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Adams KL, Mandy W, Catmur C, Bird G. Potential mechanisms underlying the association between feeding and eating disorders and autism. Neurosci Biobehav Rev 2024; 162:105717. [PMID: 38754718 DOI: 10.1016/j.neubiorev.2024.105717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.
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Affiliation(s)
- Kiera Louise Adams
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - William Mandy
- Division of Psychology and Language, University College London, London, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Liu P, Tan JXY. ERP correlates of self-referential processing moderate the association between pubertal status and disordered eating in preadolescence. Psychophysiology 2024; 61:e14534. [PMID: 38342692 DOI: 10.1111/psyp.14534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/05/2023] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
Preadolescence is a critical period for the onset of puberty and eating-related psychopathology. More advanced pubertal status is associated with elevated eating pathology. However, it was unclear whether this association was moderated by self-referential processing, an important, modifiable cognitive risk for various forms of psychopathology, including eating problems. Further, no study has examined the neural correlates of self-referential processing in relation to eating pathology. To address these gaps, we examined how the association between pubertal status and disordered eating was moderated by self-referential processing in a community sample of 115 nine-to-12-year-old preadolescents (66 girls; mean age/SD = 10.98/1.18 years; 87.5% White). Youths reported their pubertal status and disordered eating behaviors and completed an ERP version of the Self-Referent Encoding Task (SRET) to assess self-referential processing. A Principal Component Analysis of the ERP data identified an anterior late positive potential (LPP) in both the positive and negative SRET conditions. The LPP in the positive condition moderated the positive association between pubertal status and disordered eating behaviors, such that this association was significant for youths with a smaller LPP toward positive self-referential cues, but non-significant for those showing a larger LPP toward positive self-referential cues. These results suggest that a deeper processing of positive self-referential information, indicated by a potentiated LPP, may weaken the negative impact of pubertal status on disordered eating. Our findings also suggest that enhancing positive self-referential processing may be a useful tool in preventing the development of eating pathology in preadolescents, especially for those with more advanced pubertal status.
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Affiliation(s)
- Pan Liu
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Jaron X Y Tan
- Department of Psychology, Center for Visual and Cognitive Neuroscience, North Dakota State University, Fargo, North Dakota, USA
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Gilsbach S, Borzikowsy C, Herpertz-Dahlmann B. Lost in between-the transition process from a child and adolescent eating disorder service to adult mental health services in the German health care system. EUROPEAN EATING DISORDERS REVIEW 2024; 32:547-556. [PMID: 38303544 DOI: 10.1002/erv.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. METHOD We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3 years. Thirty-two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. RESULTS Only approximately one-third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. CONCLUSION Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process.
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Affiliation(s)
- Susanne Gilsbach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| | - Christoph Borzikowsy
- Fachhochschule für Verwaltung und Dienstleistung (FHVD), Campus Altenholz Rehmkamp, Altenholz, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
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Velkoff EA, Lusich R, Kaye WH, Wierenga CE, Brown TA. Early change in gastric-specific anxiety sensitivity as a predictor of eating disorder treatment outcome. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38687750 DOI: 10.1002/erv.3099] [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: 10/18/2023] [Revised: 04/08/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
Eating disorders (EDs) are often accompanied by gastrointestinal (GI) distress. Anxiety sensitivity is the tendency to interpret sensations of anxiety as threatening or dangerous, and includes both broad physical symptoms (e.g., elevated heartrate) and GI-specific symptoms. Physical and GI-specific anxiety sensitivity may be important risk and maintaining factors in EDs. This study tested the hypothesis that greater reductions in both types of anxiety sensitivity during the first month of treatment would predict lower ED symptoms and trait anxiety at discharge and 6-month follow-up. Patients (n = 424) in ED treatment reported physical and GI-specific anxiety sensitivity, ED symptoms, and trait anxiety at treatment admission, 1-month into treatment, discharge, and 6-month follow-up. Analyses were conducted with hierarchical linear regression with imputation, controlling for relevant covariates. Results indicated that early reduction in GI-specific but not general physical anxiety sensitivity predicted both lower ED symptoms and lower trait anxiety at discharge and 6-month follow-up. These findings demonstrate the importance of GI-specific anxiety sensitivity as a potential maintaining factor in EDs. Developing and refining treatments to target GI-specific anxiety sensitivity may have promise in improving the treatment not only of EDs, but also of commonly co-morbid anxiety disorders.
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Affiliation(s)
| | | | - Walter H Kaye
- University of California, San Diego, California, USA
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Williams BM, Brown ML, Levinson CA. State mechanisms of change in eating disorder symptoms and fears during an online imaginal exposure treatment for eating disorders. J Affect Disord 2024; 351:499-506. [PMID: 38309481 DOI: 10.1016/j.jad.2024.01.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
Anxiety and fear are key characteristics of eating disorders (EDs). Exposure therapy is a specific type of intervention aimed at reducing fear and anxiety and is efficacious in treating a variety of anxiety and related disorders. A growing body of research suggests that exposure therapy is also efficacious for the treatment of EDs. However, there is currently little research investigating mechanisms of change during exposure therapy for EDs. The current study (N = 143) expanded on an open series trial of imaginal exposure for EDs that found significant reductions in ED symptoms and core ED fears. In the current study we investigated change in state drive for thinness, body dissatisfaction, and anxiety as mechanisms underpinning change in ED symptoms and core ED fears during four sessions of online imaginal exposure treatment for EDs. We found that state body dissatisfaction, but not state drive for thinness or anxiety, was a mechanism of change for ED symptoms and some core ED fears. Our findings suggest that body dissatisfaction may be a mechanism driving change during exposure therapy for EDs. Optimizing exposure treatments to focus on body dissatisfaction may improve treatment outcomes for EDs.
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Affiliation(s)
- Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, United States of America
| | - Mackenzie L Brown
- Department of Psychological & Brain Sciences, University of Louisville, United States of America
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, United States of America.
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Fitterman-Harris HF, Han Y, Osborn KD, Faulkner LM, Williams BM, Pennesi JL, Levinson CA. Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns. Int J Eat Disord 2024; 57:903-915. [PMID: 38288579 PMCID: PMC11018480 DOI: 10.1002/eat.24147] [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: 09/13/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Literature comparing "atypical" anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN. METHOD Data from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between-group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t-tests, Wilcoxon rank-sum tests, and Fisher's exact test. RESULTS Participants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food-related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive-compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors. DISCUSSION Overall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive-compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization. PUBLIC SIGNIFICANCE This study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive-compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.
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Affiliation(s)
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, University of Louisville
| | - Kimberly D. Osborn
- Department of Psychological and Brain Sciences, University of Louisville
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University
| | - Loie M. Faulkner
- Department of Psychological and Brain Sciences, University of Louisville
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville
| | - Jamie-Lee Pennesi
- Department of Psychological and Brain Sciences, University of Louisville
| | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville
- Department of Pediatrics – Division of Child and Adolescent Psychiatry, University of Louisville
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Bottera AR, Dougherty EN, Todorov S, Wildes JE. Fear of negative evaluation and intolerance of uncertainty: Assessing potential internalizing correlates of eating disorder-related clinical impairment and differences across diagnostic presentations. Eat Behav 2024; 53:101869. [PMID: 38479247 PMCID: PMC11144087 DOI: 10.1016/j.eatbeh.2024.101869] [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: 09/22/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 06/03/2024]
Abstract
The Hierarchical Taxonomy of Internalizing Dimensions for Eating Disorders model positions eating disorder (ED) symptoms on an internalizing dimension alongside anxiety and mood symptoms. Symptom dimensions falling under the internalizing subfactors of distress (e.g., social anxiety) and fear/avoidance (e.g., panic, compulsions, checking) may differentially guide treatment. We examined relations between fear of negative evaluation and intolerance of uncertainty (core features of social anxiety and obsessive-compulsive disorder, respectively) and ED-related impairment and potential diagnostic differences. We hypothesized that: (a) fear of negative evaluation and intolerance of uncertainty would be related to ED-related impairment, (b) the relation between fear of negative evaluation and impairment would be strongest among individuals with "binge-eating syndromes" (i.e., bulimia nervosa [BN], binge-eating disorder [BED]), and (c) the relation between intolerance of uncertainty and impairment would be strongest among individuals with "weight-phobic syndromes" (i.e., anorexia nervosa [AN], BN, atypical AN). Participants (N = 236) included children/adolescents and adults evaluated for outpatient ED treatment. Participants completed questionnaires and semi-structured diagnostic interviews. Greater fear of negative evaluation and greater intolerance of uncertainty were related to greater clinical impairment, and the strength of these relations depended on ED diagnosis. Fear of negative evaluation was related to impairment among individuals with AN and atypical AN, and intolerance of uncertainty was related to impairment for individuals with AN, BN, and atypical AN. We identified fear of negative evaluation and intolerance of uncertainty as correlates of clinical impairment, highlighting the potential utility of developing treatments to target these internalizing constructs, especially for individuals with weight-phobic syndromes.
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Affiliation(s)
- Angeline R Bottera
- Department of Psychology, University of Kansas, United States of America
| | - Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, United States of America
| | - Sophia Todorov
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, United States of America
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, United States of America.
