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Wonderlich JA, Dodd DR, Sondag C, Jorgensen M, Blumhardt C, Evanson AN, Bjoralt C, Wonderlich SA. Clinical and scientific review of severe and enduring anorexia nervosa in intensive care settings: introducing an innovative treatment paradigm. J Eat Disord 2024; 12:131. [PMID: 39227928 PMCID: PMC11373466 DOI: 10.1186/s40337-024-01079-9] [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: 05/31/2024] [Accepted: 08/06/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Anorexia nervosa is a serious and potentially lethal psychiatric disorder. Furthermore, there is significant evidence that some individuals develop a very long-standing form of the illness that requires a variety of different treatment interventions over time. OBJECTIVE The primary goal of this paper was to provide a review of treatment strategies for severe and enduring anorexia nervosa (SE-AN) with the particular focus on treatments involving hospital care. Additionally, we wish to highlight a contemporary approach to such care and provide qualitative reactions to this model from both staff and patients. METHODS A selective and strategic review of the treatment literature for SE-AN was conducted for the current paper. Emphasis was placed on clinical or scientific papers related to hospital-based care. Additionally, staff who work on a specific inpatient eating disorder unit with a substantial treatment program for SE-AN, along with a number of SE-AN patients were surveyed regarding their experiences working on, or receiving treatment on the unit. Importantly, the staff of this unit created a specific treatment protocol for individuals receiving hospital care. The results of the highlight both advantages and challenges of a hospital-based protocol oriented toward emphasizing quality of life, medical stability, and a health-promoting meal plan. DISCUSSION While there is general inconsistency with the type of treatment that is best suited to individuals with SE-AN, this is particularly true for higher levels of care that rely on inpatient hospital units or residential treatment settings. This is a highly significant clinical topic in need of further clinical and scientific examination.
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Affiliation(s)
- Joseph A Wonderlich
- Sanford Research, Center for Biobehavioral Research, Fargo, ND, USA.
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA.
| | - Dorian R Dodd
- Sanford Research, Center for Biobehavioral Research, Fargo, ND, USA
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
| | - Cindy Sondag
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
| | | | | | | | - Casey Bjoralt
- Eating Disorders Unit, Sanford Health, Fargo, ND, USA
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Croci MS, Brañas MJAA, Javaras KN, Dechant E, Jurist J, Steigerwald G, Choi-Kain LW. General Psychiatric Management for Adolescents With Borderline Personality Disorder and Eating Disorders. Am J Psychother 2024:appipsychotherapy20230045. [PMID: 39083007 DOI: 10.1176/appi.psychotherapy.20230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Borderline personality disorder and eating disorders frequently co-occur among youths. These disorders emerge in adolescence, during the critical developmental period of building an independent sense of self and the capacity to relate to one's community. Because of core differences in the development and psychopathology of borderline personality disorder and eating disorders, adjustments are required when treating these disorders when they co-occur. Few established treatment approaches can address these disorders simultaneously. Evidence-based psychotherapies for borderline personality disorder, such as dialectical behavior therapy and mentalization-based treatment, have been adapted to accommodate the shared vulnerabilities and features of the two disorders. However, these approaches are specialized, intensive, and lengthy and are therefore poorly suited to implementation in general psychiatric or primary health care, where most frontline mental health care is provided. Generalist approaches can fill this public health gap, guiding nonspecialists in structuring informed clinical management for these impairing and sometimes fatal disorders. In this overview, the authors describe the adjustment of good (or general) psychiatric management (GPM) for adolescents with borderline personality disorder to incorporate the prevailing best practices for eating disorder treatment. The adjusted treatment relies on interventions most clinicians already use (diagnostic disclosure, psychoeducation, focusing on life outside treatment, managing patients' self-destructive behaviors, and conservative psychopharmacology with active management of comorbid conditions). Limitations of the adjusted treatment, as well as guidelines for referring patients to specialized and general medical treatments and for returning them to primary generalist psychiatric care, are discussed.
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Affiliation(s)
- Marcos S Croci
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Marcelo J A A Brañas
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Kristin N Javaras
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Esther Dechant
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Julia Jurist
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Georgia Steigerwald
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Lois W Choi-Kain
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
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Dougherty EN, Bottera AR, Murray MF, Ekwonu A, Wildes JE, Haedt-Matt AA. Habitual behavioural control moderates the relation between daily perceived stress and purging. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38995266 DOI: 10.1002/erv.3126] [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: 03/19/2024] [Revised: 06/06/2024] [Accepted: 06/30/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA). METHOD Women (N = 81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes. RESULTS Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant. CONCLUSIONS Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | | | - Matthew F Murray
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Adaora Ekwonu
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Cogodi E, Ranieri J, Martelli A, Di Giacomo D. Emotional Dysregulation in Anorexia Nervosa: Scoping Review of Psychological Treatments. Healthcare (Basel) 2024; 12:1388. [PMID: 39057531 PMCID: PMC11276072 DOI: 10.3390/healthcare12141388] [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: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.
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Affiliation(s)
- Enrica Cogodi
- Postgraduate in Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy; (E.C.); (J.R.)
| | - Jessica Ranieri
- Postgraduate in Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy; (E.C.); (J.R.)
- Life, Health and Environmental Sciences Department, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Martelli
- Faculty of Biosciences and Agri-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy;
| | - Dina Di Giacomo
- Life, Health and Environmental Sciences Department, University of L’Aquila, 67100 L’Aquila, Italy
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Dougherty EN, Wildes JE, Haedt-Matt AA. The role of habit in maintaining binge/purge behaviors: An ecological momentary assessment study. Int J Eat Disord 2024; 57:1160-1171. [PMID: 37776547 PMCID: PMC10980597 DOI: 10.1002/eat.24070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Individuals with eating disorders transdiagnostically engage in binge eating (BE) and/or purging, despite life-threatening consequences. Little is known about factors that contribute to the persistence of these behaviors. This study explored whether habitual control over binge/purge (B/P) spectrum behaviors contributes to symptom persistence and whether negative reinforcement via reductions in negative affect is less influential in maintaining B/P behaviors that are under habitual control and are persistent. METHOD Women with BE and/or purging (N = 81) completed self-report measures assessing habit strength of BE and purging. Then, they completed a 14-day ecological momentary assessment (EMA) protocol during which they completed measures of negative affect, BE, and purging multiple times per day. RESULTS Habitual control over purging was associated with a greater frequency of purging during the EMA period. However, habitual control over BE was not associated with the severity of loss of control eating or the frequency of BE episodes. Habitual control did not moderate temporal relations between negative affect and B/P behaviors during the EMA period. However, exploratory analyses revealed that individuals with a longer duration of BE and greater habitual control over BE showed a less pronounced reduction in negative affect following BE. DISCUSSION Overall, these findings suggest that purging may be maintained by habitual stimulus-response learning. In addition, they support the possibility that reduction in negative affect may play a less prominent role in maintaining BE that is habitual and persistent. PUBLIC SIGNIFICANCE This study investigated whether habit contributes to the persistence of symptoms in women with binge/purge spectrum behaviors and whether negative reinforcement via reductions in negative affect is less influential in maintaining binge/purge behaviors that are under habitual control. The findings suggest that purging may be maintained through habit. This supports the potential utility of habit reversal interventions to decrease habitual purging.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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Biçaker E, Trolio V, Miller AE, Zhu LY, White C, Racine SE. Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment. Int J Eat Disord 2024; 57:879-891. [PMID: 38192012 DOI: 10.1002/eat.24134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Certain symptom and risk/maintenance factor similarities between individuals with atypical anorexia nervosa (AN) and 'typical' AN have been documented, but few studies have investigated how atypical AN compares to bulimia nervosa (BN). Further, the role of affective mechanisms in maintaining restrictive eating in atypical AN has not been examined. The current study investigated whether atypical AN resembles AN and/or BN on affect-related processes using questionnaires and ecological momentary assessment (EMA). METHOD Women with atypical AN (n = 24), AN-restrictive subtype, (n = 27), AN-binge eating/purging subtype (n = 34), and BN (n = 58) completed questionnaires measuring depressive symptoms and emotion regulation difficulties. They also completed a 14-day EMA protocol during which they reported negative and positive affect and skipped meals five times/day (signal-contingent surveys) and restrictive eating after meals/snacks (event-contingent surveys). RESULTS Diagnostic groups generally did not differ on questionnaire measures nor affective patterns surrounding restrictive eating behaviors. Momentary changes in affect did not predict or follow restriction at meals/snacks, though higher momentary negative affect ratings predicted skipped meals, and higher positive affect was reported after skipped meals. Greater average negative affect and lower average positive affect predicted both restrictive eating behaviors. DISCUSSION Across diagnoses, reductions in food intake do not appear to be influenced by momentary changes in affect, though skipping meals may serve an emotion regulation function. Atypical AN seems to resemble AN and BN on affective processes underlying restrictive eating, raising further questions regarding the unique diagnosis of atypical AN. PUBLIC SIGNIFICANCE Though atypical anorexia appears to strongly resemble anorexia nervosa, it is less clear how this disorder relates to bulimia nervosa. It is further unknown whether affective-related processes underlie restrictive eating in atypical anorexia nervosa, and how these processes compare to those in anorexia nervosa and bulimia nervosa. Results suggest that atypical anorexia does not differ from anorexia nervosa or bulimia nervosa on emotion-related measures, nor in affective patterns surrounding restrictive eating behaviors.
