acceptance predicted changes, while worry, restlessness, and nervousness were predictive in non-maltreatment cases. CONCLUSION Temporal network analyses suggest that a change in hopelessness, worrying, and restlessness drives symptom improvement in ED behaviour and the development of self-compassion during residential treatment. These processes vary between patients with and without a history of childhood maltreatment separately, indicating the need for further analyses.
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Affiliation(s)
- Maren C G Kopland
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - KariAnne Vrabel
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Margarita Slof-Op 't Landt
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Modum Bad Psychiatric Hospital, Vikersund, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Health Campus the Hague, Leiden University, Leiden, The Netherlands
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Idini E, Paredes-Carreño P, Navarro-Gil M, Barceló-Soler A, Valera-Ceamanos D, Garcia-Campayo J. "Age of traumatic experience as a predictor of distorted body image in patients with eating disorders". Clin Child Psychol Psychiatry 2024; 29:1043-1057. [PMID: 38696812 DOI: 10.1177/13591045241251902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The timing of trauma exposure is a risk factor for the development of psychopathology in adulthood. We aim to assess the presence of adverse life events (ALEs) before age 13 in patients with eating disorders (ED). Specifically, we examined the relationship between exposure to interpersonal trauma before the age of 13 and body image distortion (BID), impulsivity, and perfectionism. We conducted a cross-sectional, retrospective study in which 79 outpatients with ED were consecutively enrolled. Assessment was performed using the Traumatic Life Event Questionnaire, Contour Drawing Rating Scale, and Eating Disorder Inventory. Linear regression models were used to analyze the predictive role of interpersonal trauma before age 13 on BID perfectionism and impulsivity. Seventy-two patients (91.1%) reported ALEs throughout their lives. Patients with trauma before age 13 (55.6%) overestimated their shape. Patients with ED and bulimic symptoms had significantly higher BID levels. Interpersonal trauma predicted higher levels of impulsivity and perfectionism. Experiencing interpersonal ALEs before age 13 may be a risk factor for the development of BID, impulsivity, and perfectionism in adulthood. Body image can be modified during childhood through interventions focused on identifying stressful relationships.
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Affiliation(s)
- Ester Idini
- Psychiatric Department, Miguel Servet Hospital, Spain
| | | | - Mayte Navarro-Gil
- Department of Psychology and Sociology, University of Zaragoza, Spain
| | - Alberto Barceló-Soler
- Department of Psychology and Sociology, University of Zaragoza, Spain
- Aragón Institute for Health Research (IIS Aragón), Spain
| | | | - Javier Garcia-Campayo
- Psychiatric Department, Miguel Servet Hospital, Spain
- Mindfulness Master Coordinator, University of Zaragoza, Spain
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11
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Lagan S, Shott ME, Frank GKW. Adverse childhood experiences, low self-esteem, and salient stimulus response in eating disorders. EUROPEAN EATING DISORDERS REVIEW 2024; 32:618-632. [PMID: 38349113 DOI: 10.1002/erv.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are elevated in individuals with eating disorders (EDs), but how the neurobiology of EDs and ACEs interact is unclear. METHODS Women 18-45 years old with anorexia nervosa (AN, n = 38), bulimia nervosa (BN, n = 32), or healthy controls (n = 60) were assessed for ACEs and ED behaviours and performed a taste-conditioning task during brain imaging. Mediation analyses tested relationships between ACE score, self-esteem, and ED behaviours. RESULTS ACE scores were elevated in EDs and correlated positively with body mass index (p = 0.001), drive for thinness (p = 0.001), and body dissatisfaction (p = 0.032); low self-esteem mediated the relationship between ACEs and body dissatisfaction, drive for thinness, and bulimia severity. ACE scores correlated negatively (FDR-corrected) with unexpected, salient stimulus receipt in AN (substantia nigra) and BN (anterior cingulate, frontal and insular cortex, ventral striatum, and substantia nigra). When ACE scores were included in the model, unexpected stimulus receipt brain response was elevated in EDs in the anterior cingulate and ventral striatum. CONCLUSIONS ACEs attenuate unexpected salient stimulus receipt response, which may be a biological marker for altered valence or hedonic tone perception in EDs. Low self-esteem mediates the relationships between ACEs and ED behaviours. Adverse childhood experiences should be assessed in biological studies, and their effects targeted in treatment.
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Affiliation(s)
- Sarah Lagan
- University of California San Diego, School of Medicine, San Diego, California, USA
| | - Megan E Shott
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Guido K W Frank
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
- Rady Children's Hospital, San Diego, California, USA
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12
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Johnsen KM, Nielsen KF, Nilsson KK, Kjaersdam Telléus G. Non-interpersonal traumatic events in patients with eating disorders: a systematic review. Front Psychol 2024; 15:1397952. [PMID: 38952827 PMCID: PMC11216314 DOI: 10.3389/fpsyg.2024.1397952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives The purpose of the systematic review was to synthesize literature on eating disorders (ED) and non-interpersonal traumatic events (NTE) and consolidate the reported prevalence of NTE in patients with an ED. Methods The literature search was performed in Embase, PsycInfo, and PubMed. The keywords in the search were "eating disorder," "trauma" and "non-interpersonal," using index-terms and free-search keywords related to NTE and ED. The PRISMA guidelines were followed. Relevant studies were screened using Rayyan. Results Of the 16 studies included in the quantitative synthesis, five overall types of NTE were identified: accidents, illness, injury, natural disaster and war. Findings provided tentative evidence for illness and injury being more prevalent in patients suffering from an ED compared to controls. The remaining subtypes of NTE did not show a higher prevalence in patients with an ED when compared to controls. Findings also suggest that those with binge/purge subtype of anorexia nervosa (AN) had a higher prevalence of non-interpersonal traumatic events compared to the restrictive subtype of AN. Discussion This systematic review provided a clear synthesis of previous findings related to NTE among patients with an ED. Noteworthy, is that many studies do not take into account if the trauma happened prior or after to ED onset, which may affect the association. Furthermore, the body of research on NTE in patients with ED is exceedingly limited, and more research is needed.
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Affiliation(s)
- Kirstine Marie Johnsen
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | | | - Kristine Kahr Nilsson
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
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13
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Hill NG, Abber SR, Keel PK. The role of sexual assault history and PTSD in responses to food intake among women with bulimic-spectrum eating disorders. Eat Disord 2024; 32:266-282. [PMID: 38093449 PMCID: PMC11116069 DOI: 10.1080/10640266.2023.2293597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Sexual abuse or assault (SA) history is associated with eating disorder severity and psychiatric comorbidity, including post-traumatic stress disorder (PTSD). Beyond persistent alterations in mood and cognitions characterizing PTSD, PTSD due to SA may contribute to greater increases in negative affect and body image concerns following food intake in bulimic syndromes (BN-S). To test this, participants (n = 172) with BN-S who reported PTSD due to SA, PTSD due to other forms of trauma, or neither completed clinical interviews and momentary reports of negative affect and shape/weight preoccupation before and after food intake. Participants with PTSD, regardless of trauma source, reported higher purging frequency whereas PTSD due to SA was associated with more frequent loss of control eating. For one task, changes in negative affect following food intake differed across the three groups. Negative affect decreased significantly in participants with PTSD without SA whereas nonsignificant increases were observed in those with PTSD with SA. Results of the present study suggest that source of trauma in PTSD may impact likelihood that eating regulates affect and provide insight into ways current treatments may be adapted to better target purging in BN-S comorbid with PTSD.