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Luo Y, Pluta D, Brodrick BB, Palka JM, McCoy J, Lohrenz T, Gu X, Vannucci M, Montague PR, McAdams CJ. Diminished Adaptation, Satisfaction, and Neural Responses to Advantageous Social Signals in Anorexia Nervosa and Bulimia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:305-313. [PMID: 37951540 PMCID: PMC10939989 DOI: 10.1016/j.bpsc.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Development and recurrence of 2 eating disorders (EDs), anorexia nervosa and bulimia nervosa, are frequently associated with environmental stressors. Neurobehavioral responses to social learning signals were evaluated in both EDs. METHODS Women with anorexia nervosa (n = 25), women with bulimia nervosa (n = 30), or healthy comparison women (n = 38) played a neuroeconomic game in which the norm shifted, generating social learning signals (norm prediction errors [NPEs]) during a functional magnetic resonance imaging scan. A Bayesian logistic regression model examined how the probability of offer acceptance depended on cohort, block, and NPEs. Rejection rates, emotion ratings, and neural responses to NPEs were compared across groups. RESULTS Relative to the comparison group, both ED cohorts showed less adaptation (p = .028, ηp2 = 0.060), and advantageous signals (positive NPEs) led to higher rejection rates (p = .014, ηp2 = 0.077) and less positive emotion ratings (p = .004, ηp2 = 0.111). Advantageous signals increased neural activations in the orbitofrontal cortex for the comparison group but not for women with anorexia nervosa (p = .018, d = 0.655) or bulimia nervosa (p = .043, d = 0.527). More severe ED symptoms were associated with decreased activation of dorsomedial prefrontal cortex for advantageous signals. CONCLUSIONS Diminished neural processing of advantageous social signals and impaired norm adaptation were observed in both anorexia nervosa and bulimia nervosa, while no differences were found for disadvantageous social signals. Development of neurocognitive interventions to increase responsivity to advantageous social signals could augment current treatments, potentially leading to improved clinical outcomes for EDs.
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Affiliation(s)
- Yi Luo
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Dustin Pluta
- Department of Statistics, Rice University, Houston, Texas
| | - Brooks B Brodrick
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jayme M Palka
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jordan McCoy
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Terry Lohrenz
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - P Read Montague
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; Department of Physics, Virginia Tech, Blacksburg, Virginia; Virginia Tech-Wake Forest School of Biomedical Engineering and Mechanics, Blacksburg, Virginia
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas.
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Pompili S, Bianchi D, Di Tata D, Cannoni E, Di Norcia A, Lonigro A, Longobardi E, Laghi F. Social Anxiety and Drunkorexia Behaviors among Adolescents and Young Adults: The Moderating Role of Resilience. Subst Use Misuse 2024; 59:825-831. [PMID: 38263611 DOI: 10.1080/10826084.2024.2305790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background: Existing evidence showed that social anxiety represents a significant factor in eating disorders. However, to our knowledge, no prior study has examined the association between social anxiety and drunkorexia behaviors. Objectives: The present study aimed at exploring the relationship between social anxiety and drunkorexia behaviors, and investigating resilience as a moderator of this relationship. Participants were 333 adolescents and young adults aged 15-24 years (Mage=18.26, SDage= 1.55; 66% females) who completed an online survey. Results: The results indicated that drunkorexia behaviors were positively correlated to three dimensions of social anxiety; however, only fear of negative evaluation had a significant predictive effect. In addition, resilience only moderated the relationship between fear of negative evaluation and drunkorexia behaviors, such that youths reporting high fear of negative evaluation and low resilience showed greater drunkorexia behaviors, whereas youths reporting high resilience showed no correlation between fear of negative evaluation and drunkorexia behaviors. Conclusions: The findings highlight the importance of drunkorexia interventions and preventive measures aimed at strengthening youths' resilience and ability to effectively manage stress and social anxiety (i.e., fear of negative evaluation).
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Affiliation(s)
- Sara Pompili
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Dora Bianchi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Daniele Di Tata
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Eleonora Cannoni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Di Norcia
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonia Lonigro
- Department of Education Science, University of Rome Tre, Rome, Italy
| | - Emiddia Longobardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Laghi
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy
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Gagliardi M. The role of developmental caregiving programming in modulating our affiliation tendency and the vulnerability to social anxiety and eating disorders. Front Psychol 2024; 14:1259415. [PMID: 38239461 PMCID: PMC10794631 DOI: 10.3389/fpsyg.2023.1259415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 01/22/2024] Open
Abstract
Attachment is the evolutionarily-established process through which humans create bonds with others to receive care from them. The phenomenon is as essential to our physical survival as it is to our psychological development. An increasing number of studies demonstrates that in sensitive periods during the early years of life, our brain circuitry is programmed in the interactions with our caregivers, with the imprinting of information over multiple attachment dimensions. Adopting a basic brain-computer analogy, we can think of this knowledge as the psycho-social firmware of our mind. According to a recently proposed extension of the classical three-dimensional view, one attachment dimension - somaticity - concerns the caregiver's task of reflecting and confirming the child's (internal) states - such as sensations, emotions, and representations - to support the child's ability to identify and define those entities autonomously. Relying on multidisciplinary evidence - from neuroscientific, developmental, evolutionary, and clinical sources - we suggest that somaticity (H1) has the adaptive function to modulate our tendency to comply and affiliate with a reference group but also (H2) increases the vulnerability to developing Social Anxiety (SA) and Eating Disorders (EDs). We evaluate H1-H2, (1) indicating the evolutionary role of somaticity in modulating our affiliation tendency to optimize the ancestral threat-opportunity balance coming from infectious diseases and (2) showing the deep connection between SA-EDs and the features most closely related to somaticity - interoception and parenting style. Finally, we discuss three relevant implications of H1-H2: (A) Bringing into research focus the adaptive role of our firmware knowledge system versus the hardware (neural substrate) and software (higher cognition) ones. (B) Complementing the well-grounded Objectification and Allocentric Lock Theories, allowing us to integrate multiple levels of explanation on the etiology of psychopathology. (C) Suggesting the design of new psychological treatments. While not aiming to prove H1-H2, our analysis supports them and encourages their direct testing.
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11
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Dougherty EN, Johnson NK, Badillo K, Haedt-Matt AA. Sleep reactivity is associated with social anxiety and disordered-eating behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2280-2285. [PMID: 34469257 DOI: 10.1080/07448481.2021.1967359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Objective: Investigate whether sleep reactivity was associated with social anxiety and disordered-eating behaviors in a college population. Participants: One hundred ninety-eight college-age men and women. Methods: Participants completed self-report measures of social anxiety, disordered-eating behaviors and sleep reactivity. Results: Sleep reactivity was associated with greater dietary restriction and purging, controlling for social anxiety but it was not associated with binge eating. Sleep reactivity was associated with elevated symptoms of social anxiety, controlling for disordered-eating behaviors. Conclusions: The results suggest that sleep reactivity represents a shared correlate of disordered-eating behaviors and social anxiety that may partially explain their co-occurrence. Interventions to help college students high in sleep reactivity effectively manage stress and regulate their sleep may aid in the prevention and treatment of social anxiety and disordered-eating behaviors.
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Affiliation(s)
| | - Nicole K Johnson
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Krystal Badillo
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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12
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Hübel C, Birgegård A, Johansson T, Petersen LV, Isomaa R, Herle M. Latent anxiety and depression dimensions differ amongst patients with eating disorders: A Swedish nationwide investigation. Int J Methods Psychiatr Res 2023; 32:e1961. [PMID: 36775941 PMCID: PMC10485306 DOI: 10.1002/mpr.1961] [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: 07/26/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVE Anxiety and depression symptoms are common in individuals with eating disorders. To study these co-occurrences, we need high-quality self-report questionnaires. The 19-item self-rated Comprehensive Psychopathological Rating Scale for Affective Syndromes (CPRS-S-A) is not validated in patients with eating disorders. We tested its factor structure, invariance, and differences in its latent dimensions. METHOD Patients were registered by 45 treatment units in the Swedish nationwide Stepwise quality assurance database for specialised eating disorder care (n = 9509). Patients self-reported their anxiety and depression symptoms on the CPRS-S-A. Analyses included exploratory and confirmatory factor analyses (CFA) in split samples, and testing of invariance and differences in subscales across eating disorder types. RESULTS Results suggested a four-factor solution: Depression, Somatic and fear symptoms, Disinterest, and Worry. Multigroup CFA indicated an invariant factor structure. We detected the following differences: Patients with anorexia nervosa binge-eating/purging subtype scored the highest and patients with unspecified feeding and eating disorders the lowest on all subscales. Patients with anorexia nervosa or purging disorder show more somatic and fear symptoms than individuals with either bulimia nervosa or binge-eating disorder. CONCLUSION Our four-factor solution of the CPRS-S-A is suitable for patients with eating disorders and may help to identify differences in anxiety and depression dimensions amongst patients with eating disorders.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- UK National Institute for Health Research (NIHR) Biomedical Research Centre for Mental HealthSouth London and Maudsley HospitalLondonUK
- National Centre for Register‐based ResearchAarhus BSS Business and Social SciencesAarhus UniversityAarhusDenmark
- Department of Pediatric NeurologyCharité Universitätsmedizin BerlinBerlinGermany
| | - Andreas Birgegård
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Therese Johansson
- Department of Immunology, Genetics and PathologyScience for Life LaboratoryUppsala UniversityUppsalaSweden
- Centre for Women's Mental Health During the Reproductive Lifespan—WomherUppsala UniversityUppsalaSweden
| | - Liselotte V. Petersen
- National Centre for Register‐based ResearchAarhus BSS Business and Social SciencesAarhus UniversityAarhusDenmark
| | - Rasmus Isomaa
- The Wellbeing Services County of OstrobothniaAboFinland
- Faculty of Education and Welfare StudiesÅbo Akademi UniversityVasaFinland
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Department of Biostatistics & Health InformaticsInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Andrade JA, Salaroli LB, Noll PRES, Noll M, Feitosa SO, Raimundo RD, de Oliveira AG, Mendonça CR, de Abreu LC. Indicators of Eating Disorders in Sexually Abused Brazilian Adolescents: Family and School Contexts. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1393. [PMID: 37628392 PMCID: PMC10453146 DOI: 10.3390/children10081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Eating disorders, characterized by abnormal eating behaviors, are among a wide variety of psychiatric conditions that mainly affect children and adolescents. These disorders have a multifactorial origin and can be associated with restrictive diets, negative feelings, harmful family relationships, and post-traumatic stress. Thus, this study's objective was to evaluate the association between indicators of eating disorders and family and school contexts in Brazilian adolescents who previously experienced sexual abuse and examine the findings based on sex. National School Health Survey data were utilized. Among 102,301 students between 11 and 19 years of age, 4124 reported having experienced sexual abuse and were included in this study. Self-report questionnaires were used to assess participants' health status and the presence of risk behaviors, which were examined through multivariate analysis using a Poisson regression model. The results indicated positive relationships between self-induced vomiting, laxative misuse, and other purgative methods and infrequent meals with family, hunger, and the presence of violence in students' daily lives, regardless of sex (p < 0.05). In addition, body dissatisfaction and negative feelings about one's body were associated with having been bullied or teased by schoolmates for both sexes (p < 0.05). Distant relationships with parents were associated with purgative methods and body dissatisfaction among female students (p < 0.05). In conclusion, body dissatisfaction, negative feelings about one's body, laxative misuse, self-induced vomiting, and purgative methods were found to be associated with factors in family and school contexts such as hunger, infrequent meals with family, family violence, distant relationships with parents, and bullying at school in adolescents who have previously experienced sexual abuse.