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Affiliation(s)
- Ege Biçaker
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Vittoria Trolio
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Lisa Y Zhu
- Department of Psychology, University of Western Ontario, Social Science Centre, London, Ontario, Canada
| | - Chloe White
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Hill L. Temperament impact on eating disorder symptoms and habit formation: a novel model to inform treatment. J Eat Disord 2024; 12:40. [PMID: 38504375 PMCID: PMC10953227 DOI: 10.1186/s40337-024-00998-x] [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: 12/20/2023] [Accepted: 03/14/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Temperament has long been described as the biological dimension of personality. Due to advancing brain-imaging technology, our understanding of temperament has deepened and transformed over the last 25 years. Temperament combines genetic, neurobiological and trait research. Temperament has been included peripherally in some eating disorder (ED) treatment approaches but has been ignored by most. Temperament fills a fundamental treatment gap by clarifying who is more vulnerable to develop ED and why some individuals are susceptible to specific ED symptoms while others are not. In addition, temperament targets possible treatment solutions. MAIN TEXT There is a need for a novel model that incorporates and explores the role of temperament in ED treatment intervention. This paper is a metaphoric temperament model to inform treatment intervention. It describes how temperament traits influences new decisions which impact new behavioural responses. In turn, it neurobiologically tracks how and why the brain efficiently transforms new decisions into new habits. This model integrates both temperament and habit research to explore (a) what temperament is; (b) how new decisions develop into habits neurobiologically; (c) that the brain wires destructive symptoms into habits in the same way that it wires healthy/productive behaviours into habits; (d) traits that trigger ED symptoms are the same traits that influence productive behaviours; and in regard to treatment implications (e) when treatment structure and intervention target client temperaments, the potential for new healthy "trait-syntonic" habits could develop. CONCLUSIONS This paper introduces a metaphoric model that synthesizes and integrates temperament neurobiological and trait findings with ED symptoms, habits, and client trait-based solutions. The model synthesizes and integrates different research domains to establish a brain-based foundation to inform treatment intervention. The model targets clients' temperament traits as central collections of innate self-expressions that could be utilized as tools to redirect client trait-syntonic ED responses into trait-syntonic productive outcomes. The brain bases of temperament and habit formation serve as a biological foundation for ED treatment intervention.
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Affiliation(s)
- Laura Hill
- Department of Psychiatry, University of California, San Diego, CA, USA.
- Adjunct Associate Clinical Professor of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
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Schroeder PA, Collantoni E, Meregalli V, Rabarbari E, Simonazzi C, Svaldi J, Cardi V. Persistent avoidance of virtual food in anorexia nervosa-restrictive type: Results from motion tracking in a virtual stopping task. Int J Eat Disord 2024; 57:624-634. [PMID: 38263753 DOI: 10.1002/eat.24143] [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: 09/01/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Food avoidance is central to patients with anorexia nervosa-restrictive type (AN-R). Competing accounts in experimental psychopathology research suggest that food avoidance may result from automatic, habitual responses or from elevated inhibitory control abilities. This study investigated behavioral trajectories of food avoidance in a novel virtual reality stopping task. METHOD Sixty patients with AN-R and 29 healthy controls with normal weight were investigated using a novel, kinematic task in virtual reality. We recorded spatial displacement in stop- and go-trials to virtual food and control objects. Inhibitory control abilities were operationalized by the VR task in stopping performance (i.e., interrupted movement in stop-trials), whereas we also measured habitual avoidance of virtual food across both go- and stop-trials (i.e., delayed movement relative to nonfood objects). RESULTS In patients with AN-R, hand displacements were shorter to food versus nonfood across stop- and go-trials, reflected in a Stimulus × Group interaction. Healthy controls showed no differences. Importantly, the food-specific effect in AN-R was identical across stop- and go-trials, indicating habitual food avoidance. Moreover, stop error rates (i.e., stop-trials with response) were lower in patients with AN-R. DISCUSSION The findings suggest food-specific habitual avoidance and heightened generalized inhibitory control in AN-R. The continuously delayed displacements during active hand movements across stop- and go-trials indicated the persistence of patients' avoidance of food. PUBLIC SIGNIFICANCE Experimental research investigates the mechanisms underlying mental disorders such as anorexia nervosa. In this study, we measured interrupted hand movements in response to food pictures or neutral pictures (shoes) in patients with anorexia nervosa and healthy controls. A virtual reality scenario was used. Findings indicated that patients were slower at approaching food, interrupted or not. Key mechanisms of food avoidance can be translated into habit-based treatment options in future research.
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Affiliation(s)
- Philipp A Schroeder
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Padova, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Valentina Meregalli
- Department of Neuroscience, University of Padova, Padova, Italy
- Department of General Psychology, University of Padova, Padova, Italy
| | - Elisa Rabarbari
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Jennifer Svaldi
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Padova, Italy
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Conceição ISR, Garcia-Burgos D, de Macêdo PFC, Nepomuceno CMM, Pereira EM, Cunha CDM, Ribeiro CDF, de Santana MLP. Habits and Persistent Food Restriction in Patients with Anorexia Nervosa: A Scoping Review. Behav Sci (Basel) 2023; 13:883. [PMID: 37998630 PMCID: PMC10669471 DOI: 10.3390/bs13110883] [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: 09/06/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
The aetiology of anorexia nervosa (AN) presents a puzzle for researchers. Recent research has sought to understand the behavioural and neural mechanisms of these patients' persistent choice of calorie restriction. This scoping review aims to map the literature on the contribution of habit-based learning to food restriction in AN. PRISMA-ScR guidelines were adopted. The search strategy was applied to seven databases and to grey literature. A total of 35 studies were included in this review. The results indicate that the habit-based learning model has gained substantial attention in current research, employing neuroimaging methods, scales, and behavioural techniques. Food choices were strongly associated with dorsal striatum activity, and habitual food restriction based on the self-report restriction index was associated with clinical impairment in people chronically ill with restricting AN. High-frequency repetitive transcranial magnetic stimulation (HF-rTMS) and Regulating Emotions and Changing Habits (REaCH) have emerged as potential treatments. Future research should employ longitudinal studies to investigate the time required for habit-based learning and analyse how developmental status, such as adolescence, influences the role of habits in the progression and severity of diet-related illnesses. Ultimately, seeking effective strategies to modify persistent dietary restrictions controlled by habits remains essential.