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Affiliation(s)
| | - Sophie R. Abber
- Department of Psychology, Florida State University, Tallahassee, FL 32304
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, FL 32304
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14
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Monssen D, Davies HL, Kakar S, Bristow S, Curzons SCB, Davies MR, Kelly EJ, Ahmad Z, Bradley JR, Bright S, Coleman JRI, Glen K, Hotopf M, Ter Kuile AR, Malouf CM, Kalsi G, Kingston N, McAtarsney-Kovacs M, Mundy J, Peel AJ, Palmos AB, Rogers HC, Skelton M, Adey BN, Lee SH, Virgo H, Quinn T, Price T, Zvrskovec J, Eley TC, Treasure J, Hübel C, Breen G. The United Kingdom Eating Disorders Genetics Initiative. Int J Eat Disord 2024; 57:1145-1159. [PMID: 37584261 DOI: 10.1002/eat.24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVE The United Kingdom Eating Disorders Genetics Initiative (EDGI UK), part of the National Institute for Health and Care Research (NIHR) Mental Health BioResource, aims to deepen our understanding of the environmental and genetic etiology of eating disorders. EDGI UK launched in February 2020 and is partnered with the UK eating disorders charity, Beat. Multiple EDGI branches exist worldwide. This article serves the dual function of providing an in-depth description of our study protocol and of describing our initial sample including demographics, diagnoses, and physical and psychiatric comorbidities. METHOD EDGI UK recruits via media and clinical services. Anyone living in England, at least 16 years old, with a lifetime probable or clinical eating disorder is eligible to sign up online: edgiuk.org. Participants complete online questionnaires, donate a saliva sample for genetic analysis, and consent to medical record linkage and recontact for future studies. RESULTS As of September 2022, EDGI UK recruited 7435 survey participants: 98% female, 93.1% white, 97.8% cisgender, 65.9% heterosexual, and 52.1% have a university degree. Over half (57.8%) of these participants have returned their saliva DNA kit. The most common diagnoses are anorexia nervosa (48.3%), purging disorder (37.8%), bulimia nervosa (37.5%), binge-eating disorder (15.8%), and atypical anorexia nervosa (7.8%). CONCLUSION EDGI UK is the largest UK eating disorders study and efforts to increase its diversity are underway. It offers a unique opportunity to accelerate eating disorder research. Researchers and participants with lived experience can collaborate on projects with unparalleled sample size. PUBLIC SIGNIFICANCE STATEMENT Eating disorders are debilitating and costly for society but are under-researched due to underfunding. EDGI UK is one of the largest eating disorder studies worldwide with ongoing recruitment. The collected data constitute a resource for secondary analysis. We will combine data from all international EDGI branches and the NIHR BioResource to facilitate research that improves our understanding of eating disorders and their comorbidities.
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Affiliation(s)
- Dina Monssen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Helena L Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Saakshi Kakar
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Shannon Bristow
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Susannah C B Curzons
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Molly R Davies
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Emily J Kelly
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Zain Ahmad
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Steven Bright
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kiran Glen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Abigail R Ter Kuile
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Chelsea Mika Malouf
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gursharan Kalsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Monika McAtarsney-Kovacs
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alicia J Peel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alish B Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Henry C Rogers
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Skelton
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Brett N Adey
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sang Hyuck Lee
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Hope Virgo
- Unit 1, Beat Eating Disorders, Norwich, UK
| | - Tom Quinn
- Unit 1, Beat Eating Disorders, Norwich, UK
| | - Tom Price
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johan Zvrskovec
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
- National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- UK National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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15
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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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Diallo A, Minier N, Bonnet JB, Bourrié C, Lacroix V, Robert A, Lefebvre P, Joumaa S, Avignon A, Renard E, Nocca D, Galtier F. Traumatic Life Events, Violence, and Obesity: A Cross-Sectional Study from 408 Patients Enrolled in a Bariatric Surgery Program. Obes Facts 2024; 17:237-242. [PMID: 38569475 PMCID: PMC11149977 DOI: 10.1159/000535067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/30/2023] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Obesity is a chronic disease that increases cardiovascular and metabolic morbidity and mortality, decreases quality of life, and increases health care costs. While the role of lifestyle behavioral factors in the development of obesity is well established, the role of traumatic life events, including violence, is unclear. The purpose of this study was to describe situations of traumatic life events reported by patients undergoing a bariatric surgery program, with a particular focus on sexual violence and its clinical correlates. METHODS In this cross-sectional study, patients with grade II or III obesity, admitted to our digestive surgery department for bariatric surgery from August 01, 2019, to December 31, 2020, underwent a structured interview by a trained psychologist to describe the history of traumatic life events self-reported by the patients. The primary endpoint was the presence of a history of sexual violence (SV). Multivariate logistic regressions were applied to identify independent risk factors for SV. RESULTS Of the 408 patients interviewed, 87.1% reported at least one traumatic life event and 33.1% reported having had an SV in the past. Female gender (aOR = 7.44, 95% confidence interval: 3.85-15.73; p < 0.001) and higher body mass index (1.05, 1.02-1.08; p = 0.002) were associated with an increased risk of SV. Male gender was associated with a higher risk of difficulties including sports cessation, depression, and work-related distress. CONCLUSION In the context of obesity, psychosocial trauma is characterized by a high frequency and several gender specificities that must be taken into account in the management of these patients.
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Affiliation(s)
- Alhassane Diallo
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
| | - Nadine Minier
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Jean-Baptiste Bonnet
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- UMR, Institute Desbrest of Epidemiology and Public Health, University Montpellier, INSERM, CHU, Montpellier, France
| | - Christine Bourrié
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Valérie Lacroix
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Alexandrine Robert
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Saadeddine Joumaa
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
| | - Antoine Avignon
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - Eric Renard
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - David Nocca
- Digestive Surgery Department Montpellier University Hospital, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Florence Galtier
- Clinical Investigation Center (CIC) 1411, INSERM, CHU of Montpellier, University of Montpellier, Montpellier, France
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
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17
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Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. TRAUMA, VIOLENCE & ABUSE 2024; 25:947-964. [PMID: 37125723 PMCID: PMC10913314 DOI: 10.1177/15248380231167399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
There is growing evidence of prior experiences of trauma and trauma-related symptoms among people with eating disorders; however, there is little understanding as to how post-traumatic stress disorder (PTSD) and exposure to traumatic events affect treatment outcomes. Without this knowledge, eating disorder clinicians are unable to tailor treatment to ensure good outcomes for the large percentage of this population that is affected by PTSD and trauma. This systematic review aimed to identify how PTSD and trauma exposure influence outcomes in eating disorder treatment. Systematic searches of PsycINFO, MEDLINE, PubMed, and Scopus databases identified 16 articles that met the inclusion criteria. The results indicated a negative effect on rates of eating disorder treatment completion and eating disorder psychopathology posttreatment. These findings were evident across studies that investigated the impact of a history of traumatic events as well as studies that investigated the impact of the presence of trauma-related symptoms seen in PTSD. Several methodological limitations were identified in the literature. These include: heterogeneous and unstandardized measures of PTSD and trauma, high attrition rates with follow-up, and insufficient data to enable comparisons by treatment setting, diagnostic presentation, and type of trauma exposure. The findings of this review have implications for future research and clinical care, including the importance of considering PTSD and trauma in assessment, treatment planning, and provision of both trauma-informed care and trauma-focused treatments for individuals with eating disorders.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, NSW, Australia
| | - Wadad. Kathy Tannous
- Translational Health Research Institute, School of Business, Western Sydney University, Penrith, NSW, Australia
| | - Scott J. Fatt
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Díaz-Marsá M, Ayad-Ahmed W, López-Villatoro JM, Fernández-Rodrigues V, Ruiz-Guerrero F, Gómez Del Barrio A, Beato-Fernández L, Polo-Montes F, León-Velasco M, Torre-Luque ADL, Carrasco JL, Caso JR, MacDowell KS, Leza JC. Inflammatory profiles in women with eating disorder: Linking inflammatory biomarkers to clinical phenotypes. Psychoneuroendocrinology 2024; 162:106956. [PMID: 38218002 DOI: 10.1016/j.psyneuen.2023.106956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/25/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Eating disorders (ED) represent a group of very complex and serious diagnoses characterized by emotional dysregulation and impulsivity. New approaches are necessary to achieve effective diagnosis and treatments. Shifting biomarker research away from the constraints of diagnostic categories may effectively contribute to a dimensional differentiation across disorders according to neurobiology (e.g., inflammatory biomarkers). Thus, the aim of our study was to identify inflammatory profiles in patients with ED. METHODS A sample of 100 women with an ED (23.4 ± 8.55 years) and 59 healthy controls (HC) (20.22 ± 4.18 years) was used. K-means cluster analysis was followed to identify inflammatory clusters considering seven blood biomarkers (iNOS, TNFα, COX2, p38, ERK, TBARS and PPARγ). Moreover, a wide assessment of clinical features was conducted. RESULTS Two distinct clusters were identified. Cluster 1 patients were characterized by higher inflammatory levels of TNF-α, COX2, p38, and ERK, and had more restrictive anorexia diagnosis than cluster 2. Cluster 2 participants showed higher inflammatory levels of iNOS and were older than cluster 1 and controls and had lower BMI than HC. In addition, they had higher levels of bulimic symptoms than those from the cluster 1 and HC, and higher impulsivity than HC. All ED patients (regardless of cluster) showed higher ED symptoms and more trauma than HC. CONCLUSIONS Our study revealed that inflammatory dysfunction may be linked with clinical endophenotypes in ED, one more restrictive (cluster 1) with an inflammation/oxidative endophenotype more cytokine and MAPK/ERK mediated, and the other more impulsive, with more bulimic symptoms (cluster 2) with NO free radical high output source iNOS. Trauma seems to be a vulnerability factor for both endophenotypes.