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Affiliation(s)
- Julia Altoé Andrade
- Nutrition and Health Postgraduate Program, Health Sciences Center, Federal University Espirito Santo, Vitória 29075-910, Brazil; (J.A.A.); (L.B.S.)
| | - Luciane Bresciani Salaroli
- Nutrition and Health Postgraduate Program, Health Sciences Center, Federal University Espirito Santo, Vitória 29075-910, Brazil; (J.A.A.); (L.B.S.)
| | | | - Matias Noll
- Instituto Federal Goiano, Ceres 76300-000, Brazil; (P.R.e.S.N.); (M.N.); (S.O.F.)
- Health Sciences Postgraduate Program, Medical School, Universidade Federal de Goiás, Goiânia 74605-080, Brazil;
| | | | - Rodrigo Daminello Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Santo André 09060-590, Brazil; (R.D.R.); (A.G.d.O.)
| | - Adriana Gonçalves de Oliveira
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário FMABC, Santo André 09060-590, Brazil; (R.D.R.); (A.G.d.O.)
| | - Carolina Rodrigues Mendonça
- Health Sciences Postgraduate Program, Medical School, Universidade Federal de Goiás, Goiânia 74605-080, Brazil;
| | - Luiz Carlos de Abreu
- Nutrition and Health Postgraduate Program, Health Sciences Center, Federal University Espirito Santo, Vitória 29075-910, Brazil; (J.A.A.); (L.B.S.)
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14
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Tchanturia K, Croft P, Holetic V, Webb J, Dapelo MM. Positive communication workshops: are they useful for treatment programmes for anorexia nervosa? Front Psychol 2023; 14:1234928. [PMID: 37645066 PMCID: PMC10461805 DOI: 10.3389/fpsyg.2023.1234928] [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: 06/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Background Social isolation, loneliness and difficulties in relationships are often described as a core feature of eating disorders. Based on the experimental research, we have designed one-off workshops for patients in inpatients and day care services and evaluated its acceptability and effectiveness using feedback questionnaires. Methods This naturalistic project is an evaluation of multiple positive communication workshops. Forty-one participants completed workshop questionnaires, which were provided immediately at the beginning and end of the workshop, including feedback on these one-off groups. The workshops consisted of educational and experiential components. The questionnaire outcomes were evaluated by independent researchers. Results All participants were female adults with a mean age of 33 (12.2) and a diagnosis of Anorexia Nervosa (AN; either restrictive or binge-purge subtype). Post-workshop questionnaires showed large effect sizes in the improvement of understanding the importance and confidence in using positive communication strategies. Discussion Addressing social communication difficulties in eating disorder treatment programmes adds valuable dimensions to these symptom-based treatments in both inpatient settings and day services, and may provide broader benefits in overall social functioning in patients with AN. Conclusion Brief one-off workshops targeting social functioning for patients with eating disorders might be useful complementary input for treatment programmes.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Ilia State University, Tbilisi, Georgia
| | - Philippa Croft
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Victoria Holetic
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jessica Webb
- Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Marcela Marin Dapelo
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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15
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Bellard A, Mathew J, Sun W, Denkow L, Najm A, Michael-Grigoriou D, Trotter P, McGlone F, Fairhurst M, Cazzato V. Topography and relationship-specific social touching in individuals displaying body image disturbances. Sci Rep 2023; 13:13198. [PMID: 37580362 PMCID: PMC10425375 DOI: 10.1038/s41598-023-39484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the 'imagined' experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to 'social' body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.
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Affiliation(s)
- Ashleigh Bellard
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jyothisa Mathew
- Department of Psychology, Bundeswehr Universität, Munich, Germany
| | - Wenhan Sun
- Faculty of Philosophy and Philosophy of Science, Munich Center for Neuroscience, Ludwig Maximilian University, Munich, Germany
| | - Linda Denkow
- Department of Psychology, Bundeswehr Universität, Munich, Germany
| | - Ali Najm
- GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
| | - Despina Michael-Grigoriou
- GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
| | - Paula Trotter
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Francis McGlone
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Merle Fairhurst
- Faculty of Electrical and Computer Engineering, Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Valentina Cazzato
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
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16
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Miquel-Nabau H, Briseño-Oloriz N, Porras-Garcia B, Ascione M, Meschberger-Annweiler FA, Ferrer-Garcia M, Moreno-Sanchez M, Serrano-Troncoso E, Carulla-Roig M, Gutiérrez Maldonado J. Modification of Body-Related Attentional Bias through Virtual Reality and Eye-Tracking in Healthy Participants: Implications for Anorexia Nervosa Treatments. Brain Sci 2023; 13:brainsci13050764. [PMID: 37239236 DOI: 10.3390/brainsci13050764] [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: 03/21/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Cognitive biases have a significant impact on the etiology and treatment of eating disorders (EDs). These biases, including selective attentional bias (AB) to disliked body parts, may reinforce concerns about body shape, fear of gaining weight and body image disturbances and may contribute to dietary restriction and restraint. Decreasing AB could reduce core symptoms in anorexia nervosa (AN). This study represents a preliminary exploration aiming to assess whether AB towards weight-related (WR) and non-weight-related (NW) body parts could be reduced through an AB modification task in a virtual reality (VR) environment in healthy participants. A total of 54 female participants, aged 22.98 ± 1.89, were recruited. The task consisted of directing the participants' attention towards all body parts equally in a VR setting. Eye-tracking (ET) measurements (complete fixation time [CFT] and number of fixations [NF]) were made before and after the task. The results showed a significant reduction of the AB in the two groups with an initial AB towards WR body parts or towards NW body parts. Participants showed a tendency to more balanced (non-biased) attention after the intervention. This study provides evidence of the usefulness of AB modification tasks in a non-clinical sample.
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Affiliation(s)
- Helena Miquel-Nabau
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | - Natalia Briseño-Oloriz
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | - Bruno Porras-Garcia
- Department of Population Health Science, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84112, USA
| | - Mariarca Ascione
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | | | - Marta Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | - Manuel Moreno-Sanchez
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Passeig de la Vall d'Hebron 171, 08035 Barcelona, Spain
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, 08950 Esplugues de Llobregat, Spain
| | - Marta Carulla-Roig
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, 08950 Esplugues de Llobregat, Spain
| | - José Gutiérrez Maldonado
- Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
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17
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Delaquis CP, Godart NT, Fatséas M, Berthoz S. Cognitive and Interpersonal Factors in Adolescent Inpatients with Anorexia Nervosa: A Network Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040730. [PMID: 37189979 DOI: 10.3390/children10040730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
The cognitive-interpersonal model of anorexia nervosa (AN) posits that cognitive and interpersonal traits contribute to the development and maintenance of AN. We investigated cognitive and interpersonal factors put forward by the model in a sample of 145 adolescent inpatients with AN using network analysis. Our main outcomes included core eating disorder symptoms, cognitive style, socio-affective factors, and mood symptoms. We estimated a cross-sectional network using graphical LASSO. Core and bridge symptoms were identified using strength centrality. Goldbricker was used to reduce topological overlap. The node with the highest strength centrality was Concern over Mistakes, followed by Eating Preoccupation, Social Fear, and Overvaluation of Weight and Shape. The nodes with the highest bridge strength were Concern over Mistakes, Doubt about Actions, Overvaluation of Weight and Shape, and Depression. Notably, both performance on a cognitive flexibility task and BMI were not connected to any other nodes and were subsequently removed from the final network. We provide partial support for the cognitive-interpersonal model while also supporting certain premises put forward by the transdiagnostic cognitive-behavioral model. The high centrality of Concern over Mistakes and Social Fear supports the theory that both cognitive and interpersonal difficulties contribute to AN, particularly in adolescence.
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Affiliation(s)
| | - Nathalie T Godart
- Fondation Santé des Etudiants de France, 75014 Paris, France
- CESP, University Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay, 94805 Villejuif, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, 78047 Montigny-le-Bretonneux, France
| | - Melina Fatséas
- INCIA CNRS UMR 5287, Université de Bordeaux, 33000 Bordeaux, France
- Department of Addictology, CHU Bordeaux, 33000 Bordeaux, France
| | - Sylvie Berthoz
- INCIA CNRS UMR 5287, Université de Bordeaux, 33000 Bordeaux, France
- Department of Psychiatry, Institut Mutualiste Montsouris, 75014 Paris, France
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18
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Fioravanti G, Cassioli E, Rossi E, Lucherini Angeletti L, Casale S, Ricca V, Castellini G. The relationship between problematic Instagram use and eating disorders psychopathology: an explanatory structural equation model. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02477-1. [PMID: 37022359 DOI: 10.1007/s00127-023-02477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
An emerging body of research has evidenced the negative influence of using and being exposed to social networking sites (SNSs) on body image. Furthermore, it has been postulated that SNS use might be related with onset and persistence of eating disorders (EDs) psychopathology. The aim of the present study is to evaluate the complex interplay between problematic Instagram use (PIU) (conceptualized as a potential behavioral addiction comprising withdrawal, conflict, tolerance, salience, mood modification and relapse) and ED psychopathology, by means of an explanatory structural equation model. We hypothesized that PIU would be associated with ED symptoms through the mediating role of appearance comparison, individual psychological investment in physical appearance, and body uneasiness. A sample of 386 young female participants (Mage = 26.04 ± 6.73) was recruited, of which 152 had received a diagnosis of ED. ED patients used Instagram more than the control group and showed higher levels of PIU. Results from structural equation modeling (fit indices: χ2 = 44.54, df = 19, p < 0.001; RMSEA = 0.059; CFI = 0.98; SRMR = 0.02) showed that PIU predicted appearance comparison and psychological investment in physical appearance, which in turn predicted body uneasiness. In turn, body uneasiness predicted ED psychopathology and interpersonal difficulties. Our model provides a useful account of how eating disorder symptoms could be triggered and maintained by an addictive use of Instagram.