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Affiliation(s)
- Ismara Santos Rocha Conceição
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | - David Garcia-Burgos
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain;
| | - Patrícia Fortes Cavalcanti de Macêdo
- Graduate Program in Food, Nutrition and Health, School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (I.S.R.C.); (P.F.C.d.M.)
| | | | | | - Carla de Magalhães Cunha
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
| | - Camila Duarte Ferreira Ribeiro
- School of Nutrition, Federal University of Bahia, Salvador 40110-907, Brazil; (C.d.M.C.); (C.D.F.R.)
- Graduate Program in Food Science, Faculty of Pharmacy, Federal University of Bahia, Salvador 40170-115, Brazil
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Abstract
INTRODUCTION Anorexia nervosa is a frequent eating disorder that affects predominantly young women and may take a severe and chronically worsening course of disease contributing to its high mortality rate. Although a multitude of treatment options exist, this disease still bears a high relapse rate. In light of these facts, an improvement of existing and development of new treatment targets and options is warranted. AREAS COVERED The present review article covers recent developments in psychotherapy associated with the respective neuropsychological and brain alterations as well as highlights current and future pharmacotherapeutic options. EXPERT OPINION Several encouraging developments in the field of psychotherapy such as interventions targeting neurocognitive profiles or addressing reward processing, brain stimulation as well as pharmacological modulation of hormones, namely leptin, oxytocin, ghrelin and nesfatin-1 signaling might be - most likely as part of a multimodal treatment approach - efficacious in order to improve treatment of patients with anorexia nervosa, especially those with a severe course of disease as well as comorbidities. As anorexia nervosa represents a complex and severe mental disorder, it seems most likely that a combination and integration of different evidence-based treatment approaches and settings will contribute to an improved prognosis of this eating disorder. This should be further explored in future studies.
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Affiliation(s)
- Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Katrin Giel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
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Garcia-Burgos D, Wilhelm P, Vögele C, Munsch S. Food Restriction in Anorexia Nervosa in the Light of Modern Learning Theory: A Narrative Review. Behav Sci (Basel) 2023; 13:bs13020096. [PMID: 36829325 PMCID: PMC9952578 DOI: 10.3390/bs13020096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Improvements in the clinical management of anorexia nervosa (AN) are urgently needed. To do so, the search for innovative approaches continues at laboratory and clinical levels to translate new findings into more effective treatments. In this sense, modern learning theory provides a unifying framework that connects concepts, methodologies and data from preclinical and clinical research to inspire novel interventions in the field of psychopathology in general, and of disordered eating in particular. Indeed, learning is thought to be a crucial factor in the development/regulation of normal and pathological eating behaviour. Thus, the present review not only tries to provide a comprehensive overview of modern learning research in the field of AN, but also follows a transdiagnostic perspective to offer testable explanations for the origin and maintenance of pathological food rejection. This narrative review was informed by a systematic search of research papers in the electronic databases PsycInfo, Scopus and Web of Science following PRISMA methodology. By considering the number and type of associations (Pavlovian, goal-directed or habitual) and the affective nature of conditioning processes (appetitive versus aversive), this approach can explain many features of AN, including why some patients restrict food intake to the point of life-threatening starvation and others restrict calorie intake to lose weight and binge on a regular basis. Nonetheless, it is striking how little impact modern learning theory has had on the current AN research agenda and practice.
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Affiliation(s)
- David Garcia-Burgos
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
- Department of Psychobiology, The “Federico Olóriz” Institute of Neurosciences, Biomedical Research Centre, University of Granada, 18071 Granada, Spain
- Correspondence:
| | - Peter Wilhelm
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 4365 Esch-sur-Alzette, Luxembourg
| | - Simone Munsch
- Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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Seidel M, King JA, Fürtjes S, Labitzke N, Wronski ML, Boehm I, Hennig J, Gramatke K, Roessner V, Ehrlich S. Increased Habit Frequency in the Daily Lives of Patients with Acute Anorexia Nervosa. Nutrients 2022; 14:nu14193905. [PMID: 36235556 PMCID: PMC9573582 DOI: 10.3390/nu14193905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Strict eating routines and frequent rigid behavior patterns are commonly observed in patients with anorexia nervosa (AN). A recent theory proposes that while these behaviors may have been reinforced initially, they later become habitual. To date, however, research has been overly focused on eating-disorder (ED)-related habits. Over the course of seven days, we applied an ecological momentary assessment (EMA) to investigate the habit frequency and strength of ED-specific (food intake) and ED-unspecific (hygiene) habits in the daily lives of a sample of n = 57 AN and n = 57 healthy controls (HC). The results of the hierarchical models revealed that habits were significantly more likely in patients compared with HC for both categories, independently. Furthermore, a lower body mass index (BMI) was associated with increased habit frequency in AN. Our study strengthens the habit theory of AN by showing the relevance of habits beyond ED-specific behavioral domains. This also supports the development of innovative therapeutic interventions targeting habitual behavior in EDs.
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Affiliation(s)
- Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-(0)351-458-2244
| | - Joseph A. King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Sophia Fürtjes
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Natalie Labitzke
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ilka Boehm
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Julius Hennig
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Katrin Gramatke
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, 01307 Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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13
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Bijsterbosch JM, Keizer A, Boelen PA, van den Brink F, Sternheim LC. Understanding relations between intolerance of uncertainty and body checking and body avoiding in anorexia nervosa. J Eat Disord 2022; 10:122. [PMID: 35982486 PMCID: PMC9389820 DOI: 10.1186/s40337-022-00647-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key feature of anorexia nervosa is body image disturbances and is often expressed by dysfunctional body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of AN, yet empirical evidence is scarce. One variable that may contribute to the need for engaging in these behaviours is intolerance of uncertainty. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). METHODS Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. One-way ANOVAS were used to test group differences. Moderation analyses were used to investigate associations between variables. RESULTS Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill followed by AN-rec and, lastly, the control group, confirming group differences. Intolerance of uncertainty was associated with body checking in the AN-rec group and the control group but not in the AN-ill group. The association between intolerance of uncertainty and body avoiding was reported in the AN-rec group and only marginally in the control group. CONCLUSION Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill, however still elevated in AN-rec, confirming the presence of body image disturbances, even after recovery. The unique associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may eventually have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty. Women with anorexia nervosa often experience disturbances in their body image and are expressed in body-related behaviours such as body checking and body avoiding. These behaviours are thought to contribute to both the maintenance and relapse of anorexia nervosa. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and may contribute to the need for engaging in these behaviours. This study aims to investigate body checking and body avoiding and its relations with intolerance of uncertainty in women with anorexia nervosa (AN-ill; 70), women recovered from AN (AN-rec; 85) and control group (127). Three questionnaires were completed, measuring eating pathology, intolerance of uncertainty and body checking and body avoiding. Levels of intolerance of uncertainty, body checking and body avoiding were highest in AN-ill and still elevated in AN-rec, even after recovery. The associations between intolerance of uncertainty and body checking and body avoiding within the studied groups may represent different stages of the illness. In the AN-rec group, the relation between intolerance of uncertainty, body checking and body avoiding may be driven by trait anxiety. For AN-ill group, body checking and body avoiding may have grown into habitual patterns, rather than a strategy to ameliorate anxiety and uncertainty.