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Affiliation(s)
- Marina Díaz-Marsá
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | | | - José Manuel López-Villatoro
- Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain.
| | | | - Francisco Ruiz-Guerrero
- Hospital Universitario Marqués de Valdecilla, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Andrés Gómez Del Barrio
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Hospital Universitario Marqués de Valdecilla, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | | | | | - Alejandro de la Torre-Luque
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - José Luis Carrasco
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Javier R Caso
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
| | - Karina S MacDowell
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
| | - Juan C Leza
- Network Center for Biomedical Research in Mental Health, Institute of Health "Carlos III" (CIBERSAM, ISCIII), Madrid, Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre (Imas12), IUIN-UCM, Madrid, Spain
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19
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Associations between major depressive and bipolar disorders and eating disorder, PTSD, and comorbid symptom severity in eating disorder patients. EUROPEAN EATING DISORDERS REVIEW 2024; 32:188-200. [PMID: 37788327 DOI: 10.1002/erv.3035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) and bipolar disorder (BD) are commonly comorbid with eating disorders (EDs). However, there is limited data about the clinical features of such patients, especially their association with traumatic histories and PTSD, which occur commonly in patients admitted to residential treatment. METHODS Adults (≥18 years, 91% female, n = 2155) admitted to residential ED treatment were evaluated upon admission for DSM-5 defined MDD and BD. Patients were divided into three groups based on an admission diagnosis of no mood disorder (NMD), MDD, and BD (types I and II) and compared on a number of demographic variables, clinical features and assessments. RESULTS Mood disorders occurred in 76.4% of participants. There were statistically significant differences across groups in most measures with the BD group showing higher rates and doses of traumatic events; higher current PTSD; higher BMIs; higher severity of ED, depression and state-trait anxiety symptoms; worse quality of life; and higher rates of substance use disorders. Similarly, the MDD group had higher rates than the NMD group on most measures. CONCLUSIONS These findings have important implications for prevention, treatment and long-term follow-up and highlight the need for early trauma-focused treatment of ED patients with comorbid mood disorders and PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Timothy D. Brewerton, MD, LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
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20
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Marffy MJ, Fox J, Williams M. An exploration of the relationship between loneliness, the severity of eating disorder-related symptoms and the experience of the 'anorexic voice'. Psychol Psychother 2024; 97:122-137. [PMID: 37792343 DOI: 10.1111/papt.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Many individuals with eating disorders (EDs) report the experience of an 'Anorexic voice' (AV). Negative experiences of loneliness are also often associated with EDs. This study sought to explore the relationship between experiences of loneliness, the frequency of the AV and the impact of this on ED symptom severity. DESIGN 165 individuals (mean age 27.54 years) who accessed online forums relating to EDs participated in this study. The sample included individuals who have experienced an AV [AV group (N = 141)] and those who have not [non-AV group (N = 23)]. METHODS The study utilised self-report measures via an online questionnaire to explore the predictive validity of loneliness and frequency of the AV on ED symptom severity. RESULTS Confirmatory analysis (AV group only) demonstrated the significance of the independent variables individually predicting ED symptom severity. However, a significant interaction was not found between the two primary variables in predicting ED symptom severity, more significantly than the influence of either variable alone. Exploratory analysis considered the differences between the two groups (AV and Non-AV), as well as considering alternate predictors. CONCLUSIONS The findings offer insight into possible drivers behind engagement with the AV, as part of ED presentations in the community.
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Affiliation(s)
| | - John Fox
- DClinPsy, Cardiff University, Cardiff, UK
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21
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Rossi E, Cassioli E, Cecci L, Arganini F, Martelli M, Redaelli CA, Anselmetti S, Bertelli S, Fernandez I, Ricca V, Castellini G. Eye movement desensitisation and reprocessing as add-on treatment to enhanced cognitive behaviour therapy for patients with anorexia nervosa reporting childhood maltreatment: A quasi-experimental multicenter study. EUROPEAN EATING DISORDERS REVIEW 2024; 32:322-337. [PMID: 37903082 DOI: 10.1002/erv.3044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE This quasi-experimental study aimed to compare the outcome of patients with Anorexia Nervosa (AN) reporting moderate/severe childhood maltreatment (CM) treated exclusively with Enhanced Cognitive Behaviour Therapy (CBT-E) or with CBT-E plus Eye Movement Desensitisation and Reprocessing (EMDR). METHOD A total of 75 patients with AN reporting moderate/severe CM were initially assessed regarding body mass index (BMI), general and eating disorder (ED)-specific psychopathology, and dissociative symptoms, and re-evaluated after 40 CBT-E sessions (T1). Then, 18 patients received EMDR, whereas the others were placed on a waiting list and continued CBT-E. T2 assessment was performed after 20-25 sessions of EMDR or CBT-E. A control group of 67 patients without CM was also enroled and treated with CBT-E. RESULTS Contrary to patients without CM, neither of the traumatised groups improved in BMI, general and ED psychopathology, or dissociation at T1. However, at T2, both traumatised groups improved in BMI and ED-specific psychopathology, with the CBT + EMDR group demonstrating greater improvements. Moreover, only the CBT + EMDR group improved in general psychopathology and dissociative symptoms. The reduction of ED symptoms in traumatised patients was mediated by the amelioration of dissociation. DISCUSSION The addition of EMDR to CBT-E may benefit patients with AN reporting moderate/severe CM.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lucia Cecci
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Arganini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Michela Martelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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22
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van den Berg E, Pellemans K, Planting C, Daansen P, van Beers E, de Jonge M, Christ C, Dekker J. Treatment of patients with anorexia nervosa and comorbid post-traumatic stress disorder; where do we stand? A systematic scoping review. Front Psychiatry 2024; 15:1365715. [PMID: 38469034 PMCID: PMC10925640 DOI: 10.3389/fpsyt.2024.1365715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/12/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Comorbid post-traumatic stress disorder in patients with anorexia nervosa may negatively affect the course of anorexia nervosa treatment, which is already challenging. There are currently no guidelines or recommendations on concurrent treatment approaches for both anorexia nervosa and post-traumatic stress disorder. This systematic scoping review aims to explore the feasibility, acceptability and effectiveness of psychological trauma-focused treatment concurrently offered to underweight patients receiving anorexia nervosa treatment. Method A multi-step literature search, according to an a priori protocol was performed. Databases PubMed, Embase, APA PsycINFO, Web of Science, Scopus and Cochrane Central were searched up to September 19th 2022, and the search was rerun June 19th 2023. For quality assessment, Risk of Bias in Non-randomised Studies-of Interventions tool was used. Results The extensive search yielded 1769 reports, out of which only three observational pilot studies, both English and German, published between 2004 and 2022, could be included. The included studies reported on a total of 13 female participants between 16 and 58 years old, with anorexia nervosa or otherwise specified feeding or eating disorder, baseline BMI ranging between 14.6 and 16.5, who received concurrent anorexia and post-traumatic stress disorder treatment. In all participants, the emotional and cognitive functioning was sufficient to process the offered trauma-focused interventions, despite their significantly low body weight. Discussion The findings of this review identify a dearth of treatment research on knowledge of concurrent trauma-focused treatments for patients with anorexia nervosa. Refraining patients with anorexia nervosa from trauma-focused treatment may not be warranted.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
- Arkin Mental Health Institute, Amsterdam, Netherlands
| | | | - Caroline Planting
- GGZ Ingeest VU University Medical Center Mental Health Institute, Amsterdam, Netherlands
| | - Peter Daansen
- PsyQ Mental Health Institute, Beverwijk, Netherlands
| | - Ella van Beers
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders, Amstelveen, Netherlands
| | - Carolien Christ
- Arkin Mental Health Institute, Amsterdam, Netherlands
- GGZ Ingeest VU University Medical Center Mental Health Institute, Amsterdam, Netherlands
| | - Jack Dekker
- Arkin Mental Health Institute, Amsterdam, Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, Netherlands
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23
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Brewerton TD, Perlman MM, Gavidia I, Suro G. The treatment of dissociative identity disorder in an eating disorder residential treatment setting. Int J Eat Disord 2024; 57:450-457. [PMID: 38041242 DOI: 10.1002/eat.24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. METHOD We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. RESULTS Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. DISCUSSION These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. PUBLIC SIGNIFICANCE EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
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24
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Mendoza RR, Convertino AD, Blashill AJ. A longitudinal study of potentially traumatic events and binge-purge eating disorder onset in children. Appetite 2024; 193:107132. [PMID: 37995848 DOI: 10.1016/j.appet.2023.107132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/25/2023]
Abstract
Although the association between childhood trauma and subsequent binge-purge spectrum eating disorders (BP-EDs) is established in adult samples, little is known about the temporal association between potentially traumatic life events and BP-ED onset in children. Using longitudinal data from the U.S.-nationwide Adolescent Brain Cognitive Development (ABCD) study with children aged 9-10 at baseline, logistic regression with complex sampling assessed the longitudinal association of exposure to potentially traumatic events (PTEs) at baseline and meeting BP-ED criteria one year later. Children exposed to PTEs prior to baseline had 1.91 times greater odds of being diagnosed with a BP-ED one year later (95% CI: 1.26 - 2.90; p = .004), compared to those who had not experienced a PTE. The current study extends previous cross-sectional research to show a significant temporal association between childhood PTEs before ages 9-10 and the subsequent onset of BP-EDs one year later. Future research should consider specific timing of PTE exposure as well as examining children diagnosed with restrictive eating disorders.