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Affiliation(s)
- Giulia Fioravanti
- Psychology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Silvia Casale
- Psychology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
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19
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Tan EJ, Raut T, Le LKD, Hay P, Ananthapavan J, Lee YY, Mihalopoulos C. The association between eating disorders and mental health: an umbrella review. J Eat Disord 2023; 11:51. [PMID: 36973817 PMCID: PMC10044389 DOI: 10.1186/s40337-022-00725-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/18/2022] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE There have been an increasing number of systematic reviews indicating the association between eating disorders (ED), including its risk factors, with mental health problems such as depression, suicide and anxiety. The objective of this study was to conduct an umbrella review of these reviews and provide a top-level synthesis of the current evidence in this area. METHOD A systematic search was performed using four databases (MEDLINE Complete, APA PyscInfo, CINAHL Complete and EMBASE). The inclusion criteria were systematic reviews (with or without meta-analysis), published in the English language between January 2015 and November 2022. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for use of JBI Systematic reviews. RESULTS A total of 6,537 reviews were identified, of which 18 reviews met the inclusion criteria, including 10 reviews with meta-analysis. The average quality assessment score for the included reviews was moderate. Six reviews investigated the association between ED and three specific mental health problems: (a) depression and anxiety, (b) obsessive-compulsive symptoms and (c) social anxiety. A further 3 reviews focused on the relationship between ED and attention deficit hyperactivity disorder (ADHD) while 2 reviews focused on ED and suicidal-related outcomes. The remaining 7 reviews explored the association between ED and bipolar disorders, personality disorders, and non-suicidal self-injury. Depression, social anxiety and ADHD are likely to have a stronger strength of association with ED relative to other mental health problems. DISCUSSION Mental health problems such as depression, social anxiety and ADHD were found to be more prevalent among people suffering from eating disorders. Further research is necessary to understand the mechanism and health impacts of potential comorbidities of ED.
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Affiliation(s)
- Eng Joo Tan
- School of Public Health and Preventive Medicine, Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC, 3004, Australia
| | - Tejeesha Raut
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
| | - Long Khanh-Dao Le
- School of Public Health and Preventive Medicine, Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC, 3004, Australia.
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Camden and Campbelltown Hospital, SWSLHD, Campbelltown, NSW, 2560, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, 3125, Australia
| | - Yong Yi Lee
- School of Public Health and Preventive Medicine, Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC, 3004, Australia
- School of Public Health, The University of Queensland, QLD, 4006, Herston, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, QLD, 4076, Wacol, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University Health Economics Group (MUHEG), Monash University, Melbourne, VIC, 3004, Australia
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20
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Social physical anxiety and eating disorders: A systematic review and meta-analysis. Body Image 2023; 45:133-141. [PMID: 36871312 DOI: 10.1016/j.bodyim.2023.02.008] [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: 11/25/2022] [Revised: 01/30/2023] [Accepted: 02/20/2023] [Indexed: 03/07/2023]
Abstract
The present study's aim was to summarize existing quantitative evidence linking social physique anxiety (SPA) and eating disorders (ED). Eligible studies were searched for up to June 2, 2022 in six databases: MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information derived from self-report instruments that allowed for computing the relationship between SPA and ED. Pooled effect sizes (r) were computed using three-level meta-analytic models. Potential sources of heterogeneity were examined using univariable and multivariable meta-regressions. Influence analyses and a three-parameter selection model (3PSM) were used for the purpose of examining the robustness of the results and publication bias, respectively. Results summarizing 170 effect sizes from 69 studies (N = 41,257) showed two main groups of findings. Firstly, that SPA and ED were very largely related (i.e., r = .51). Secondly, that this relationship was stronger (i) among individuals from Western countries, and (ii) when ED scores concerned the diagnostic feature of bulimia/anorexia nervosa involving body image disturbances. The present study adds to the current understanding of ED by suggesting that SPA is a maladaptive emotion with a potential role in the onset and maintenance of these group of pathologies.
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21
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Tagini S, Bastoni I, Villa V, Mendolicchio L, Castelnuovo G, Mauro A, Scarpina F. Affective touch in anorexia nervosa: Exploring the role of social anhedonia and lifespan experiences. J Affect Disord 2023; 324:607-615. [PMID: 36587904 DOI: 10.1016/j.jad.2022.12.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The pleasantness of a gentle and slow, namely affective, touch experienced in interpersonal interactions motivates social closeness. In anorexia nervosa (AN), independent evidence suggests lower pleasantness of affective touch, as well as social withdrawal. We aim to probe both the experience of affective touch and its possible association with social anhedonia and lifespan experiences of affective bodily contacts in AN. METHODS The pleasantness of affective and non-affective touch was compared between fourteen women with AN and fourteen healthy women. Stimuli were traditionally delivered with a brush, with the experimenter's hand, as novelty, and with a stick, as control. The pleasantness of imagined and real touch was probed. Self-report questionnaires assessed social anhedonia and lifespan experiences of affective touch. RESULTS A preserved pleasantness of affective touch emerged in AN in both the imagery and real task, despite higher social anhedonia and less lifespan experience of affective touch than healthy women. LIMITATIONS Affective touch involves loved ones; thus, the experimenter's touch may not resemble real-life interactions. Future research may take advantage of imagery procedures to solve this issue. CONCLUSIONS Body-oriented therapy for AN recognizes touch as a therapeutic tool: ascertaining how touch is experienced is crucial to maximize rehabilitative outcomes. Furthermore, clarifying the possible interplay between interpersonal difficulties in AN and affective touch is especially relevant considering the possible role of the attachment style, which is intensively debated in AN, on affective touch.
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Affiliation(s)
- Sofia Tagini
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, VCO, Italy; "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.
| | - Ilaria Bastoni
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
| | - Valentina Villa
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
| | - Leonardo Mendolicchio
- Istituto Auxologico Italiano, IRCCS, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, VCO, Italy.
| | - Gianluca Castelnuovo
- Istituto Auxologico Italiano, IRCCS, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, VCO, Italy; Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy.
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, VCO, Italy; "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.
| | - Federica Scarpina
- Istituto Auxologico Italiano, IRCCS, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, VCO, Italy; "Rita Levi Montalcini" Department of Neurosciences, University of Turin, Turin, Italy.
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22
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Melles H, Jansen A. Transdiagnostic fears and avoidance behaviors in self-reported eating disorders. J Eat Disord 2023; 11:19. [PMID: 36782316 PMCID: PMC9926724 DOI: 10.1186/s40337-023-00745-8] [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: 07/06/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Fears and avoidance behaviors are common symptoms of eating disorders. It was investigated whether different eating disorder diagnoses are equally characterized by similar fears and avoidance behaviors. METHODS Individuals with self-reported eating disorders (n = 250) and healthy controls (n = 95) completed online questionnaires assessing general fears, eating related fears, and avoidance behaviors. RESULTS All self-reported eating disorder diagnoses showed more eating related fears, general fears, and avoidance behaviors than healthy controls. Individuals with binge eating disorder showed less specific and general fears on some but by no means all scales, yet they showed less food avoidance behaviors than all other eating disorders and less eating restraint than anorexia nervosa and bulimia nervosa. CONCLUSIONS Eating related fears, general fears, and food avoidance behaviors were found to be transdiagnostic symptoms in self-reported eating disorders. Individuals with binge eating disorder also exhibit more fears and avoidance behaviors than healthy controls, but to a lesser extent than the other eating disorders. Specialized interventions targeting fears and avoidance may be promising add-on interventions not only in the treatment of anorexia nervosa, but in the treatment of all eating disorders.
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Affiliation(s)
- Hanna Melles
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Martini M, Marzola E, Musso M, Brustolin A, Abbate-Daga G. Association of emotion recognition ability and interpersonal emotional competence in anorexia nervosa: A study with a multimodal dynamic task. Int J Eat Disord 2023; 56:407-417. [PMID: 36373846 DOI: 10.1002/eat.23854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Interpersonal difficulties are evidenced in Anorexia Nervosa (AN) and are thought to contribute to disease onset and maintenance, however, research in the framework of emotional competence is currently limited. Previous studies have often only used static images for emotion recognition tasks, and evidence is lacking on the relationships between performance-based emotional abilities and self-reported intra- and interpersonal emotional traits. This study aimed to test multimodal dynamic emotion recognition ability in AN and analyze its correlation with the psychometric scores of self- and other-related emotional competence. METHOD A total of 268 participants (128 individuals with AN and 140 healthy controls) completed the Geneva Emotion Recognition Test, the Profile of Emotional Competence, the Reading the Mind in the Eyes Test, and measures of general and eating psychopathology. Scores were compared between the two groups. Linear mixed effects models were utilized to examine the relationship between emotion recognition ability and self-reported measures and clinical variables. RESULTS Individuals with AN showed significantly poorer recognition of emotions of both negative and positive valence and significantly lower scores in all emotional competence dimensions. Beside emotion type and group, linear mixed models evidenced significant effects of interpersonal comprehension on emotion recognition ability. DISCUSSION Individuals with AN show impairment in multimodal emotion recognition and report their difficulties accordingly. Notably, among all emotional competence dimensions, interpersonal comprehension emerges as a significant correlate to emotion recognition in others, and could represent a specific area of intervention in the treatment of individuals with AN. PUBLIC SIGNIFICANCE In this study, we evidence that the ability to recognize the emotions displayed by others is related to the level of interpersonal emotional competence reported by individuals with anorexia nervosa. This result helps in understanding the social impairments in people with anorexia nervosa and could contribute to advancements in the application of the training of emotional competence in the treatment of this disorder.