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Affiliation(s)
- Jojanneke M Bijsterbosch
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.,ARQ National Psychotrauma Centre, Nienoord 5, 1112 XE, Diemen, The Netherlands.,ARQ Centrum'45, Nienoord 5, 1112 XE, Diemen, The Netherlands
| | - Femke van den Brink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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14
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Foerde K, Schebendach JE, Davis L, Daw N, Walsh BT, Shohamy D, Steinglass JE. Restrictive eating across a spectrum from healthy to unhealthy: behavioral and neural mechanisms. Psychol Med 2022; 52:1755-1764. [PMID: 33046142 PMCID: PMC8449514 DOI: 10.1017/s0033291720003542] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Restriction of food intake is a central feature of anorexia nervosa (AN) and other eating disorders, yet also occurs in the absence of psychopathology. The neural mechanisms of restrictive eating in health and disease are unclear. METHODS This study examined behavioral and neural mechanisms associated with restrictive eating among individuals with and without eating disorders. Dietary restriction was examined in four groups of women (n = 110): healthy controls, dieting healthy controls, patients with subthreshold (non-low weight) AN, and patients with AN. A Food Choice Task was administered during fMRI scanning to examine neural activation associated with food choices, and a laboratory meal was conducted. RESULTS Behavioral findings distinguished between healthy and ill participants. Healthy individuals, both dieting and non-dieting, chose significantly more high-fat foods than patients with AN or subthreshold AN. Among healthy individuals, choice was primarily influenced by tastiness, whereas, among both patient groups, healthiness played a larger role. Dorsal striatal activation associated with choice was most pronounced among individuals with AN and was significantly associated with selecting fewer high-fat choices in the task and lower caloric intake in the meal the following day. CONCLUSIONS A continuous spectrum of behavior was suggested by the increasing amount of weight loss across groups. Yet, data from this Food Choice Task with fMRI suggest there is a behavioral distinction between illness and health, and that the neural mechanisms underlying food choice in AN are distinct. These behavioral and neural mechanisms of restrictive eating may be useful targets for treatment development.
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Affiliation(s)
- Karin Foerde
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Janet E. Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Lauren Davis
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Nathaniel Daw
- Department of Psychology, Princeton Neuroscience Institute, Princeton University, Princeton, USA
| | - B. Timothy Walsh
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Daphna Shohamy
- Psychology Department and Zuckerman Mind Brain and Behavior Institute, Columbia University, New York, USA
| | - Joanna E. Steinglass
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
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15
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Steinglass JE, Attia E, Glasofer DR, Wang Y, Ruggiero J, Walsh BT, Thomas JG. Optimizing relapse prevention and changing habits (REACH+) in anorexia nervosa. Int J Eat Disord 2022; 55:851-857. [PMID: 35488866 PMCID: PMC9167790 DOI: 10.1002/eat.23724] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Relapse rates in anorexia nervosa (AN) are high, even after full weight restoration. This study aims to develop a relapse prevention treatment that specifically addresses persistent maladaptive behaviors (habits). Relapse Prevention and Changing Habits (REACH+) aims to support patients in developing routines that promote weight maintenance, encourage health, and challenge habits that perpetuate illness. The clinical trial design uses the Multiphase Optimization STrategy (MOST) framework to efficiently identify which components of treatment contribute to positive outcomes. METHODS Participants will be 60 adults with AN who have achieved weight restoration in an inpatient setting. Treatment will consist of 6 months of outpatient telehealth sessions. REACH+ consists of behavior, cognitive, and motivation components, as well as food monitoring and a skill consolidation phase. A specialized online platform extends therapy between sessions. Participants will be randomly assigned to different versions of each component in a fractional factorial design. Outcomes will focus on maintenance of remission, measured by rate of weight loss and end-of-trial status. Interventions that contribute to remission will be included in an optimized treatment package, suitable for a large-scale clinical trial of relapse prevention in AN.
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Affiliation(s)
- Joanna E. Steinglass
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
| | - Yuanjia Wang
- Columbia University Irving Medical Center, New York, New York, USA
| | - Julia Ruggiero
- Columbia University Irving Medical Center, New York, New York, USA
| | - B. Timothy Walsh
- New York State Psychiatric Institute, New York, New York, USA,Columbia University Irving Medical Center, New York, New York, USA
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16
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Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
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Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA
- Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA
- Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
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17
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Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry 2022; 13:793094. [PMID: 35280172 PMCID: PMC8904925 DOI: 10.3389/fpsyt.2022.793094] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Background Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology. Methodology A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency. Results The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI. Discussion The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Dalia Brown
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Hannah McLinden
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust National Eating Disorder Service, London, United Kingdom
- Psychology Department, Illia State University, Tbilisi, Georgia
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18
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Coniglio KA, Cooper M, Selby EA. Behavioral reinforcement of pathological exercise in anorexia nervosa. Int J Eat Disord 2022; 55:184-192. [PMID: 34626127 DOI: 10.1002/eat.23626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
Pathological exercise in anorexia nervosa (AN) is a harmful behavior associated with a chronic course and poor prognosis. To date, no comprehensive theoretical model exists to describe pathological exercise in the context of AN, and as such, few treatments are effective at promoting direct and sustained pathological exercise extinction. Using a framework put forth by Wise & Koob (2014), debating the relative importance of positive and negative reinforcement in substance use, we present three hypotheses of behavioral reinforcement of exercise, encompassing biological, psychological, and environmental influences. Specifically, we argue that exercise is positively reinforced through receipt of biological and behavioral rewards, negatively reinforced through avoidance of aversive emotions, and that these two systems work in tandem over time to engrain pathological exercise as a habit. We then present suggestions for testing each of these hypotheses as future directions for the field.
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Affiliation(s)
- Kathryn A Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Marita Cooper
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, USA
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19
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The Automaticity of Positive and Negative Thinking: A Scoping Review of Mental Habits. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Tadayonnejad R, Pizzagalli F, Murray SB, Pauli WM, Conde G, Bari AA, Strober M, O'Doherty JP, Feusner JD. White matter tracts characteristics in habitual decision-making circuit underlie ritual behaviors in anorexia nervosa. Sci Rep 2021; 11:15980. [PMID: 34354139 PMCID: PMC8342714 DOI: 10.1038/s41598-021-95300-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022] Open
Abstract
Anorexia nervosa (AN) is a difficult to treat, pernicious psychiatric disorder that has been linked to decision-making abnormalities. We examined the structural characteristics of habitual and goal-directed decision-making circuits and their connecting white matter tracts in 32 AN and 43 healthy controls across two independent data sets of adults and adolescents as an explanatory sub-study. Total bilateral premotor/supplementary motor area-putamen tracts in the habit circuit had a significantly higher volume in adults with AN, relative to controls. Positive correlations were found between both the number of tracts and white matter volume (WMV) in the habit circuit, and the severity of ritualistic/compulsive behaviors in adults and adolescents with AN. Moreover, we found a significant influence of the habit circuit WMV on AN ritualistic/compulsive symptom severity, depending on the preoccupations symptom severity levels. These findings suggest that AN is associated with white matter plasticity alterations in the habit circuit. The association between characteristics of habit circuit white matter tracts and AN behavioral symptoms provides support for a circuit based neurobiological model of AN, and identifies the habit circuit as a focus for further investigation to aid in development of novel and more effective treatments based on brain-behavior relationships.