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Affiliation(s)
- Rebecca R Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
| | - Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Aaron J Blashill
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA.
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25
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Naimi M, Sanahuja A. Clinical identification of a specific psychic envelope in families with anorexic symptoms. FAMILY PROCESS 2024. [PMID: 38267831 DOI: 10.1111/famp.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024]
Abstract
Our clinical experience in psychoanalytic family therapy with families where one member has anorexic symptoms has shown that the therapy space is often invaded by the deathly dimension, by an absence of family historicity, and by a lack of autonomy. These different elements appear as "voids," missing pieces of a family puzzle, and reflect a psychic container damaged by the weight of inherited intergenerational trauma. Rather than disappear, these elements are passed down from one generation to the next, their effects weakening the current group whose psychic envelope develops "holes" and becomes "elastic." This paper will focus on the changes in this psychic container, which shift according to the rhythm of family functioning, oscillating between activation of the deathly toxic function within the group, on the one hand, and tension between the isomorphic and homomorphic mode, on the other. We will show how this clinical identification around the quality of the psychic envelope and its changes is valuable for family therapy.
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Affiliation(s)
- Marie Naimi
- Clinical psychologist and Doctor of Clinical Psychology, University of Franche-Comté, Psychology Laboratory, Besançon, France
| | - Almudena Sanahuja
- Professor of Clinical Psychology and Psychopathology, Clinical Psychologist, Family Psychotherapist, University of Franche-Comté, Psychology Laboratory, Besançon, France
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26
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Isaksson M, Isaksson J, Schwab-Stone M, Ruchkin V. Longitudinal associations between community violence exposure, posttraumatic stress symptoms, and eating disorder symptoms. J Eat Disord 2024; 12:6. [PMID: 38212849 PMCID: PMC10785541 DOI: 10.1186/s40337-024-00965-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Eating disorder (ED) symptoms have been associated with different types of traumatic events, such as exposure to sexual and physical violence, and emotional abuse. However, the relation between ED symptoms and community violence exposure (CVE) is underexplored, despite the latter's adverse effects on many aspects of adolescent functioning. The primary aim of this study was to evaluate the relation between CVE and ED symptoms in adolescents, while also investigating the potential mediating and moderating roles of posttraumatic stress (PTS) symptoms, gender, and ethnicity. METHODS Data were collected longitudinally over two consecutive years in the city of New Haven, CT, in the United States. Participants were 2612 adolescent students from the public school system (1397 girls and 1215 boys) with an average age of 12.8 years (SD = 1.29). The students were comprised of several different ethnic groups, including Caucasians, African Americans and Hispanic Americans. Associations between CVE (no exposure, witnessing, and victimization) and PTS symptoms at year one, and ED symptoms (thoughts and compensatory behaviors) at year two, were assessed with self-rating instruments. Moderation and mediation analyses were conducted using a variant of linear regression (Hayes PROCESS macro). RESULTS ED symptoms at year two were significantly associated with both witnessing and being a victim of community violence at year one, with most or all of the relations being explained by PTS symptoms. Overall, neither gender nor ethnicity had a meaningful moderating effect in the observed relations. CONCLUSIONS The findings support the notion that assessing and addressing PTS symptoms might be beneficial when treating individuals with ED symptoms who have experienced community violence, irrespective of gender or ethnicity.
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Affiliation(s)
- Martina Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, S-751 85, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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27
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Eielsen HP, Ulvenes P, Hoffart A, Rø Ø, Rosenvinge JH, Vrabel K. Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years. Int J Eat Disord 2024; 57:81-92. [PMID: 37897047 DOI: 10.1002/eat.24067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. METHOD A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. RESULTS We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, "continuous improvement" (54.8%); (b) a high symptom level at baseline and moderate decrease over time, "high and declining" (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, "consistently low" (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, "high and increasing" (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome DISCUSSION: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. PUBLIC SIGNIFICANCE Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care.
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Affiliation(s)
- Hanna Punsvik Eielsen
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Pål Ulvenes
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Division of Mental Health and Addiction, University of Oslo, Oslo, Norway
| | - Jan H Rosenvinge
- Institute of Psychology, Faculty of Health Sciences, UiT - The Artic University of Norway, Tromsø, Norway
| | - KariAnne Vrabel
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
- Institute of Psychology, University of Oslo, Oslo, Norway
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28
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Cascino G, Monteleone AM. Early traumatic experiences and the hypothalamus-pituitary-adrenal axis in people with eating disorders: A narrative review. Psychoneuroendocrinology 2024; 159:106665. [PMID: 37944210 DOI: 10.1016/j.psyneuen.2023.106665] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
Exposure to trauma during childhood is a non-specific risk factor for psychiatric disorders, including eating disorders (EDs), over the life course. Moreover, an association between stressful life events and the onset/maintenance of EDs has been documented. Therefore, the hypothalamus-pituitary-adrenal (HPA) axis, namely the main component of the endogenous stress response system, has been proposed to be implicated in the pathophysiology of EDs. In this narrative review the current knowledge concerning the effects of early trauma exposure on the HPA axis activity and their putative role in the pathophysiology of EDs will be illustrated. Research findings corroborate the idea that childhood trauma exposure has long-lasting dysregulating effects on the activity of the HPA axis, which may contribute to the biological background of the early trauma-related risk for the development of EDs across the life span. Moreover, literature data support the existence of a "maltreated ecophenotype" in EDs characterized by specific clinic and neuroendocrine features, which may have important implications in treatment programming for such a type of patients.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Salerno, Italy.
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29
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Barone E, Carfagno M, Cascino G, Landolfi L, Colangelo G, Della Rocca B, Monteleone AM. Childhood maltreatment, alexithymia and eating disorder psychopathology: A mediation model. CHILD ABUSE & NEGLECT 2023; 146:106496. [PMID: 37820393 DOI: 10.1016/j.chiabu.2023.106496] [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: 01/22/2023] [Revised: 08/28/2023] [Accepted: 10/01/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The relationship between childhood maltreatment and eating disorder psychopathology has been under-investigated. OBJECTIVE The purpose of this study was to investigate the role of alexithymia in mediating the relationship between childhood maltreatment experiences and eating disorder (ED) symptoms. PARTICIPANTS AND SETTING One-hundred-forty-three women with anorexia nervosa, 110 women with bulimia nervosa and 108 healthy women filled in the Eating Disorder Inventory-2, the Childhood Trauma Questionnaire and the Toronto Alexithymia Scale-20 (TAS-20). METHODS A mediator path model including childhood trauma types as predictors, the subscales of the TAS-20 as mediators and ED specific symptoms as dependent variables was conducted in individuals with EDs and in healthy women. RESULTS In women with EDs emotional abuse was directly associated with body dissatisfaction and was associated to drive to thinness, bulimia and body dissatisfaction through the mediation of difficulties to identify emotions. In healthy women, physical neglect was directly associated to drive to thinness and bulimia, but no significant mediation effect through alexithymia emerged. CONCLUSION Impaired emotion recognition mediates the association between childhood emotional abuse and ED symptoms. Individuals with early emotional abuse may experience ED symptoms to manage confused emotional perceptions. Improving emotional understanding and acceptance may be a treatment target in early maltreated individuals with EDs.