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Affiliation(s)
- Matteo Martini
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Maria Musso
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience "Rita Levi Montalcini,", University of Turin, Turin, Italy
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Psychometric Examination of the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) among Spanish Adolescents and Young Adults. Nutrients 2023; 15:nu15030626. [PMID: 36771333 PMCID: PMC9921885 DOI: 10.3390/nu15030626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
The Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) has been frequently used within the context of research on eating disorders (ED). Although both long (BEECOM-L) and short (BEECOM-S) versions of the instrument exist, their psychometric properties have not yet been concurrently investigated across different populations in terms of age and gender. The present study aimed to compare the psychometric properties of both the BEECOM-L and the BEECOM-S among Spanish male and female non-clinical adolescents and young adults. Data from 4 samples including 1213 middle school and college students enrolled in 10 education centers from southern Spain (age ranging from 12 to 35 years, Mage = 17.796, SDage = 4.796, 53% females) were analyzed using factorial, correlation, and regression analysis techniques. Results provided evidence that support the reliability, measurement invariance according to age and gender, and convergent/incremental validity for the scores from both the BEECOM-L and BEECOM-S. Concerning factorial validity, marginally acceptable and adequate goodness-of-fit indices were obtained for the BEECOM-L and BEECOM-S, respectively. The BEECOM-S proves to be a psychometrically sound instrument with potential value for assessing social comparisons focused on body, eating, and exercise in non-clinical adolescents and young adults from Spain.
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25
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A predictor of emotional eating in adolescents: Social anxiety. Arch Psychiatr Nurs 2023; 43:71-75. [PMID: 37032018 DOI: 10.1016/j.apnu.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/27/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023]
Abstract
This descriptive, cross-sectional study was conducted to determine the effect of social anxiety on emotional eating in adolescents. The sample consisted of 1027 adolescents between aged 14-18 studying in the 9-12th grades of the high schools in the Central Anatolia Region in the 2018-2019 academic year. Ethics Committee and institutional permission was obtained in this study, data were collected by a questionnaire, the Social Anxiety Scale for Children-Revised (SASC-R), and The Emotional Eating Scale Adapted for Use in Children and Adolescents (EES-C). Data were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test and simple linear regression analysis. Adolescents had a mean SASC-R and EES-C score of 43.49 ± 16.56 and 61.93 ± 18.68, respectively. It was found that there was a relationship between EES-C mean scores and SASC-R mean scores, and they explained 35.0 % of the scores they got from the EES-C scale (p < 0.05). In conclusion, adolescents had moderate emotional eating and social anxiety. The higher the social anxiety, the higher the emotional eating. School personnel, parents and healthcare professionals need education about social anxiety and eating disorders in adolescents in order to detect symptoms early and intervene to better support adolescents struggling with social anxiety.
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26
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Hart LM, Mitchison D, Fuller-Tyszkiewicz M, Giles S, Fardouly J, Jarman HK, Damiano SR, McLean SA, Prichard I, Yager Z, Krug I. "Can you see me?" Videoconferencing and eating disorder risk during COVID-19: Anxiety, impairment, and mediators. Int J Eat Disord 2023; 56:235-246. [PMID: 36331070 PMCID: PMC10100378 DOI: 10.1002/eat.23844] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of videoconferencing has increased during the pandemic, creating prolonged exposure to self-image. This research aimed to investigate whether eating disorder (ED) risk was associated with videoconferencing performance for work or study and to explore whether the use of safety behaviors and self-focused attention mediated the relationship between ED risk and perceived control over performance anxiety, impaired engagement, or avoidance of videoconferencing for work or study. METHOD In 2020, an online survey was distributed within Australia to those aged over 18 years via academic and social networks, measuring: use of videoconferencing for work/study, demographics, ED risk, safety behaviors for appearance concerns, self-focused attention, perceived control over performance anxiety, perceived engagement impairment, and avoidance of videoconferencing. A total of 640 participants (77.3% female, Mage = 26.2 years) returned complete data and were included in analyses. RESULTS 245 participants (38.7%) were considered at-risk for EDs (SCOFF > 2). Those at-risk reported significantly more safety behaviors, self-focused attention, impaired engagement, and avoidance, plus lower perceived control over performance anxiety than those not at-risk. Multiple mediation models found the effects of ED risk on control over performance anxiety, impaired engagement, and avoidance were partially mediated by safety behaviors and self-focused attention. DISCUSSION Our cross-sectional findings suggest videoconferencing for work/study-related purposes is associated with performance anxiety, impaired engagement, and avoidance among individuals at-risk for EDs. Poorer videoconferencing outcomes appear more strongly related to social anxiety variables than ED status. Clinicians and educators may need to provide extra support for those using videoconferencing. PUBLIC SIGNIFICANCE Because videoconferencing often involves seeing your own image (via self-view) we wondered whether the appearance concerns experienced by those with eating disorders (EDs) might interfere with the ability to focus on or to contribute to work/study videoconferencing meetings. We found that although those with EDs experience more impairments in their videoconferencing engagement/contribution, these were linked just as strongly to social anxiety as they were to appearance concerns.
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Affiliation(s)
- Laura M Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.,EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,The Body Confident Collective, Coffs Habour, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | | | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | | | - Hannah K Jarman
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Stephanie R Damiano
- EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Siân A McLean
- EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ivanka Prichard
- The Body Confident Collective, Coffs Habour, New South Wales, Australia.,College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Zali Yager
- The Body Confident Collective, Coffs Habour, New South Wales, Australia.,Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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27
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Gilbert K, Sudit E, Fox NA, Barch DM, Luby JL. Childhood behavioral inhibition and overcontrol: Relationships with cognitive functioning, error monitoring, anxiety and obsessive-compulsive symptoms. Res Child Adolesc Psychopathol 2022; 50:1629-1642. [PMID: 35852701 PMCID: PMC9906714 DOI: 10.1007/s10802-022-00953-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
Anxiety and obsessive-compulsive disorders are common childhood psychiatric disorders. Behavioral inhibition (BI) is a widely studied risk factor for anxiety. Less is known about overcontrol, a related behavioral phenotype characterized by concern for errors, perfectionism, and inflexibility and also associated with anxiety and obsessive-compulsive disorder. Both BI and overcontrol show associations with aberrant cognitive control and neural error responding (via the error-related negativity; ERN) yet it is unknown whether each imparts differential risk. Understanding whether overcontrol demonstrates independent associations from BI with cognitive functioning, neural error monitoring, and childhood anxiety and obsessive-compulsive presentations could aid in identifying a novel mechanistic treatment target. We assessed BI, overcontrol, cognitive functioning and psychopathology in a cross-sectional sample of 5-6 year old children (N = 126). Children completed an electroencephalogram (EEG) to assess the ERN. Overcontrol was associated with worse cognitive shifting, worse inhibitory control and higher anxiety and obsessive-compulsive symptoms, beyond BI. BI was associated with worse cognitive shifting, better inhibitory control and higher anxiety symptoms, beyond overcontrol. When assessed simultaneously, only overcontrol demonstrated a significant relationship with a blunted ERN. Moreover, overcontrol mediated (cross-sectionally) the well-established relationship between ERN and anxiety and obsessive-compulsive symptoms. BI and overcontrol impart differential risk for child cognitive functioning and anxiety while overcontrol demonstrates additional risk for aberrant neural error monitoring, anxiety and obsessive-compulsive presentations. Overcontrol may also be a mechanistic pathway between the ERN and transdiagnostic anxiety and obsessive-compulsive symptoms. Overcontrol may be a target warranted for early-childhood intervention in anxiety and OCD.
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Affiliation(s)
- Kirsten Gilbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ella Sudit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Kerr-Gaffney J, Jones E, Mason L, Hayward H, Murphy D, Loth E, Tchanturia K. Social attention in anorexia nervosa and autism spectrum disorder: Role of social motivation. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1641-1655. [PMID: 34845940 PMCID: PMC9483678 DOI: 10.1177/13623613211060593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LAY ABSTRACT Research suggests a relationship between autism and anorexia nervosa. For example, rigid and inflexible behaviour, a preference for routine and social difficulties are seen in both conditions. In this study, we examined whether people with anorexia and people with autism show similarities in social attention (where they look while engaging in social interactions or watching a scene with people interacting). This could help us understand why people with anorexia and autism experience difficulties in social situations. Participants with either anorexia or autism, as well as participants with no mental health problems watched a video of a social scene while we recorded which parts of the scene they looked at with an eye-tracker. Participants also completed questionnaires to assess characteristics of autism. We found that autistic participants looked at faces less than typically developing participants. However, participants with anorexia did not show a similar reduction in attention to faces, contrary to our predictions. Autistic features were not related to attention in either group. The results suggest that autistic people may miss important social cues (like facial expressions), potentially contributing to social difficulties. However, this mechanism does not appear explain social difficulties in people with anorexia.