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Affiliation(s)
- Reza Tadayonnejad
- Division of Neuromodulation, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Room # 57.464, 760 Westwood Plaza, Los Angeles, CA, 90024, USA. .,Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.
| | - Fabrizio Pizzagalli
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, Marina del Rey, CA, USA.,Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Wolfgang M Pauli
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.,Artificial Intelligence Platform, Redmond, WA, USA
| | - Geena Conde
- Division of Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neursurgery, University of California at Los Angeles, Los Angeles, CA, USA
| | - Michael Strober
- Division of Child and Adolescent, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - John P O'Doherty
- Computation and Neural Systems Program and Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Jamie D Feusner
- Division of Cognitive Neuroscience, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Division of Neurosciences and Clinical Translation, University of Toronto, Toronto, ON, Canada
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21
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Walker DC, Gorrell S, Hildebrandt T, Anderson DA. Consequences of Repeated Critical Versus Neutral Body Checking in Women With High Shape or Weight Concern. Behav Ther 2021; 52:830-846. [PMID: 34134824 PMCID: PMC8827350 DOI: 10.1016/j.beth.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Body checking is a repeated behavior conducted in an attempt to gain information about one's shape, weight, size, or body composition. Body checking is associated with negative behavioral, emotional, and cognitive outcomes and may maintain body dissatisfaction and eating disorders. The precise function and consequences of body checking remain less well understood. Specifically, immediate and delayed impacts of repeated critical body checking (CBC) have not been determined. The current study randomly assigned 142 young women with high shape/weight concern to daily 10-min CBC, neutral body checking (NBC), or a non-body critical checking (NBCC) comparison condition, examining their immediate and delayed (one-week follow-up) effects on body satisfaction, self-esteem, and negative affect. Multilevel modeling and follow-up planned comparisons found that compared to NBCC, CBC participants' body satisfaction and self-esteem immediately decreased, but negative affect improved from baseline to follow-up. Compared to CBC, NBC participants' self-esteem and negative affect improved immediately, and their self-esteem improved over time compared to NBCC. Over time, all participants' state body satisfaction improved, regardless of condition. Our findings suggest a 10-min CBC session may function differently than typical (harmful) in vivo body checking. However, reasons for this difference are unclear. Additional research is needed to distinguish (harmful) in vivo body checking from CBC procedures such as this and other mirror exposure interventions. Research is needed to examine the effects of varying CBC duration and instructions during body exposure to further clarify mechanisms of change during body exposures.
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22
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Foerde K, Walsh BT, Dalack M, Daw N, Shohamy D, Steinglass JE. Changes in brain and behavior during food-based decision-making following treatment of anorexia nervosa. J Eat Disord 2021; 9:48. [PMID: 33865441 PMCID: PMC8052661 DOI: 10.1186/s40337-021-00402-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a severe illness with a high mortality rate, driven in large part by severe and persistent restriction of food intake. A critical challenge is to identify brain mechanisms associated with maladaptive eating behavior and whether they change with treatment. This study tested whether food choice-related caudate activation in anorexia nervosa changes with treatment. METHODS Healthy women (n = 29) and women hospitalized with anorexia nervosa (n = 24), ages 18 to 40 years, completed a Food Choice Task during fMRI scanning at two timepoints. Among patients, procedures occurred upon hospital admission (Time 1) and again after patients had gained to normal weight (Time 2). Healthy controls were tested twice at an interval group-matched to patients. Choice-related caudate activation was assessed at each timepoint, using parametric analyses in an a priori region of interest. RESULTS Among patients, the proportion of high-fat foods selected did not change over time (p's > 0.47), but decreased neural activity in the caudate after treatment was associated with increased selection of high-fat foods (r23 = - 0.43, p = 0.037). Choice-related caudate activation differed among women with anorexia nervosa vs healthy control women at Time 1 (healthy control: M = 0.15 ± 0.87, anorexia nervosa: M = 0.70 ± 1.1, t51 = - 2.05, p = 0.045), but not at Time 2 (healthy control: M = 0.18 ± 1.0, anorexia nervosa: M = 0.37 ± 0.99, t51 = - 0.694, p = 0.49). CONCLUSIONS Caudate activity was more strongly associated with decisions about food among individuals with anorexia nervosa relative to healthy comparison individuals prior to treatment, and decreases in caudate engagement among individuals with anorexia nervosa undergoing treatment were associated with increases in high-fat food choices. The findings underscore the need for treatment development that more successfully alters both eating behavior and the neural mechanisms that guide it.
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Affiliation(s)
- Karin Foerde
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - B Timothy Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Maya Dalack
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Nathaniel Daw
- Princeton Neuroscience Institute, Department of Psychology, Princeton University, Princeton, NJ, 08540, USA
| | - Daphna Shohamy
- Psychology Department and Zuckerman Mind Brain and Behavior Institute, Columbia University, 3227 Broadway, New York, NY, 10027, USA
| | - Joanna E Steinglass
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA. .,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
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23
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Favier M, Janickova H, Justo D, Kljakic O, Runtz L, Natsheh JY, Pascoal TA, Germann J, Gallino D, Kang JI, Meng XQ, Antinora C, Raulic S, Jacobsen JP, Moquin L, Vigneault E, Gratton A, Caron MG, Duriez P, Brandon MP, Neto PR, Chakravarty MM, Herzallah MM, Gorwood P, Prado MA, Prado VF, El Mestikawy S. Cholinergic dysfunction in the dorsal striatum promotes habit formation and maladaptive eating. J Clin Invest 2021; 130:6616-6630. [PMID: 33164988 DOI: 10.1172/jci138532] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Dysregulation of habit formation has been recently proposed as pivotal to eating disorders. Here, we report that a subset of patients suffering from restrictive anorexia nervosa have enhanced habit formation compared with healthy controls. Habit formation is modulated by striatal cholinergic interneurons. These interneurons express vesicular transporters for acetylcholine (VAChT) and glutamate (VGLUT3) and use acetylcholine/glutamate cotransmission to regulate striatal functions. Using mice with genetically silenced VAChT (VAChT conditional KO, VAChTcKO) or VGLUT3 (VGLUT3cKO), we investigated the roles that acetylcholine and glutamate released by cholinergic interneurons play in habit formation and maladaptive eating. Silencing glutamate favored goal-directed behaviors and had no impact on eating behavior. In contrast, VAChTcKO mice were more prone to habits and maladaptive eating. Specific deletion of VAChT in the dorsomedial striatum of adult mice was sufficient to phenocopy maladaptive eating behaviors of VAChTcKO mice. Interestingly, VAChTcKO mice had reduced dopamine release in the dorsomedial striatum but not in the dorsolateral striatum. The dysfunctional eating behavior of VAChTcKO mice was alleviated by donepezil and by l-DOPA, confirming an acetylcholine/dopamine deficit. Our study reveals that loss of acetylcholine leads to a dopamine imbalance in striatal compartments, thereby promoting habits and vulnerability to maladaptive eating in mice.
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Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Helena Janickova
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Damian Justo
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Ornela Kljakic
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Léonie Runtz
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Joman Y Natsheh
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Jerusalem, Palestine.,Kessler Foundation, East Hanover, New Jersey, USA
| | - Tharick A Pascoal
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jurgen Germann
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Daniel Gallino
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Jun-Ii Kang
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Xiang Qi Meng
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Christina Antinora
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sanda Raulic
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | | | - Luc Moquin
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Erika Vigneault
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alain Gratton
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marc G Caron
- Department of Cell Biology and.,Department of Medicine, Duke University, Durham, North Carolina, USA.,Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Philibert Duriez
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Mark P Brandon
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Pedro Rosa Neto
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada.,Department of Biological and Biomedical Engineering and.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Abu Dis, Jerusalem, Palestine.,Center for Molecular and Behavioral Neuroscience, School of Arts & Sciences-Newark Rutgers University, Newark, New Jersey, USA
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences (CMME, Hospital Sainte-Anne), Institute of Psychiatry and Neuroscience of Paris (INSERM UMR1266), Paris, France
| | - Marco Am Prado
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Vania F Prado
- Robarts Research Institute, Department of Physiology and Pharmacology and Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Salah El Mestikawy
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Sorbonne Universités, Université Pierre et Marie Curie UM 119 - CNRS UMR 8246 - INSERM U1130, Neurosciences Paris Seine - Institut de Biologie Paris Seine, Paris, France
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24
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Reward Learning Through the Lens of RDoC: a Review of Theory, Assessment, and Empirical Findings in the Eating Disorders. Curr Psychiatry Rep 2021; 23:2. [PMID: 33386514 DOI: 10.1007/s11920-020-01213-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Reward-related processes may represent important transdiagnostic factors underlying eating pathology. Using the NIMH Research Domain Criteria as a guide, the current article reviews theories, behavioral and self-report assessments, and empirical findings related to reward learning in the eating disorders. RECENT FINDINGS Data from behavioral tasks suggest deficits in reinforcement learning, which may become more pronounced with increasing disorder severity and duration. Self-report data strongly implicate positive eating and thinness/restriction expectancies (an element of reward prediction error) in the onset and maintenance of eating pathology. Finally, self-report measures of habit strength demonstrate relationships with eating pathology and illness duration; however, behavioral task data do not support relationships between eating pathology and a propensity towards general habit development. Existing studies are limited, but provide preliminary support for the presence of abnormal reward learning in eating disorders. Continued research is needed to address identified gaps in the literature.