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Affiliation(s)
- Eugenia Barone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Lorenzo Landolfi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia Colangelo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bianca Della Rocca
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Gearhart MG, Brewerton TD. Psychogenic Nonepileptic Seizures Associated with an Eating Disorder and PTSD Are Responsive to Cognitive Processing Therapy. Case Rep Psychiatry 2023; 2023:5539951. [PMID: 38033475 PMCID: PMC10684327 DOI: 10.1155/2023/5539951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Objective Eating disorders (EDs) are often associated with prior histories of trauma, subsequent PTSD and related psychiatric comorbidities. There is a paucity of information about their relationship to somatic symptom disorders, specifically psychogenic nonepileptic seizures (PNES), a type of functional neurological symptom disorder or conversion disorder. Methods We report a case of a 39-year-old bisexual female with bulimia nervosa (BN), PTSD, recurrent major depressive disorder (MDD), cannabis use disorder, and PNES who responded to integrated trauma-focused treatment during residential ED treatment using cognitive processing therapy (CPT). Symptoms of ED, PTSD, major depression, and state-trait anxiety were measured using validated assessment instruments. Results During the course of CPT treatment, the patient's total scores on the PTSD Symptom Checklist for DSM-5 (PCL-5) went from 59 to 26, which is below the diagnostic threshold for PTSD. In addition, she demonstrated improvements in the Eating Disorder Examination Questionnaire (EDE-Q) Global Severity score, the Eating Disorder Inventory (EDI-2) total score, the Patient Health Questionnaire (PHQ-9) total score, the Spielberger State and Trait Anxiety Inventory scores, and the Eating Disorder Quality of Life (EDQOL) total score. Furthermore, her PNES also abated, and she remained seizure free for ∼1 year following discharge with the exception of one short seizure, per report of the patient. Conclusion The use of CPT as part of an integrated trauma-informed treatment approach during residential ED treatment was successful in a woman with PNES, BN, PTSD, MDD, and cannabis use disorder.
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Affiliation(s)
| | - Timothy D. Brewerton
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Fereidooni F, Daniels JK, D Krause-Utz A, Hagenaars MA, Smeets T, Heins J, Dorahy MJ, Emmerik AAPV, de Jong PJ, Hoekstra S, Warrens MJ, Lommen MJJ. Childhood maltreatment and adulthood victimization: An evidence-based model. J Psychiatr Res 2023; 167:46-62. [PMID: 37832203 DOI: 10.1016/j.jpsychires.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/12/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
There is ample evidence showing that childhood maltreatment increases two to three fold the risk of victimization in adulthood. Various risk factors, including posttraumatic stress disorder (PTSD) symptoms, dissociation, self-blame, and alcohol abuse are related to revictimization. Although previous research examined associations between risk factors for revictimization, the evidence is limited and the proposed models mostly include a handful of risk factors. Therefore, it is critical to investigate a more comprehensive model explaining the link between childhood maltreatment and adulthood (re)victimization. Accordingly, this study tested a data-driven theoretical path model consisting of 33 variables (and their associations) that could potentially enhance understanding of factors explaining revictimization. Cross-sectional data derived from a multi-wave study were used for this investigation. Participants (N = 2156, age mean = 19.94, SD = 2.89) were first-year female psychology students in the Netherlands and New Zealand, who responded to a battery of questionnaires and performed two computer tasks. The path model created by structural equation modelling using modification indices showed that peritraumatic dissociation, PTSD symptoms, trauma load, loneliness, and drug use were important mediators. Attachment styles, maladaptive schemas, meaning in life, and sex motives connected childhood maltreatment to adulthood victimization via other factors (i.e., PTSD symptoms, risky sex behavior, loneliness, emotion dysregulation, and sex motives). The model indicated that childhood maltreatment was associated with cognitive patterns (e.g., anxious attachment style), which in turn were associated with emotional factors (e.g., emotion dysregulation), and then with behavioral factors (e.g., risky sex behavior) resulting in revictimization. The findings of the study should be interpreted in the light of the limitations. In particular, the cross-sectional design of the study hinders us from ascertaining that the mediators preceded the outcome variable.
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Affiliation(s)
- Fatemeh Fereidooni
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Judith K Daniels
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.
| | - Anne D Krause-Utz
- Department of Clinical Psychology, Leiden University, the Netherlands
| | | | - Tom Smeets
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jenna Heins
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Martin J Dorahy
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Steven Hoekstra
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
| | - Matthijs J Warrens
- Department of Educational Sciences, University of Groningen, the Netherlands
| | - Miriam J J Lommen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands
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Lie SØ, Wisting L, Stedal K, Rø Ø, Friborg O. Stressful life events and resilience in individuals with and without a history of eating disorders: a latent class analysis. J Eat Disord 2023; 11:184. [PMID: 37845712 PMCID: PMC10577902 DOI: 10.1186/s40337-023-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are associated with a range of stressful life events, but few have investigated protective factors that may affect these associations. The current study used mixture modelling to describe typologies in life stress exposure and availability of protective resources in individuals with and without eating disorders (EDs). METHODS A case - control sample (n = 916) completed measures of stressful life events, resilience protective factors, emotion regulation, and symptoms of EDs, depression and anxiety. We conducted latent class analyses to identify subgroups of stress exposure and profile analyses of emotional regulation and resilience. The resulting two latent variables were combined to explore effects on ED status and symptomatology, depression, and anxiety as distal outcome variables. RESULTS We identified four classes of stressful life events (generally low, some abuse/bullying, sexual/emotional assaults, and high adversity). For protective resources, we identified six profiles that ranged from low to higher levels of protection with variations in social/family resources. The latent protection variable contributed more strongly to the distal outcomes than the latent stress variable, but did not moderate the latent stress and distal outcome variable relationships. Profiles characterized by lower protective resources included higher proportions of individuals with a lifetime ED, and were associated with higher scores on all symptom measures. CONCLUSIONS Intra- and interpersonal protective resources were strongly associated with lifetime EDs and current mental health symptom burden after accounting for stressful event exposure, suggesting protective factors may be useful to target in the clinical treatment of patients with ED.
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Affiliation(s)
- Selma Øverland Lie
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway.
| | - Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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Malecki JS, Rhodes P, Ussher J, Boydell K. The embodiment of childhood abuse and anorexia nervosa: A body mapping study. Health Care Women Int 2023; 44:1192-1217. [PMID: 35727112 DOI: 10.1080/07399332.2022.2087074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 04/25/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
Childhood trauma has long been implicated in the development of anorexia nervosa and is known to impact more women than men. Still, less is known about the meaning women attribute to food and bodily practices and how they contribute to feminine subjectivity. In this article, we examine the subjective experiences of women with histories of childhood abuse and anorexia and women who did not develop an eating disorder. Through a visual narrative analysis of eight body maps and narratives, we identified five themes: "time and the body have a way of showing what matters," "femininity and family," "sexual subjectivities and food meanings," "voices, dissociation, and sexual subjectivities," and "religion and healthism." In women with anorexia, specific eating and bodily practices reconstructed the traumatic events to align with the available cultural discourses related to health, religion, and family and had implications for their feminine and sexual subjectivities and self-worth. This research showcased how arts-based methodologies add value and advance knowledge about the role of culturally available representations in the development of anorexia and has implications for therapy and prevention of anorexia.
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Affiliation(s)
| | - Paul Rhodes
- University of Sydney, Camperdown, New South Wales, Australia
| | - Jane Ussher
- Women's Health Psychology, Translational Research Institute School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Katherine Boydell
- Hospital Road Randwick, Black Dog Institute, Randwick, New South Wales, Australia
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Isaksson J, Isaksson M, Stickley A, Vermeiren R, Koposov R, Schwab-Stone M, Ruchkin V. Community Violence Exposure and Eating Disorder Symptoms among Belgian, Russian and US Adolescents: Cross-Country and Gender Perspectives. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01590-1. [PMID: 37606867 DOI: 10.1007/s10578-023-01590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/23/2023]
Abstract
Community violence exposure (CVE) is one of the most common adverse childhood experiences worldwide. Despite this, its potential effect on disordered eating in adolescents from different cultures is underexplored. In the present cross-sectional study, self-reported data were collected from 9751 students (Mean age = 14.27) from Belgium, Russia and the US on CVE (witnessing violence and violence victimization), eating disorder (ED) symptoms (ED thoughts with associated compensatory behaviors), and comorbid symptoms of posttraumatic stress, depression and anxiety. Increased CVE (from no exposure to witnessing to victimization) was associated with more ED symptoms, and the associations remained significant after adjusting for comorbid conditions. The associations were similar for adolescents across the three countries. No gender differences were observed in the association between CVE and ED symptoms, even though girls in general reported more ED symptoms than boys. We conclude that CVE appears to be associated with ED symptoms in three culturally different samples of adolescents.
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Affiliation(s)
- Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Martina Isaksson
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Robert Vermeiren
- Department of Child and Adolescent Psychiatry Curium, Leiden University Medical Center, Leiden, Netherlands
| | - Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, Tromsö, Norway
- Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mary Schwab-Stone
- Child Study Center, Yale University School of Medicine, New Haven, USA
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
- Child Study Center, Yale University School of Medicine, New Haven, USA.
- Sala Forensic Psychiatric Clinic, Sala, Sweden.