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Affiliation(s)
| | | | | | | | | | | | - Kate Tchanturia
- King’s College London, UK
- South London and Maudsley NHS
Trust, UK
- Ilia State University,
Georgia
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29
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Affective cognition in eating disorders: a systematic review and meta-analysis of the performance on the "Reading the Mind in the Eyes" Test. Eat Weight Disord 2022; 27:2291-2307. [PMID: 35384555 PMCID: PMC9556412 DOI: 10.1007/s40519-022-01393-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/13/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Reading the Mind in the Eyes Test (RMET) is listed in the National Institute of Mental Health's Research Domain Criteria as a tool apt to measure the understanding of others' mental states. People diagnosed with anorexia nervosa (AN) showed poorer performances on the RMET than healthy controls. Less data are available concerning other eating disorders. METHODS Systematic review of four major databases from inception to July 15, 2021 following the PRISMA guidelines. Meta-analysis of cross-sectional observational studies comparing the scores of the RMET between patients with eating disorders and age- and-gender matched control groups. RESULTS Out of 21 studies, we retrieved 29 independent samples of patients diagnosed with an eating disorder. Patients with active AN (n = 580) showed worse performances on the RMET than controls (n = 1019). Year of publication accounted for 61% of the (substantial: I2 = 81%) heterogeneity in the meta-analysis. Earlier studies were more likely to find worse performances on the RMET of patients with active AN than later studies. Patients with bulimia nervosa (n = 185) performed poorly as compared to controls (n = 249), but the results were not statistically significant on the random-effect model. Obese patients with binge-eating disorder (n = 54) did not differ on the RMET from obese controls (n = 52). Patients with eating disorder not otherwise specified (n = 57) showed minimal differences compared to controls (n = 96). Study quality was good in six studies only. CONCLUSIONS Patients with eating disorders do not suffer from an impaired understanding of others' mental states, except for a still-to-be-identified subgroup of patients with active AN. LEVEL OF EVIDENCE I, systematic review and meta-analysis.
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30
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Thorsteinsdottir S, Njardvik U, Bjarnason R, Olafsdottir AS. Changes in Eating Behaviors Following Taste Education Intervention: Focusing on Children with and without Neurodevelopmental Disorders and Their Families: A Randomized Controlled Trial. Nutrients 2022; 14:4000. [PMID: 36235654 PMCID: PMC9571701 DOI: 10.3390/nu14194000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Fussy-eating children often display problematic behaviors around mealtimes, such as irritation, opposition, or may even throw tantrums. This may lead to reduced food variety and poor nutritional profiles, which may increase parents' worries about their children's diet, particularly when the children also have neurodevelopmental disorders (ND) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactive Disorder (ADHD). To investigate the effect of Taste Education on problematic mealtime behaviors, 81 children aged 8-12 years, with ND (n = 33) and without (n = 48), and their parents, participated in a 7-week Taste Education intervention. Children were matched on age, sex, and ND, and allocated at random into Immediate-intervention and Delayed-intervention groups. Parents completed the Meals in Our Household Questionnaire (MiOH). To examine changes in MiOH-scores, repeated-measures analysis-of-variance with time-points were used, with condition as factors (Immediate intervention and Delayed intervention). Baseline measures were adjusted for, and a robust linear mixed-model was fitted. Results showed superior outcomes for Intervention compared to waiting on all measures of MiOH, with stable effects through six-month follow-up. Differences were non-significant between children with and without ND. The Taste Education program suggests a promising, simple, and non-intrusive way to reduce children's problematic mealtime behaviors in the long term.
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Affiliation(s)
- Sigrun Thorsteinsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
| | - Urdur Njardvik
- Faculty of Psychology, School of Health Sciences, University of Iceland, Saemundargata 12, 102 Reykjavik, Iceland
| | - Ragnar Bjarnason
- Faculty of Medicine, School of Health Sciences, University of Iceland, Laeknagardur 4th Floor, Vatnsmyrarvegur 16, 101 Reykjavik, Iceland
- Department of Pediatrics, National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure Studies, School of Education, University of Iceland, Stakkahlid, 105 Reykjavik, Iceland
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31
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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Kenny B, Fuller-Tyszkiewicz M, Moodie M, Brown V, Williams J. Bi-directional associations between depressive symptoms and eating disorder symptoms in early adolescence. Body Image 2022; 42:246-256. [PMID: 35841698 DOI: 10.1016/j.bodyim.2022.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022]
Abstract
Despite frequently co-occurring, the temporal relationship between depression and eating disorder symptoms remains poorly understood. This exploratory study sought to investigate the reciprocal relationship between depressive symptoms and (1) shape and weight dissatisfaction, (2) shape and weight overvaluation, (3) preoccupation with shape or weight, (4) preoccupation with food, (5) dietary restraint and (6) binge eating in early adolescence. Adolescents (N = 1393) aged between 11.4 and 13.9 years (M = 12.50, SD = 0.38) completed the Centre for Epidemiological Depression Scale-Revised and Eating Disorder Examination Questionnaire-Adolescent version at the beginning of secondary school (T1) and 12-months later (T2). Cross-lagged models were created to assess the reciprocal relationship between depressive symptoms and ED symptoms. Depressive symptoms at T1 predicted shape and weight dissatisfaction, shape and weight overvaluation, preoccupation with shape or weight, preoccupation with food, dietary restraint and binge eating at T2. Shape and weight dissatisfaction and binge eating were the only ED symptoms at T1 to predict depressive symptoms at T2. Findings suggest young adolescents who experience depressive symptoms in their first year of secondary school are at-risk of developing ED symptoms over the subsequent 12-month period.
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Affiliation(s)
- Bridget Kenny
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia.
| | - Matthew Fuller-Tyszkiewicz
- Deakin University, School of Psychology, Geelong, Victoria, Australia; Deakin University, Strategic Research Centre for Social and Early Emotional Development, Geelong, Victoria, Australia.
| | - Marj Moodie
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia; Deakin University, Deakin Health Economics, Geelong, Victoria, Australia.
| | - Vicki Brown
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia; Deakin University, Deakin Health Economics, Geelong, Victoria, Australia.
| | - Joanne Williams
- Deakin University, Institute for Health Transformation, School of Health and Social Development, Geelong, Victoria, Australia; Swinburne University of Technology, School of Health Sciences, Hawthorn, Victoria, Australia.
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Brown ML, Levinson CA. Core eating disorder fears: Prevalence and differences in eating disorder fears across eating disorder diagnoses. Int J Eat Disord 2022; 55:956-965. [PMID: 35567750 DOI: 10.1002/eat.23728] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Fear and anxiety are key maintaining factors for eating disorder (ED) pathology. Maladaptive fears lead to ED behaviors and avoidance, which provide temporary relief, but ultimately reinforce the fear and contribute to a cycle that maintains the ED. To date, fears of food and weight gain are the most explored fears underlying ED pathology. However, recently other important ED fears have been identified, including fears of social consequences and personal consequences. METHOD The current study (N = 229 individuals with an ED) aimed to better characterize ED fears. Specifically, this study examined which ED fears were most endorsed across and within ED diagnoses, and if there were differences in ED fears by diagnosis and by weight status. RESULTS Overall, fear of gaining weight was the most frequently endorsed fear, followed by fear of food, and fear of judgment. Individuals with anorexia nervosa (AN) most frequently endorsed fear of food, individuals with atypical AN and bulimia nervosa: fear of gaining weight, and those with other specified feeding and eating disorder: fear of judgment. Limited differences were found between diagnoses. When examining by weight category, participants with underweight most frequently endorsed fear of food, participants with normal weight: fear of gaining weight, and participants with overweight and obesity: fear of judgment. DISCUSSION These findings suggest ED fears are heterogenous. Given such high heterogeneity, this work highlights the importance of assessing for specific ED fears at the beginning of treatment, which could be used to deliver personalized exposure treatment. PUBLIC SIGNIFICANCE STATEMENT Eating disorders (EDs) are serious mental illnesses with high rates of medical and psychiatric comorbidities. Fear plays an important role in the development and maintenance of EDs. The present study found fear of food, weight gain, and judgment are the most frequently endorsed fears for individuals with EDs and found few differences in fears based on ED diagnosis. These findings highlight the importance of assessing individuals' specific ED fears for treatment.
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Affiliation(s)
- Mackenzie L Brown
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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A network approach can improve eating disorder conceptualization and treatment. NATURE REVIEWS PSYCHOLOGY 2022; 1:419-430. [PMID: 36330080 PMCID: PMC9624475 DOI: 10.1038/s44159-022-00062-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eating disorders are severe mental illnesses with the second highest mortality rate of all psychiatric illnesses. Eating disorders are exceedingly deadly because of their complexity. Specifically, eating disorders are highly comorbid with other psychiatric illnesses (up to 95% of individuals with an eating disorder have at least one additional psychiatric illness), have extremely heterogeneous presentations, and individuals often migrate from one specific eating disorder diagnosis to another. In this Perspective, we propose that understanding eating disorder comorbidity and heterogeneity via a network theory approach offers substantial benefits for both conceptualization and treatment. Such a conceptualization, strongly based on theory, can identify specific pathways that maintain psychiatric comorbidity, how diagnoses vary across individuals, and how specific symptoms and comorbidities maintain illness for one individual, thereby paving the way for personalized treatment.
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35
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Thorsteinsdottir S, Olafsdottir AS, Brynjolfsdottir B, Bjarnason R, Njardvik U. Odds of fussy eating are greater among children with obesity and anxiety. Obes Sci Pract 2022; 8:91-100. [PMID: 35127125 PMCID: PMC8804926 DOI: 10.1002/osp4.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fussy eating has been associated with autism spectrum disorder (ASD), attention-deficit/hyperactive disorder (ADHD), anxiety, and depression. Despite these disorders being prevalent in obesity treatment, no studies have been published on the association of fussy eating in children with obesity and these disorders. Understanding fussy eating in children with obesity and comorbid disorders is important as acceptance of healthy foods tends to be low, especially in children with sensory sensitivities. OBJECTIVES Investigate the prevalence of fussy eating in a cross-sectional sample of children with obesity and ASD, ADHD, anxiety, and depression; and whether they were more likely to be fussy eaters, comparing those with and without these disorders. METHODS One hundred and four children referred to family-based obesity treatment in Iceland 2011-2016, mean age 12.0 (SD = 3.0), mean body mass index standard deviation score 3.5 (SD = 0.9). Binary logistic regression was used to estimate the relationship between fussy eating and disorders, adjusting for medication use. RESULTS A large minority (41.6%) were fussy eaters and 48.9% had at least one comorbid disorder. Over a third of children rejected bitter and sour tastes, and 1.9% and 7.9% rejected sweet and salty tastes, respectively. Compared with those without disorders, the odds of being a fussy eater were increased by a factor of 4.11 when having anxiety (95% confidence intervals) (1.02-16.58, p = 00.046), adjusting for medication use. The odds of being a fussy eater were not increased for other disorders; ASD, ADHD, or depression. CONCLUSIONS In children attending obesity treatment, fussy eating was common. Clinical care models in pediatric obesity treatment should address fussy eating, especially in children with anxiety.