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25
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Muratore AF, Attia E. Current Therapeutic Approaches to Anorexia Nervosa: State of the Art. Clin Ther 2020; 43:85-94. [PMID: 33293054 DOI: 10.1016/j.clinthera.2020.11.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022]
Abstract
Anorexia nervosa (AN) is a devastating psychiatric disorder characterized by extreme restriction of food intake and low body weight, both associated with significant medical and psychological morbidity. The clinical severity of AN has prompted the consideration and study of behavioral and pharmacological treatments in efforts to establish empirically based methods to reduce the burden of the disorder. Among adolescents, family-based treatment is considered a first-line behavioral treatment. Research continues to explore the efficacy of family-based treatment and predictors of treatment response to further improve outcomes. Several behavioral treatments for adults also exist, including cognitive-behavioral therapy, exposure and response prevention, third-wave acceptance-based treatments, and supportive psychotherapy, all of which help to improve symptoms and promote modest weight gain. Despite this, no one treatment is considered superior, and all existing behavioral approaches leave a proportion of adults symptomatic or at a high risk of relapse. As such, among adults, there is continued need for development of novel, mechanism-based approaches to better target the core symptoms of AN. Although antidepressants impart little benefit on weight or symptoms, the second-generation antipsychotic olanzapine has shown ability to promote modest weight gain in outpatients with AN. Most recently, the field's evolving conceptualization of AN as a biologically based disorder coupled with technological advancements has led to consideration of varying neuromodulation strategies as a potential therapeutic approach that remains under investigation.
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Affiliation(s)
- Alexandra F Muratore
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
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26
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Racine SE, Suissa-Rocheleau L, Martin SJ, Benning SD. Implicit and explicit motivational responses to high- and low-calorie food in women with disordered eating. Int J Psychophysiol 2020; 159:37-46. [PMID: 33245920 DOI: 10.1016/j.ijpsycho.2020.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
Eating disorders and their symptoms are thought to be associated with altered motivational responding to food. Binge eating may relate to increased reward reactivity, restrictive eating may be associated with increased threat and/or decreased reward reactivity, and the combination of these symptoms within an individual may be linked to motivational conflict to food. Using both implicit (i.e., physiological) and explicit (i.e., self-reported) measures, we tested these hypotheses in 88 women with binge eating only, restrictive eating only, both binge eating and restrictive eating, or no eating pathology. Participants viewed and rated high-calorie food, low-calorie food, and emotional images while startle eye blink and postauricular reflexes were measured. Arousal and craving, but not valence, ratings were significantly greater for high- than low-calorie food. Startle blink reflexes during all food images were significantly lower than during neutral images, whereas only high-calorie foods related to greater postauricular reactivity than neutral images. Eating pathology group did not predict implicit and explicit motivational reactions to food. Exploratory dimensional analyses revealed that rating low-calorie foods as lower on craving predicted endorsement of restrictive eating, while rating low-calorie foods as lower on valence and arousal, and experiencing lower postauricular reactivity to high-calorie foods minus neutral images, predicted greater frequency of restrictive eating episodes. Decreased implicit and explicit appetitive motivation to high- and low-calorie food may relate to the presence and frequency of restrictive eating. Future longitudinal research should investigate whether decreased appetitive responding to food is a risk factor for, versus consequence of, restrictive eating.
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Affiliation(s)
- Sarah E Racine
- Department of Psychology, McGill University, 2001 Avenue McGill College, Montréal, QC H3A 1G1, Canada.
| | - Léah Suissa-Rocheleau
- Department of Psychology, McGill University, 2001 Avenue McGill College, Montréal, QC H3A 1G1, Canada
| | - Shelby J Martin
- Department of Psychology, Ohio University, Porter Hall, Athens, OH 45701, United States
| | - Stephen D Benning
- Department of Psychology, University of Nevada Las Vegas, 4505 S. Maryland Pkwy, Las Vegas, NV 89154-5030, United States
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27
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Wonderlich SA, Bulik CM, Schmidt U, Steiger H, Hoek HW. Severe and enduring anorexia nervosa: Update and observations about the current clinical reality. Int J Eat Disord 2020; 53:1303-1312. [PMID: 32359125 DOI: 10.1002/eat.23283] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE-AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE-AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE-AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE-AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE-AN and their families.
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Affiliation(s)
- Stephen A Wonderlich
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Howard Steiger
- Eating Disorder Continuum, Douglas Mental Health University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada
| | - Hans W Hoek
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA.,Parnassia Psychiatric Institute, The Hague, The Netherlands
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28
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Phillipou A, Meyer D, Neill E, Tan EJ, Toh WL, Van Rheenen TE, Rossell SL. Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. Int J Eat Disord 2020; 53:1158-1165. [PMID: 32476163 PMCID: PMC7300745 DOI: 10.1002/eat.23317] [Citation(s) in RCA: 254] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Emerging evidence suggests that the coronavirus (COVID-19) pandemic may be negatively impacting mental health. The impact on eating and exercise behaviors is, however, currently unknown. This study aimed to identify changes in eating and exercise behaviors in an Australian sample among individuals with an eating disorder, and the general population, amidst the COVID-19 pandemic outbreak. METHOD A total of 5,469 participants, 180 of whom self-reported an eating disorder history, completed questions relating to changes in eating and exercise behaviors since the emergence of the pandemic, as part of the COLLATE (COvid-19 and you: mentaL heaLth in AusTralia now survEy) project; a national survey launched in Australia on April 1, 2020. RESULTS In the eating disorders group, increased restricting, binge eating, purging, and exercise behaviors were found. In the general population, both increased restricting and binge eating behaviors were reported; however, respondents reported less exercise relative to before the pandemic. DISCUSSION The findings have important implications for providing greater monitoring and support for eating disorder patients during the COVID-19 pandemic. In addition, the mental and physical health impacts of changed eating and exercise behaviors in the general population need to be acknowledged and monitored for potential long-term consequences.