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Cascino G, Canna A, Russo AG, Monaco F, Monteleone AM, Ceres R, Carfagno M, Di Salle F, Monteleone P. Association between childhood maltreatment and cortical folding in women with eating disorders. Eur J Neurosci 2023; 58:2868-2873. [PMID: 37369968 DOI: 10.1111/ejn.16076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Childhood maltreatment (CM) is associated with distinct clinical and biological characteristics in people with eating disorders (EDs). The measurement of local gyrification index (lGI) may help to better characterize the impact of CM on cortical structure. Thus, the present study investigated the association of CM with lGI in women with EDs. Twenty-six women with anorexia nervosa (AN) and 24 with bulimia nervosa (BN) underwent a 3T MRI scan. All participants filled in the Childhood Trauma Questionnaire. All neuroimaging data were processed by FreeSurfer. LGI maps underwent a general linear model to evaluate differences between groups with or without CM. People with AN and BN were merged together. Based on the Childhood Trauma Questionnaire cutoff scores, 24 participants were identified as maltreated and 26 as non-maltreated. Maltreated people with EDs showed a significantly lower lGI in the left middle temporal gyrus compared with non-maltreated people, whereas no differences emerged in the right hemisphere between groups. The present study showed that in people with EDs, CM is associated with reduced cortical folding in the left middle temporal gyrus, an area that could be involved in ED psychopathology. This finding corroborates the hypothesis of a 'maltreated ecophenotype', which argues that CM may allow to biologically, other than clinically, distinguish individuals with the same psychiatric disorder.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Antonietta Canna
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrea Gerardo Russo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | - Rossella Ceres
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
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O'Loghlen E, Galligan R, Grant S. Childhood maltreatment, shame, psychological distress, and binge eating: testing a serial mediational model. J Eat Disord 2023; 11:96. [PMID: 37312168 PMCID: PMC10265894 DOI: 10.1186/s40337-023-00819-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE Despite evidence of causal relationships between childhood maltreatment and the development of binge eating disorder (BED), research on mediating mechanisms is lacking. The present study sought to understand the childhood maltreatment-binge eating relationship more fully by examining three types of shame (internal, external, body) and psychological distress as mediators in this relationship. There is evidence that shame and psychological distress are associated with both childhood maltreatment and binge eating pathology. It was hypothesised that shame stemming from childhood maltreatment would contribute to psychological distress, and to binge eating as a dysfunctional emotion regulation strategy, in a serial mediational model. METHOD Five hundred and thirty adults with self-reported binge eating symptoms completed an online survey, which included measures of childhood maltreatment, internal shame, external shame, body shame, psychological distress, and binge eating and other eating disorder symptoms. RESULTS Path analyses showed three specific relationships: (1) a relationship between childhood emotional maltreatment and binge eating, which was serially mediated by internal shame and psychological distress; (2) a relationship between childhood sexual abuse and binge eating, which was mediated by body shame; and (3) a relationship between childhood physical maltreatment and binge eating, which was mediated by psychological distress. We also found a feedback loop, whereby binge eating might lead to increased overvaluation of body shape and weight (possibly due to increased weight) and then to an increase in internal shame and body shame. The final model showed excellent fit for the data. DISCUSSION Findings extend our understanding of the link between childhood maltreatment and BED. Future intervention research should focus on examining the efficacy of interventions for different forms of childhood maltreatment, based on the key mediating factors.
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Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
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Friedman J, Yoon C, Emery Tavernier R, Mason S, Neumark-Sztainer D. Associations of childhood maltreatment with binge eating and binge drinking in emerging adult women. Prev Med Rep 2023; 33:102217. [PMID: 37223561 PMCID: PMC10201826 DOI: 10.1016/j.pmedr.2023.102217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/26/2023] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Background Binge drinking and binge eating are prevalent, frequently co-occurring, high-risk behaviors among emerging adult women, each with physical and psychological consequences. The mechanisms driving their co-occurrence are not well understood, though a history of adverse childhood experiences (ACEs) may increase the risk for both binge behaviors. Objective To assess the association between ACE subtypes and individual and co-occurring binge drinking and eating in emerging adult women. Participants and Setting A diverse sample of women participating in the population-based study EAT 2018: Eating and Activity over Time (N = 788; aged 18-30; 19% Asian, 22% Black, 19% Latino, and 36% White). Methods Multinomial logistic regression estimated associations among ACE subtypes (i.e., sexual abuse, physical abuse, emotional abuse, household dysfunction), and binge drinking, binge eating, and their co-occurrence. Results are reported as predicted probabilities (PP) of each outcome. Results Over half of the sample (62%) reported at least one ACE. In models mutually adjusted for other ACEs, physical and emotional abuse showed the strongest associations with binge behaviors. Experiences of physical abuse had the strongest association with a ten-percentage point higher predicted probability of binge drinking (PP = 37%, 95% [CI 27-47%]) and seven-percentage point higher PP of co-occurring binge eating and drinking (PP = 12%, 95% CI [5-19%]). Emotional abuse had the strongest association with an 11-percentage point higher PP binge eating only (PP = 20%, 95% CI [11-29%]). Conclusions This study found childhood physical and emotional abuse to be particularly relevant risk factors for binge drinking, binge eating, and their co-occurrence among emerging adult women.
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Affiliation(s)
- J.K. Friedman
- Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Minneapolis Veterans Administration Heath Care System, Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - C.Y. Yoon
- Health and Human Performance, University of Houston, Houston, TX, USA
| | - R.L. Emery Tavernier
- Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
| | - S.M. Mason
- Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - D. Neumark-Sztainer
- Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Uziel O, Dickstein H, Beery E, Lewis Y, Loewenthal R, Uziel E, Shochat Z, Weizman A, Stein D. Differences in Telomere Length between Adolescent Females with Anorexia Nervosa Restricting Type and Anorexia Nervosa Binge-Purge Type. Nutrients 2023; 15:2596. [PMID: 37299559 PMCID: PMC10255620 DOI: 10.3390/nu15112596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Physiological and psychological distress may accelerate cellular aging, manifested by shortening of telomere length (TL). The present study focused on TL shortening in anorexia nervosa (AN), an illness combining physiological and psychological distress. For that purpose, we measured TL in 44 female adolescents with AN at admission to inpatient treatment, in a subset of 18 patients also at discharge, and in 22 controls. No differences in TL were found between patients with AN and controls. At admission, patients with AN-binge/purge type (AN-B/P; n = 18) showed shorter TL compared with patients with AN-restricting type (AN-R; n = 26). No change in TL was found from admission to discharge, despite an improvement in body mass index standard deviation score (BMI-SDS) following inpatient treatment. Older age was the only parameter assessed to be correlated with greater TL shortening. Several methodological changes have to be undertaken to better understand the putative association of shorter TL with B/P behaviors, including increasing the sample size and the assessment of the relevant pathological eating disorder (ED) and non-ED psychological correlates in the two AN subtypes.
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Affiliation(s)
- Orit Uziel
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadar Dickstein
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Einat Beery
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
| | - Yael Lewis
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shalvatah Mental Health Center, Hod Hasahron 45100, Israel
| | - Ron Loewenthal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eran Uziel
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Zipi Shochat
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Abraham Weizman
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Statistical Service, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Daniel Stein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
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Convertino AD, Mendoza RR. Posttraumatic stress disorder, traumatic events, and longitudinal eating disorder treatment outcomes: A systematic review. Int J Eat Disord 2023; 56:1055-1074. [PMID: 36916450 PMCID: PMC10247514 DOI: 10.1002/eat.23933] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Many individuals diagnosed with an eating disorder (ED) have been exposed to traumatic events, and some of these individuals are diagnosed with posttraumatic stress disorder (PTSD). Although theorized by researchers and clinicians, it is unclear whether traumatic event exposure or PTSD interferes with outcomes from ED treatment. The objective of the current study was to systematically review the literature on traumatic events and/or PTSD as either predictors or moderators of psychological treatment outcomes in EDs. METHOD A PRISMA search was conducted to identify studies that assessed the longitudinal association between traumatic events or PTSD and ED outcomes. Eighteen articles met the inclusion criteria for review. RESULTS Results indicated that traumatic event exposure was associated with greater ED treatment dropout, but individuals with a traumatic event history benefited from treatment similarly to their unexposed peers. Findings also indicated that traumatic events may be associated with greater symptom relapse posttreatment. DISCUSSION Given the limited number of studies examining PTSD, results are considered very tentative; however, similar to studies comparing trauma-exposed and nontrauma-exposed participants, individuals with PTSD may have similar treatment gains compared to individuals without PTSD, but individuals with PTSD may experience greater symptom relapse posttreatment. Future researchers are encouraged to examine whether trauma-informed care or integrated treatment for EDs and PTSD mitigates dropout from treatment and improves symptom remission outcomes. Furthermore, researchers are encouraged to examine how the developmental timing of traumatic events, self-perceived impact of trauma, and cumulative trauma exposure may be associated with differential ED treatment outcomes. PUBLIC SIGNIFICANCE Eating disorders (EDs), trauma, and posttraumatic stress disorder (PTSD) often co-occur. Individuals with traumatic event exposure and/or PTSD demonstrate greater ED symptoms; it is unclear whether these individuals benefit similarly in ED treatment to their peers. The current study found that individuals with traumatic event exposure are more likely to drop out of treatment but benefit from treatment with similar symptom remission. Traumatic history was associated with greater relapse posttreatment.