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Affiliation(s)
| | - Anna S. Olafsdottir
- Faculty of Health Promotion, Sport and Leisure StudiesUniversity of IcelandReykjavikIceland
| | | | - Ragnar Bjarnason
- Department of PediatricsLandspitali University HospitalReykjavikIceland
- Faculty of MedicineUniversity of IcelandReykjavikIceland
| | - Urdur Njardvik
- Faculty of PsychologyUniversity of IcelandReykjavikIceland
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Gilbert KE, Wheelock MD, Kandala S, Eggebrecht AT, Luby JL, Barch DM. Associations of observed preschool performance monitoring with brain functional connectivity in adolescence. Cortex 2021; 142:15-27. [PMID: 34174721 PMCID: PMC8405590 DOI: 10.1016/j.cortex.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/12/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Monitoring one's performance helps detect errors and adapt to prevent future mistakes. However, elevated performance monitoring is associated with increased checking behaviors and perfectionism and is characteristic of multiple psychiatric disorders. Understanding how heightened performance monitoring in early childhood relates to subsequent brain connectivity may elucidate mechanistic risk factors that influence brain and psychiatric outcomes. The aim of this study was to examine the association between performance monitoring in preschool-aged children and functional connectivity during adolescence. In the current prospective longitudinal study, we performed seed-based functional connectivity analysis using a dorsal anterior cingulate cortex (dACC) seed to assess brain-behavior relationships between observationally coded performance monitoring in preschool-aged children and adolescent functional connectivity (n = 79). We also utilized enrichment analysis to investigate network-level connectome-wide associations. Seed-based analysis revealed negative correlations between preschool performance monitoring and adolescent fc between dACC and orbitofrontal and dorsolateral prefrontal cortex while a positive correlation was observed between dACC-occipital cortex connectivity. Enrichment analysis revealed a negative correlation between preschool performance monitoring and connectivity between motor (MOT) - cingulo-opercular (CO) and salience (SN) - Reward (REW) and a positive correlation with MOT-DMN, and cerebellum (CB) - motor connectivity. Elevated performance monitoring in early childhood is associated with functional connectivity during adolescence in regions and networks associated with cognitive control, sensorimotor processing and cortico-striatal-thalamic-cortico (CTSC) aberrations. These regions and networks are implicated in psychiatric disorders characterized by elevated performance monitoring. Findings shed light on a mechanistic risk factor in early childhood with long-term associations with neural functioning.
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Affiliation(s)
- Kirsten E Gilbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Muriah D Wheelock
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sridhar Kandala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Adam T Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA; Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
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Kerr-Gaffney J, Mason L, Jones E, Hayward H, Harrison A, Murphy D, Tchanturia K. Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa. J Autism Dev Disord 2021; 51:2077-2090. [PMID: 32910314 PMCID: PMC8124046 DOI: 10.1007/s10803-020-04686-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Ilia State University, Tbilisi, GA, USA
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Kerr-Gaffney J, Hayward H, Jones EJH, Halls D, Murphy D, Tchanturia K. Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder. Mol Autism 2021; 12:47. [PMID: 34193255 PMCID: PMC8247081 DOI: 10.1186/s13229-021-00455-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
Background Recent research suggests a link between autism spectrum disorder (ASD) and anorexia nervosa (AN). Individuals with AN show high scores on measures of ASD symptoms, relative to individuals without AN, however, there are currently no studies directly comparing women with AN to women with ASD. The aim of the current study was to examine profiles of ASD symptoms in young women in the acute and recovered stages of AN, women with ASD, and typically developing controls (TD), on both self-report and clinical interview measures. Methods Four groups of participants aged 12–30 years were included (n = 218): AN, recovered AN (REC), ASD, and TD. Group differences on the Social Responsiveness Scale, 2nd edition (SRS-2), 10-item Autism Quotient (AQ-10), and the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) were examined. To explore similarities and differences in specific symptom profiles associated with AN and ASD, individual item endorsement on the ADOS-2 was also examined in AN, REC, and ASD. Results Across measures, women with ASD showed the highest scores, and TDs the lowest. Generally, individuals with AN and REC showed intermediate levels of ASD symptoms, scoring between the other two groups. However, AN and ASD did not differ on restricted interests and repetitive behaviour subscales. The ADOS-2 item ‘quality of social response’ adequately discriminated between ASD and non-ASD participants. Limitations A full diagnostic assessment for ASD was not provided for participants with AN/REC, nor were eating disorders assessed in the ASD group. Therefore, some diagnostic overlap between groups is possible. The cross-sectional design is another limitation. Conclusions The results suggest similarities in scores on both self-report and clinical interview measures in AN and ASD. However, individual ADOS-2 item analyses also revealed subtle differences, particularly in reciprocal social interaction. ASD symptoms may be a combination of both state and trait features in AN. Supplementary Information The online version contains supplementary material available at 10.1186/s13229-021-00455-5.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.,Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders. Nutrients 2021; 13:nu13072145. [PMID: 34201433 PMCID: PMC8308216 DOI: 10.3390/nu13072145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (EDs) are severe psychiatric illnesses that require individualized treatments. Decision-making deficits have been associated with EDs. Decision-making learning deficits denote a lack of strategies to elaborate better decisions that can have an impact on recovery and response to treatment. This study used the Iowa Gambling Task (IGT) to investigate learning differences related to treatment outcome in EDs, comparing between patients with a good and bad treatment outcome and healthy controls. Likewise, the predictive role of impaired learning performance on therapy outcome was explored. Four hundred twenty-four participants (233 ED patients and 191 healthy controls) participated in this study. Decision making was assessed using the Iowa Gambling Task before any psychological treatment. All patients received psychological therapy, and treatment outcome was evaluated at discharge. Patients with bad outcome did not show progression in the decision-making task as opposed to those with good outcome and the healthy control sample. Additionally, learning performance in the decision-making task was predictive of their future outcome. The severity of learning deficits in decision making may serve as a predictor of the treatment. These results may provide a starting point of how decision-making learning deficits are operating as dispositional and motivational factors on responsiveness to treatment in EDs.
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40
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Peleg O, Tzischinsky O, Spivak-Lavi Z. Depression and social anxiety mediate the relationship between parenting styles and risk of eating disorders: A study among Arab adolescents. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:853-864. [PMID: 34132397 DOI: 10.1002/ijop.12787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
In multicultural Israel, the prevalence of eating disorders (EDs), a common chronic disorder among Western adolescents (especially females), has risen for Arab adolescents, who belong to an Eastern collectivist society. The study examines family and psychological factors that may increase the risk of EDs among Muslim Arab adolescents. We expected social anxiety and depressive symptoms to mediate the association between parenting styles and risk of EDs, with possible gender differences in the mediation model. Participants were 613 Muslim adolescents (394 females and 219 males); mean age = 15.4 ± 1.6; range = 12-19. The analyses revealed that the severity of depressive symptoms and especially social anxiety mediate the relationship between authoritarian parenting style and risk of EDs. Females reported higher levels of risk of EDs, social anxiety, depression and authoritative parenting style than males; no differences appeared for authoritarian or permissive parenting styles. The research sheds new light on risk factors for EDs and the likelihood of authoritarian parenting style and social anxiety being involved in the aetiology of EDs among Arab adolescents. The outcomes meaningfully add to understanding of specific psychological processes that may be associated with the risk of EDs in this population.
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Affiliation(s)
- Ora Peleg
- Department of School Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Orna Tzischinsky
- Department of School Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Zohar Spivak-Lavi
- Department of School Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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Melles H, Spix M, Jansen A. Avoidance in Anorexia Nervosa: Towards a research agenda. Physiol Behav 2021; 238:113478. [PMID: 34058219 DOI: 10.1016/j.physbeh.2021.113478] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/15/2021] [Accepted: 05/26/2021] [Indexed: 01/27/2023]
Abstract
Anorexia Nervosa is a severe and disabling mental disorder and a huge challenge to treat. Intense fears of e.g., food, eating, weight gain and social evaluation are core features of anorexia nervosa and obstacles during treatment. The perceived threats trigger avoidance and safety behaviors like highly restrictive eating, strict eating rules, vomiting and body checking, to minimize feared outcomes. The role of avoidance in anorexia nervosa is however hardly studied experimentally. In the present article, the focus is on a new transdiagnostic research agenda featuring both basic and clinical experimental research into avoidance as a most important mechanism maintaining the eating disorder. Avoidance learning and the generalization of learned avoidance behaviors are discussed, as well as safety behaviors and the need for inhibitory learning as a treatment target during exposure therapy.
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Affiliation(s)
- Hanna Melles
- Clinical Psychological Science, Maastricht University, the Netherlands
| | - Michelle Spix
- Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anita Jansen
- Clinical Psychological Science, Maastricht University, the Netherlands.
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Harrison A. Experimental Investigation of Non-Verbal Communication in Eating Disorders. Psychiatry Res 2021; 297:113732. [PMID: 33535088 DOI: 10.1016/j.psychres.2021.113732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to be the first to measure non-verbal communication in 25 eating disorder (ED) and 25 non-ED control participants during a naturalistic social interaction incorporating positive, negative and neutrally-valenced topics. The first hypothesis, that ED participants would show significantly reduced facial emotional expression than controls, was not supported. Supporting the second hypothesis of between-group differences in non-verbal behaviour, ED participants were less likely to lean in towards their interlocutor (d=.81) discussing negatively-valanced topics and were more likely to be positioned upright when discussing positively-valenced topics (d=.1.09) than controls. Irrespective of emotional valence, ED participants positioned their gaze on their interlocutor significantly less (d=.29) and spent more time looking down (d=.54), or away than controls (d=.63). ED participants moved their hands along with speech significantly less (d=.63) and gestured fewer real/hypothetical/imagined images/actions/objects) than controls (d=.57), irrespective of emotional valence. Instead, ED participants indicated discomfort in the social interaction, touching their nose (d=.89) or playing with their nails (d=.95) more often than controls. ED participants, regardless of emotional valence, showed significantly lowered electro-dermal activity (d=.60) than controls, supporting the exploratory hypothesis. People with EDs appear to make less efficient use of non-verbal communication than controls.