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Affiliation(s)
- Andrea Phillipou
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Department of Mental HealthSt Vincent's HospitalMelbourneVictoriaAustralia,Department of Mental HealthAustin HospitalMelbourneVictoriaAustralia,Department of PsychiatryThe University of MelbourneMelbourneVictoriaAustralia
| | - Denny Meyer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Erica Neill
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Department of Mental HealthSt Vincent's HospitalMelbourneVictoriaAustralia,Department of PsychiatryThe University of MelbourneMelbourneVictoriaAustralia
| | - Eric J. Tan
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Department of Mental HealthSt Vincent's HospitalMelbourneVictoriaAustralia
| | - Wei Lin Toh
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Department of PsychiatryAlfred HealthMelbourneVictoriaAustralia
| | | | - Susan L. Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,Department of Mental HealthSt Vincent's HospitalMelbourneVictoriaAustralia
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29
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Glashouwer KA, Brockmeyer T, Cardi V, Jansen A, Murray SB, Blechert J, Levinson CA, Schmidt U, Tchanturia K, Wade TD, Svaldi J, Giel KE, Favaro A, Fernández-Aranda F, Friederich HC, Naumann E, Treasure JL, Tuschen-Caffier B, Vocks S, Werthmann J. Time to make a change: A call for more experimental research on key mechanisms in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:361-367. [PMID: 32567176 DOI: 10.1002/erv.2754] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, The Netherlands
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
| | - Valentina Cardi
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Jens Blechert
- Centre for Cognitive Neuroscience, Department of Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Ulrike Schmidt
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, UK
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Tracey D Wade
- Discipline of Psychology and Orama Institute, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Clinic Tübingen, Tübingen, Germany
- Competence Center for Eating Disorders, Tübingen, Germany
| | - Angela Favaro
- Department of Neuroscience, Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Hans-Christoph Friederich
- General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Janet L Treasure
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Institute of Psychology, Freiburg, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Jessica Werthmann
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Institute of Psychology, Freiburg, Germany
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30
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Davis L, Walsh BT, Schebendach J, Glasofer DR, Steinglass JE. Habits are stronger with longer duration of illness and greater severity in anorexia nervosa. Int J Eat Disord 2020; 53:413-419. [PMID: 32227516 PMCID: PMC7217727 DOI: 10.1002/eat.23265] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between habit strength and clinical features of anorexia nervosa (AN). Habit strength, separate from intention, relates to the persistence of behavior, and is measured by the Self-Report Habit Index (SRHI). We hypothesized that habit strength would be greater among individuals with AN than healthy controls (HC) and that habit strength would be associated with duration and severity of illness. METHOD Participants were 116 women with AN (n = 69) and HC (n = 47) who completed the SRHI, the Eating Disorder Examination-Questionnaire (EDE-Q), and a multi-item laboratory meal. The SRHI assessed four domains and these subscales were averaged for the total score. RESULTS Individuals with AN demonstrated significantly greater habit strength than HC in the total score (t114 = 7.00, p < .01), and within each domain (restrictive eating, compensatory behavior, delay of eating, and rituals). Total SRHI score was significantly associated with EDE-Q scores for both AN and HC groups (rAN = .59, pAN = <.001; rHC = .32, pHC = .030). Among patients, there was a significant association between SRHI and duration of illness (r = .38, p = .001). There was no significant association between SRHI and caloric intake (rAN = -.20, pAN = .10; rHC = -.25, pHC = .09). DISCUSSION Habit strength was related to chronicity and severity of AN, suggesting that habit formation may play an important role in illness. These data suggest avenues for mechanism research and treatment development.
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Affiliation(s)
- Lauren Davis
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - B. Timothy Walsh
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Janet Schebendach
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Deborah R. Glasofer
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
| | - Joanna E. Steinglass
- Department of PsychiatryColumbia University Irving Medical Center & New York State Psychiatric Institute New York New York USA
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31
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Zhu J, Yang Y, Touyz S, Park R, Hay P. Psychological Treatments for People With Severe and Enduring Anorexia Nervosa: A Mini Review. Front Psychiatry 2020; 11:206. [PMID: 32265758 PMCID: PMC7106475 DOI: 10.3389/fpsyt.2020.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022] Open
Abstract
This Mini-Review presents recent research into evidence for psychological treatments for people with severe and enduring anorexia nervosa (SEAN). Two psychological therapies, specialist supportive clinical management (SSCM), and cognitive behavior therapy for anorexia nervosa (CBT-AN) have limited (one randomized controlled study) evidence of efficacy. Both have had adaptations for SEAN, notably with revision of the primary treatment goal of improved quality of life and full weight recovery a secondary goal. A major issue with existing studies is poor definition of SEAN, and the large deficit in research that has used an agreed definition of SEAN. In particular, it may be problematic to extrapolate from studies of people with either severe and/or enduring but not intractable or "resistant" illness. People with longstanding AN who have not received evidence based care should be offered this with an expectation of recovery. Similarly, people with SEAN may be offered care with judicious mitigation of expectations. In the future, trials should include people with SEAN clearly defined. Trials with a subsample of participants likely to have SEAN, if identified at randomisation, are an opportunity for secondary analyses of such participants. This would widen the evidence base for psychological treatments providing hope for people with this devastating illness. Finally, there is an urgent need not only to strengthen our existing knowledge with studies of sufficient power, but also, fundamentally, to derive novel conceptualizations of what "treatment" involves.
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Affiliation(s)
- James Zhu
- South West and North Coast Psychiatry Training Network, Sydney Local Health District, Sydney, NSW, Australia
| | - Yive Yang
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Park
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Phillipa Hay
- Western Sydney University, Translational Health Research Institute, Sydney, NSW, Australia
- South Western Sydney Local Health District, Camden and Campbelltown Hospitals, Sydney, NSW, Australia
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Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness. J Clin Med 2020; 9:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
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Vogel V, Dittrich M, Horndasch S, Kratz O, Moll GH, Erim Y, Paslakis G, Rauh E, Steins‐Loeber S. Pavlovian‐to‐instrumental transfer in Anorexia Nervosa: A pilot study on conditioned learning and instrumental responding to low‐ and high‐calorie food stimuli. Eur J Neurosci 2019; 51:1794-1805. [DOI: 10.1111/ejn.14592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/08/2019] [Indexed: 01/28/2023]
Affiliation(s)
- Verena Vogel
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
| | - Marie Dittrich
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
| | - Stefanie Horndasch
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Gunther H. Moll
- Department of Child and Adolescent Mental Health University of Erlangen‐Nuremberg Erlangen Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy University of Erlangen‐Nuremberg Erlangen Germany
| | - Georgios Paslakis
- Department of Psychosomatic Medicine and Psychotherapy University of Erlangen‐Nuremberg Erlangen Germany
| | | | - Sabine Steins‐Loeber
- Department of Clinical Psychology and Psychotherapy University of Bamberg Bamberg Germany
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Coniglio KA, Christensen KA, Haynos AF, Rienecke RD, Selby EA. The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease. Int J Eat Disord 2019; 52:971-976. [PMID: 31361353 PMCID: PMC7176354 DOI: 10.1002/eat.23147] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/19/2019] [Accepted: 07/18/2019] [Indexed: 01/01/2023]
Abstract
Anorexia nervosa (AN) is a complex and life-threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self-report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.
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Affiliation(s)
- Kathryn A. Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
| | - Kara A. Christensen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Department of Psychology, The Ohio State University, Columbus, Ohio
| | - Ann F. Haynos
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
| | - Renee D. Rienecke
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Edward A. Selby
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey
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Abstract
The authors present the theoretic model, structure of treatment, and preliminary evidence for several emerging treatments that are increasingly being used and studied in eating disorders treatment, including dialectical behavior therapy, acceptance and commitment therapy, integrative cognitive-affective therapy, and neuromodulation. In addition, the article discusses treatments that address mindfulness, interpersonal factors, and habit.