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Affiliation(s)
- Alexandra D. Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA 92120, USA
| | - Rebecca R. Mendoza
- Department of Psychology, College of Sciences, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182, USA
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Brewerton TD. The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14:1149433. [PMID: 37252137 PMCID: PMC10213703 DOI: 10.3389/fpsyt.2023.1149433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.
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Martin GM, Tremblay J, Gagnon-Girouard MP. Sexual self-concept, functioning, and practices of women with binge eating episodes. Eat Weight Disord 2023; 28:37. [PMID: 37069446 PMCID: PMC10108796 DOI: 10.1007/s40519-023-01565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/21/2023] [Indexed: 04/19/2023] Open
Abstract
PURPOSE Positive sexuality has received little empirical attention in relation to eating disorders. Two tendencies related to sexuality have been identified among women with anorexia nervosa (avoidance) and bulimia nervosa (disinhibition), but it is unclear if they also apply to women with binge eating episodes without compensatory behaviors. This study aimed at (1) exploring the sexual self-concept, functioning, and practices of women with binge eating episodes with or without comorbid restrictive and/or compensatory behaviors, considering past experiences of violence, and (2) verifying the presence of distinct profiles of sexual dispositions among this population. METHODS In total, 253 women reporting recurrent episodes of loss of control related to food intake in the past 5 years, completed a web-based questionnaire. Descriptive and correlational analyses were conducted to outline participants' sexual self-concept, functioning, and practices and to examine the relationship between these factors. A two-step cluster analysis was also performed to determine whether participants presented distinct profiles of sexual dispositions. RESULTS Participants were generally characterized by a negative sexual self-concept and poor sexual functioning. While a first subgroup of participants displayed a pattern of sexual difficulties and avoidance, a second subgroup had a positive sexual self-concept, better sexual functioning and a wider range of sexual practices. Subgroups did not differ relative to binge eating. CONCLUSIONS Sexuality offers a platform for positive embodiment, which can lead to the improvement of body image and mind-body connection and may thus constitute an essential clinical target to improve treatment related to binge eating episodes. LEVEL OF EVIDENCE Level II: The experimental study is a non-randomized controlled trial.
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Affiliation(s)
- Geneviève Manuela Martin
- Department of Psychiatry and Neurosciences, Faculty of Medicine, Université Laval, 1050 Avenue de la Médecine, G1V 0A6, Québec, Canada.
| | - Jérôme Tremblay
- Department of Sexology, Université du Québec à Montréal, Montréal, Canada
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Christoffersen H, Skårderud HR, Vrabel K, Weider S. Self-compassion as a mechanism of change in patients with eating disorders and childhood trauma receiving CFT-E; a study of within-person processes. NORDIC PSYCHOLOGY 2023. [DOI: 10.1080/19012276.2023.2192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Hedvig Christoffersen
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - Hanna Røed Skårderud
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - KariAnne Vrabel
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Siri Weider
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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O'Loghlen E, Galligan R, Grant S. The functions of binge eating scale (FBES): Development and preliminary psychometric validation. Appetite 2023; 183:106479. [PMID: 36736905 DOI: 10.1016/j.appet.2023.106479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs). METHOD The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity. RESULTS Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs. DISCUSSION Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.
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Affiliation(s)
- Elyse O'Loghlen
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Sharon Grant
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
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44
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Brewerton TD, Gavidia I, Suro G, Perlman MM. Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results. J Eat Disord 2023; 11:48. [PMID: 36973828 PMCID: PMC10044735 DOI: 10.1186/s40337-023-00773-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION We studied whether provisional posttraumatic stress disorder (PTSD) moderated discharge (DC) and 6-month follow-up (FU) outcomes of multi-modal, integrated eating disorder (ED) residential treatment (RT) based upon principles of cognitive processing therapy (CPT). METHODS ED patients [N = 609; 96% female; mean age (± SD) = 26.0 ± 8.8 years; 22% LGBTQ +] with and without PTSD completed validated assessments at admission (ADM), DC and 6-month FU to measure severity of ED, PTSD, major depressive disorder (MDD), state-trait anxiety (STA) symptoms, and eating disorder quality of life (EDQOL). We tested whether PTSD moderated the course of symptom change using mixed models analyses and if ED diagnosis, ADM BMI, age of ED onset and LGBTQ + orientation were significant covariates of change. Number of days between ADM and FU was used as a weighting measure. RESULTS Despite sustained improvements with RT in the total group, the PTSD group had significantly higher scores on all measures at all time points (p ≤ .001). Patients with (n = 261) and without PTSD (n = 348) showed similar symptom improvements from ADM to DC and outcomes remained statistically improved at 6-month FU compared to ADM. The only significant worsening observed between DC and FU was with MDD symptoms, yet all measures remained significantly lower than ADM at FU (p ≤ .001). There were no significant PTSD by time interactions for any of the measures. Age of ED onset was a significant covariate in the EDI-2, PHQ-9, STAI-T, and EDQOL models such that an earlier age of ED onset was associated with a worse outcome. ADM BMI was also a significant covariate in the EDE-Q, EDI-2, and EDQOL models, such that higher ADM BMI was associated with a worse ED and quality of life outcome. CONCLUSIONS Integrated treatment approaches that address PTSD comorbidity can be successfully delivered in RT and are associated with sustained improvements at FU. Improving strategies to prevent post-DC recurrence of MDD symptoms is an important and challenging area of future work.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
- Timothy D. Brewerton, MD, LLC, Mount Pleasant, SC, USA.
- Monte Nido and Affiliates, Miami, FL, USA.
| | | | | | - Molly M Perlman
- Monte Nido and Affiliates, Miami, FL, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, FL, USA
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Elwyn R, Mitchell J, Kohn MR, Driver C, Hay P, Lagopoulos J, Hermens DF. Novel ketamine and zinc treatment for anorexia nervosa and the potential beneficial interactions with the gut microbiome. Neurosci Biobehav Rev 2023; 148:105122. [PMID: 36907256 DOI: 10.1016/j.neubiorev.2023.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/13/2023]
Abstract
Anorexia nervosa (AN) is a severe illness with diverse aetiological and maintaining contributors including neurobiological, metabolic, psychological, and social determining factors. In addition to nutritional recovery, multiple psychological and pharmacological therapies and brain-based stimulations have been explored; however, existing treatments have limited efficacy. This paper outlines a neurobiological model of glutamatergic and γ-aminobutyric acid (GABA)-ergic dysfunction, exacerbated by chronic gut microbiome dysbiosis and zinc depletion at a brain and gut level. The gut microbiome is established early in development, and early exposure to stress and adversity contribute to gut microbial disturbance in AN, early dysregulation to glutamatergic and GABAergic networks, interoceptive impairment, and inhibited caloric harvest from food (e.g., zinc malabsorption, competition for zinc ions between gut bacteria and host). Zinc is a key part of glutamatergic and GABAergic networks, and also affects leptin and gut microbial function; systems dysregulated in AN. Low doses of ketamine in conjunction with zinc, could provide an efficacious combination to act on NMDA receptors and normalise glutamatergic, GABAergic and gut function in AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia.
| | - Jules Mitchell
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Michael R Kohn
- AYA Medicine Westmead Hospital, CRASH (Centre for Research into Adolescent's Health) Western Sydney Local Health District, Sydney University, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Christina Driver
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI) School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia; SouthWest Sydney Local Health District, Liverpool Hospital, Liverpool, NSW, Australia
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46
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Nelson JD, Martin LN, Izquierdo A, Kornienko O, Cuellar AE, Cheskin LJ, Fischer S. The role of discrimination and adverse childhood experiences in disordered eating. J Eat Disord 2023; 11:29. [PMID: 36850009 PMCID: PMC9969653 DOI: 10.1186/s40337-023-00753-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND In clinical research, there has been a call to move beyond individual psychosocial factors towards identifying cultural and social factors that inform mental health. Similar calls have been made in the eating disorders (ED) field underscoring the need to understand larger sociocultural influences on EDs. Discrimination is a social stressor that may influence mental health in similar ways to traumatic or adverse childhood experiences (ACEs). Given the high rates of EDs and discrimination among marginalized groups, it is vital to understand the role of discrimination and ACEs as predictors of ED symptoms in these populations. The aim of this study is to examine how perceived discrimination predicts ED pathology when statistically adjusting for gender, race, and ACEs. METHODS The diverse study sample consisted of 331 undergraduate students from a longitudinal cohort study (ages 18-24; 66% female; 35% White/non-Hispanic). Participants completed measures of everyday discrimination, ACEs, and ED pathology. RESULTS Following adjustment for multiple statistical comparisons, the frequency of daily discrimination predicted all ED symptoms above and beyond history of ACEs. In follow-up analyses, number of reasons for discrimination predicted cognitive restraint and purging. Differences in ED symptomatology were found based on the reason for discrimination, gender, and race. Specifically, those who experienced weight discrimination endorsed higher scores on all ED symptoms, and those experiencing gender discrimination endorsed higher body dissatisfaction, cognitive restraint, and restriction. People of color endorsed higher restriction, while female participants endorsed higher scores on all ED symptom with the exception of cognitive restraint. CONCLUSION Discrimination is a salient risk factor for ED symptoms even when accounting for individuals' history of ACEs. Future research should utilize an intersectional approach to examine how perceived discrimination affects ED pathology over time. (Word count: 234).
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Affiliation(s)
- Jillian D Nelson
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
| | - Laura N Martin
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alyssa Izquierdo
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Olga Kornienko
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Alison E Cuellar
- Department of Health Administration and Policy, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
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47
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Güzel Â, Mutlu NL, Molendijk M. COVID-19-related changes in eating disorder pathology, emotional and binge eating and need for care: a systematic review with frequentist and Bayesian meta-analyses. Eat Weight Disord 2023; 28:19. [PMID: 36805344 PMCID: PMC9941242 DOI: 10.1007/s40519-023-01547-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has been a leading cause of stress and feelings of loss of control, both of which have been related to eating disorder (ED) pathology onset and deterioration. We aim to estimate the magnitude of changes in the prevalence rates of, and indicators for, ED psychopathology in the face of the COVID-19 pandemic. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Searches for eligible studies were performed in PubMed, Web of Science and pre-print servers until January 15 2023. RESULTS Our searches yielded 46 eligible studies reporting on a total of 4,688,559 subjects. These data provide strong evidence indicating increased rates of diagnosed and self-reported ED's and a concordant increased need for care in the face of the pandemic. ED symptom severity scores in patients were not elevated during the pandemic, except for those related to anorexia nervosa. On average, people in the general population report relatively high levels of emotional and binge eating during the pandemic, although the evidential strength for these associations is only anecdotal to moderate. Moderators of between-study heterogeneity were not detected. CONCLUSIONS Altogether, our results suggest that the COVID-19 pandemic is associated with a wide spread negative effect on ED pathology in patient samples and the general population. The development of online prevention and intervention programs for EDs during stressful times like a pandemic is encouraged. A limitation is that the results reported here may be prone to biases, amongst others, self-report bias. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis. PREREGISTRATION Prospero [ https://www.crd.york.ac.uk/prospero ] ID: CRD42022316105.
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Affiliation(s)
- Âmine Güzel
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Naz Lâl Mutlu
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands
| | - Marc Molendijk
- Clinical Psychology Department, Leiden University, Leiden, The Netherlands.
- Leiden Institute of Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands.
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Huckstepp TJ, Allen A, Maher AL, Houlihan C, Mason J. Factor structure of the Young Positive Schema Questionnaire in an eating disorder sample. Eat Weight Disord 2023; 28:13. [PMID: 36800100 PMCID: PMC9938060 DOI: 10.1007/s40519-023-01549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The Young Positive Schema Questionnaire (YPSQ) measures early adaptive schemas (EAS) which could be used to develop positive psychology and schema-based interventions to benefit the treatment of eating disorders (EDs). METHODS The present study investigated the factor structure of the YPSQ in a sample of 826 participants (18-73 years; n = 753 women) with ED symptomatology (e.g., restricting, binging, and purging). The sample was randomly split into two groups for exploratory and confirmatory factor analyses. Full sample analysis using Pearson correlations was conducted to explore convergent validity of the new YSPQ factor structure with ED symptomatology, emotional regulation, and cognitive flexibility. RESULTS A nine-factor model was found, demonstrating good fit indices and internal consistency (α = 0.77-0.92). The YPSQ showed an inverse relationship to ED symptomatology and emotional suppression, and a positive relationship with cognitive flexibility and emotion reappraisal. CONCLUSION Further research is needed to explore the clinical benefits of the YPSQ to identify EAS deficits in individuals with EDs to improve treatment outcomes. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Tyrone J Huckstepp
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Allen
- The Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia.
| | - Anthea L Maher
- Discipline of Psychology, School of Health, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Catherine Houlihan
- Wandi Nerida, Residential Eating Disorders Facility, Mooloolah Valley, Sunshine Coast, QLD, Australia
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Kopland MCG, Vrabel K, Melsom L, Hoffart A, Johnson SU. Self-compassion in eating disorders and childhood trauma: A study of within-person effects in a randomized controlled trial. Psychother Res 2023; 33:640-653. [PMID: 36630619 DOI: 10.1080/10503307.2022.2149363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Patients with eating disorders and childhood trauma have clinical presentations that make them less suitable for standard eating disorder treatment. This might be due to high levels of shame and self-criticism. Self-compassion can be a mechanism of change, especially for patients with eating disorders and childhood trauma. METHOD A total of 130 patients with or without childhood trauma were admitted to 13 weeks of inpatient treatment and randomized to either compassion-focused therapy or cognitive-behavioral therapy. Self-compassion and eating disorder symptoms were measured every week. The data were analyzed for within-person effects using multilevel modeling. RESULTS We did not find a within-person effect of self-compassion on eating disorder symptoms. Rather, the analysis indicated that eating disorder symptoms predict self-compassion in the overall sample. However, we found a stronger within-person relationship between self-compassion and eating disorder symptoms in patients with trauma receiving compassion-focused therapy compared to the remaining patients in the study. CONCLUSION Overall, eating disorder symptoms predicted subsequent self-compassion at a within-person level. Patients with trauma in compassion-focused therapy demonstrated a stronger relationship between self-compassion and eating disorder symptoms. More studies with a cross-lagged design are needed to further illuminate self-compassion as a mechanism of change for these patients.Trial registration: ClinicalTrials.gov identifier: NCT02649114.
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Affiliation(s)
| | - Karianne Vrabel
- Modum Bad Psychiatric Hospital, Vikersund, Norway.,Department of Psychology, University of Oslo
| | - Linne Melsom
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Modum Bad Psychiatric Hospital, Vikersund, Norway.,Department of Psychology, University of Oslo
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50
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Rosenberg T, Lahav Y, Ginzburg K. Child abuse and eating disorder symptoms: Shedding light on the contribution of identification with the aggressor. CHILD ABUSE & NEGLECT 2023; 135:105988. [PMID: 36493509 DOI: 10.1016/j.chiabu.2022.105988] [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: 07/09/2022] [Revised: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Childhood abuse has been increasingly recognized as a risk factor for eating disorder symptoms. Additionally, it has been demonstrated that childhood abuse may lead to identification with the aggressor, an automatic defensive process, to survive the abuse. Although it has been clinically implied, the role of identification with the aggressor as a potential mechanism underlying the relation between childhood abuse and eating disorder symptoms has not yet been empirically explored. OBJECTIVE This study examines the role of identification with the aggressor as mediator in the association between history of childhood abuse and eating disorder symptoms among adults. PARTICIPANTS AND METHODS A convenience sample of 198 participants completed self-report questionnaires assessing history of childhood abuse, eating disorder symptoms, and the various facets of identification with the aggressor. RESULTS Severity of childhood abuse was significantly associated with shape and weight overevaluation, body dissatisfaction, and binge eating, as well as with all components of identification with the aggressor. In addition, almost all components of identification with the aggressor were significantly associated with eating disorder symptoms. Finally, identifying with the perpetrator's aggression mediated the association between childhood abuse and eating disorder symptoms. CONCLUSIONS The findings may contribute to future clinical interventions by illuminating identification with the aggressor as an important aspect in treating eating disorders. Understanding the pervasive effects of identification with the aggressor on survivors' self and their interactions with others may point to the significance of the therapeutic relationship, through which survivors can reprocess and weaken its detrimental effects.
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Affiliation(s)
- Tamar Rosenberg
- Tel Aviv University, Bob Shapell School of Social Work, Gershon H. Gordon Faculty of Social Sciences, Israel
| | - Yael Lahav
- Department of Occupational Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Karni Ginzburg
- Tel Aviv University, Bob Shapell School of Social Work, Gershon H. Gordon Faculty of Social Sciences, Israel.
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