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Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
| | - Lauren M Schaefer
- Sanford Center for Biobehavioral Research, 120 South Eighth Street, Fargo, ND 58103, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, 120 South Eighth Street, Fargo, ND 58103, USA; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454, USA
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Abstract
Anorexia nervosa is a complex psychiatric illness associated with food restriction and high mortality. Recent brain research in adolescents and adults with anorexia nervosa has used larger sample sizes compared with earlier studies and tasks that test specific brain circuits. Those studies have produced more robust results and advanced our knowledge of underlying biological mechanisms that may contribute to the development and maintenance of anorexia nervosa. It is now recognized that malnutrition and dehydration lead to dynamic changes in brain structure across the brain, which normalize with weight restoration. Some structural alterations could be trait factors but require replication. Functional brain imaging and behavioral studies have implicated learning-related brain circuits that may contribute to food restriction in anorexia nervosa. Most notably, those circuits involve striatal, insular, and frontal cortical regions that drive learning from reward and punishment, as well as habit learning. Disturbances in those circuits may lead to a vicious cycle that hampers recovery. Other studies have started to explore the neurobiology of interoception or social interaction and whether the connectivity between brain regions is altered in anorexia nervosa. All together, these studies build upon earlier research that indicated neurotransmitter abnormalities in anorexia nervosa and help us develop models of a distinct neurobiology that underlies anorexia nervosa.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Megan E Shott
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Marisa C DeGuzman
- Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA.,Neuroscience Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, 80045, USA
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Schebendach JE, Uniacke B, Walsh BT, Mayer LES, Attia E, Steinglass J. Fat preference and fat intake in individuals with and without anorexia nervosa. Appetite 2019; 139:35-41. [PMID: 30981752 DOI: 10.1016/j.appet.2019.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/29/2019] [Accepted: 04/10/2019] [Indexed: 12/22/2022]
Abstract
Fat restriction is a characteristic eating behavior among individuals with anorexia nervosa (AN), and laboratory meal studies demonstrate restricted fat intake among low-weight patients. The Geiselman Food Preference Questionnaire-I© (FPQ) is a validated self-report measure that yields a fat preference score (FPS). Prior research reported that patients with AN had a significantly lower FPS than did healthy control (HC) participants. The goal of the current study was to compare self-reported fat preference (FPS) to fat intake (multi-item meal (MIM) study) in low-weight ANs and HCs. Specific aims were 1) to determine if the FPS differed between ANs and HCs; 2) to determine if fat and energy intakes differed between ANs and HCs; and 3) to determine if the FPS was associated with fat and energy intakes in ANs and HCs. Forty-four female AN inpatients and 48 female HCs completed the FPQ and participated in a MIM study. Compared to HCs, ANs consumed less energy (469.1 ± 397.7 vs. 856.4 ± 346.8 kcal, p < 0.001), less fat (16.4 ± 20.4 vs. 36.7 ± 18.9 g, p < 0.001), and a smaller percentage of calories from fat (22.9 ± 13.8 vs. 36.6 ± 8.0%, p < 0.001) at the MIM. Compared to HCs, ANs also had a lower FPS (79.7 ± 27.4 vs. 102.3 ± 18.9, p < 0.001). The FPS was significantly and positively correlated with caloric intake (r = 0.481, p < 0.01), total fat (r = 0.453, p < 0.01), and the percentage of calories from fat (r = 0.37, p < 0.05) in ANs as well as in HCs (kcal: r = 0.583, p < 0.001; fat: r = 0.621, p < 0.001; % fat kcal: r = 0.601, p < 0.001). The FPS is related to objective measures of energy and fat intake in patients with AN as well as in healthy individuals.
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Affiliation(s)
- Janet E Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA.
| | - Blair Uniacke
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Laurel E S Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, NY, NY, USA; Department of Psychiatry, New York State Psychiatric Institute, NY, NY, USA
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Frank GKW, DeGuzman MC, Shott ME. Motivation to eat and not to eat - The psycho-biological conflict in anorexia nervosa. Physiol Behav 2019; 206:185-190. [PMID: 30980856 DOI: 10.1016/j.physbeh.2019.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022]
Abstract
Anorexia nervosa is a severe psychiatric illness with high mortality. Brain imaging research has indicated altered reward circuits in the disorder. Here we propose a disease model for anorexia nervosa, supported by recent studies, that integrates psychological and biological factors. In that model, we propose that there is a conflict between the conscious motivation to restrict food, and a body-homeostasis driven motivation to approach food in response to weight loss. These opposing motivations trigger anxiety, which maintains the vicious cycle of ongoing energy restriction and weight loss.
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Affiliation(s)
- Guido K W Frank
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA; Department of Neuroscience, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA.
| | - Marisa C DeGuzman
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA; Department of Neuroscience, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Megan E Shott
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
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Zambrowicz R, Schebendach J, Sysko R, Mayer LES, Walsh BT, Steinglass JE. Relationship between three factor eating questionnaire-restraint subscale and food intake. Int J Eat Disord 2019; 52:255-260. [PMID: 30638263 PMCID: PMC6601332 DOI: 10.1002/eat.23014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Dietary restraint refers to an individual's intention to restrict food intake, measured via self-report questionnaires, whereas dietary restriction refers to actual reduction in caloric intake. The aim of this research was to investigate the association between dietary restraint scales and actual caloric restriction. METHOD Data were collected from six previously published or two ongoing eating behavior studies in which participants (n = 183) completed the Three Factor Eating Questionnaire (TFEQ) and Eating Disorders Examination Questionnaire (EDE-Q) and participated in a laboratory-based research lunch meal. Participants were individuals with anorexia nervosa (AN), bulimia nervosa (BN), and healthy controls (HC). The primary analysis was the association between TFEQ Restraint subscale and caloric intake in the meal. RESULTS There was a significant negative correlation between total caloric intake and TFEQ Restraint scores (r = -.60, p < .001) and EDE-Q Restraint scores (r = -.54, p < .001). For TFEQ Restraint score, this relationship was significant within each diagnostic group (HC: r = -.32, p = .007; AN: r = -.38, p < .001; BN: r = -.43, p = .02). DISCUSSION These results suggest that the TFEQ Restraint scale is a useful measure of dietary restriction, especially among individuals with eating disorders.
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Affiliation(s)
- Rachel Zambrowicz
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Janet Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Robyn Sysko
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel E S Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
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Roustaee R, Houshiarrad A, Tajik E, Hajifaraji M. Assessment of Dietary Intakes and Food habits in Female Adolescents with Eating Disorders. NUTRITION AND FOOD SCIENCES RESEARCH 2018. [DOI: 10.29252/nfsr.5.4.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Uniacke B, Walsh BT, Foerde K, Steinglass J. The Role of Habits in Anorexia Nervosa: Where We Are and Where to Go From Here? Curr Psychiatry Rep 2018; 20:61. [PMID: 30039342 PMCID: PMC6550313 DOI: 10.1007/s11920-018-0928-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The persistent maladaptive eating behavior characteristic of anorexia nervosa (AN) can be understood as a learned habit. This review describes the cognitive neuroscience background and the existing data from research in AN. RECENT FINDINGS Behavior is habitual after it is frequently repeated and becomes nearly automatic, relatively insensitive to outcome, and mediated by dorsal frontostriatal neural systems. There is evidence for such behavior in AN, in which restrictive intake has been related to dorsal frontostriatal systems. Other neural and neurocognitive data provide mixed findings, some of which suggest disturbances in habit systems in AN. There are compelling behavioral and neural data to suggest that habit systems may underlie the persistence of AN. The habit model needs further research, via more direct behavioral hypothesis testing and probes of the development of habitual behavior. Investigation of the habit-centered model of AN may open avenues for the development of novel treatments.
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Affiliation(s)
- Blair Uniacke
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA. .,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
| | - B. Timothy Walsh
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
| | - Karin Foerde
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
| | - Joanna Steinglass
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA,Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
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Zeeck A, Herpertz-Dahlmann B, Friederich HC, Brockmeyer T, Resmark G, Hagenah U, Ehrlich S, Cuntz U, Zipfel S, Hartmann A. Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis. Front Psychiatry 2018; 9:158. [PMID: 29765338 PMCID: PMC5939188 DOI: 10.3389/fpsyt.2018.00158] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 04/09/2018] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults). Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included. Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment. Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Hans-Christoph Friederich
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrich Hagenah
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universitaet Dresden, Dresden, Germany
| | - Ulrich Cuntz
- Schön Klinik Roseneck, Prien am Chiemsee, Germany
| | - Stephan Zipfel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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