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Affiliation(s)
- A Harrison
- Associate Professor in Psychology, University College London, Institute of Education, Department of Psychology and Human Development.
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de Souza ALG, de Almeida AA, Noll PRES, Noll M. Unhealthy life habits associated with self-induced vomiting and laxative misuse in Brazilian adolescents. Sci Rep 2021; 11:2482. [PMID: 33510267 PMCID: PMC7843628 DOI: 10.1038/s41598-021-81942-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023] Open
Abstract
Adolescence is a stage in life characterized by important social, cognitive, and physical changes. Adolescents are vulnerable to various psychosocial disorders, including eating disorders. We aimed to investigate the association between unhealthy habits, sociodemographic characteristics, and the practice of self-induced vomiting or laxative misuse in a representative sample of Brazilian adolescent girls and boys. Data from 102,072 students who participated in the National Adolescent School-based Health Survey were analyzed using the dependent variable: presence or absence of self-induced vomiting and/or laxative misuse; independent variables: consumption of unhealthy and high-calorie food items, age during first sexual intercourse, and the use of tobacco, alcohol, and/or illicit drugs. Associations between exposure and outcome were estimated using Poisson's regression models stratified by sex, and including region, school, age group, and mother's educational history as adjustment variables. Eating ultra-processed foods and age during first sexual intercourse were associated with self-induced vomiting and laxative misuse only for girls; all other variables (consuming unhealthy foods and using legal or illicit substances) were associated with these behaviors for both sexes after applying adjustment variables. Early interventions focusing on changing unhealthy behaviors may prevent development of eating disorders in adolescents. Our findings demonstrate a strong association of many unhealthy habits with laxative misuse and self-induced vomiting practices in Brazilian adolescents.
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Affiliation(s)
| | | | - Priscilla Rayanne E Silva Noll
- Instituto Federal de Educação, Ciência e Tecnologia Goiano, Campus Ceres, Ceres, GO, Brazil
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Matias Noll
- Instituto Federal de Educação, Ciência e Tecnologia Goiano, Campus Ceres, Ceres, GO, Brazil.
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Barnhart WR, Hamilton L, Jordan AK, Pratt M, Musher-Eizenman DR. The interaction of negative psychological well-being and picky eating in relation to disordered eating in undergraduate students. Eat Behav 2021; 40:101476. [PMID: 33581480 DOI: 10.1016/j.eatbeh.2021.101476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/29/2022]
Abstract
The extant literature on picky eating focuses on children, leaving adults understudied. A sparse and mixed evidence base suggests relationships exist between picky eating and disordered eating in adults. The present study furthered this research by examining shared negative psychological correlates as moderators that may strengthen relationships between picky eating and disordered eating in undergraduate students. Participants (N = 509; 76.3% female) completed a cross-sectional survey assessing picky eating (Adult Picky Eating Questionnaire), disordered eating (Binge Eating Scale and Eating Disorder Examination-Questionnaire), and negative psychological correlates including anxiety, depression, and stress (Depression, Anxiety and Stress Scale - 21 Items), inflexible eating (Inflexible Eating Questionnaire), obsessive compulsive disorder (Short Obsessive Compulsive Disorder Screener), and social eating anxiety (adapted Social Phobia Scale) symptoms. Positive relationships were observed between picky eating and binge eating, dietary restraint, eating concerns, overall eating pathology, and all negative psychological correlates. Moderation analyses examined if negative psychological correlates strengthened relationships between picky eating and disordered eating. Higher inflexible eating and anxiety and stress symptoms interacted with higher picky eating in relation to disordered eating, specifically eating concerns. Interactions between picky eating and negative psychological correlates did not explain variance in binge eating, dietary restraint, and overall eating pathology. Findings complement research demonstrating overlap between picky eating and disordered eating and highlight specific negative psychological correlates that may strengthen relationships between picky eating and disordered eating. Researchers and clinicians interested in concurrent picky eating and disordered eating should consider these negative psychological correlates given their potential to worsen disordered eating.
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Affiliation(s)
| | | | - Amy K Jordan
- Department of Psychology, Bowling Green State University, USA
| | - Mercedes Pratt
- Department of Psychology, Bowling Green State University, USA
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Mandelli L, Draghetti S, Albert U, De Ronchi D, Atti AR. Rates of comorbid obsessive-compulsive disorder in eating disorders: A meta-analysis of the literature. J Affect Disord 2020; 277:927-939. [PMID: 33065835 DOI: 10.1016/j.jad.2020.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/21/2020] [Accepted: 09/01/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The high comorbidity between Eating Disorders (EDs) and Obsessive-Compulsive disorder (OCD) is well known, as well as its implications in terms of worse outcome and need to adapt treatment. Estimates of OCD comorbidities in EDs are variable in different studies and poorly informative for clinical purposes. In this study, we sought to derive more consistent estimates, taking into account potential methodological and sampling confounding factors. METHODS We searched published studies reporting lifetime and current rates of comorbid OCD in ED samples based on recent diagnostic criteria. Comorbidity rates were meta-analyzed using a binary random effects model. Heterogeneity among the studies and publication bias were systematically checked. Potential confounding factors were tested by meta-regression analysis and adjusted by sensitivity analysis. RESULTS Globally, respectively 18% and 15% of all patients with an ED had a lifetime and current comorbidity with OCD. Rates were slightly higher in anorexia (19% and 14%) than in bulimia nervosa (13% and 9%), although only the current comorbid OCD was significantly higher in anorexia than in bulimia. Prospective follow-up studies provided considerably higher lifetime estimates (EDs 38%, anorexia 44%, bulimia 19%). LIMITATIONS Temporal/causal relationship between ED and OCD could not be defined. CONCLUSIONS OCD comorbidity in EDs is a relevant phenomenon, affecting almost one fifth of the patients in cross-sectional observations and up to nearly 40% in prospective follow-up studies. These data indicate the need for focused attention to non-food or body-shape related OCD symptoms, for better diagnostic and prognostic accuracy, and targeted treatment.
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Affiliation(s)
- Laura Mandelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Stefano Draghetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Italy Azienda Sanitaria Universitaria Giuliano-Isontina - ASUGI, Trieste, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy
| | - Anna-Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna Italy.
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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47
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Price T, Zebitz M, Giraldi A, Lokind TS, Treasure J, Sjögren JM. Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review. Int J Eat Disord 2020; 53:1377-1399. [PMID: 32449544 DOI: 10.1002/eat.23299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN. METHOD We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded. RESULTS N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions. DISCUSSION Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.
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Affiliation(s)
- Tom Price
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Martin Zebitz
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet Capitol Region of Denmark Psychiatry Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea Stine Lokind
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Jan Magnus Sjögren
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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48
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Benau EM, Wiatrowski R, Timko CA. Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes. Front Psychol 2020; 11:1646. [PMID: 32774318 PMCID: PMC7387713 DOI: 10.3389/fpsyg.2020.01646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.
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Affiliation(s)
- Erik M Benau
- Department of Psychology, University of Kansas, Lawrence, KS, United States
| | - Ryan Wiatrowski
- Department of Psychology, Towson University, Towson, MD, United States
| | - C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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49
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Kerr-Gaffney J, Halls D, Harrison A, Tchanturia K. Exploring Relationships Between Autism Spectrum Disorder Symptoms and Eating Disorder Symptoms in Adults With Anorexia Nervosa: A Network Approach. Front Psychiatry 2020; 11:401. [PMID: 32477185 PMCID: PMC7235355 DOI: 10.3389/fpsyt.2020.00401] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 12/21/2022] Open
Abstract
Over the past few decades, research has accumulated to suggest a relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). Elevated ASD traits are present in around one third of those with AN, and there is some evidence to suggest that ASD traits are associated with more severe eating disorder (ED) psychopathology. The current study aimed to examine relationships between ED and ASD symptoms in individuals with a lifetime history of AN using network analysis. One hundred and one participants completed the ED Examination Questionnaire (EDE-Q) and the Social Responsiveness Scale (SRS-2). A regularized partial correlation network was estimated using a graphical least absolute shrinkage and selection operator. Expected influence (EI) and bridge EI values were calculated to identify central and bridge symptoms respectively. Isolation, difficulties with relating to others, and feelings of tension during social situations were most central to the network, while poor self-confidence, concerns over eating around others, and concerns over others seeing one's body were the strongest bridge symptoms. Our findings confirm that interpersonal problems are central to ED psychopathology. They also suggest poor self-confidence and social anxiety-type worries may mediate the relationship between ED and ASD symptoms in those with a lifetime diagnosis of AN. Longitudinal studies examining fluctuations in symptoms over time may be helpful in understanding direction of causality.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, United Kingdom
- National Eating Disorders Service, Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
- National Eating Disorders Service, Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, United Kingdom
- Department of Psychology, Ilia State University, Tbilisi, Georgia
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50
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Kerr-Gaffney J, Mason L, Jones E, Hayward H, Ahmad J, Harrison A, Loth E, Murphy D, Tchanturia K. Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits. J Clin Med 2020; 9:E1057. [PMID: 32276387 PMCID: PMC7230901 DOI: 10.3390/jcm9041057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Difficulties in socio-emotional functioning are proposed to contribute to the development and maintenance of anorexia nervosa (AN). This study aimed to examine emotion recognition abilities in individuals in the acute and recovered stages of AN compared to healthy controls (HCs). A second aim was to examine whether attention to faces and comorbid psychopathology predicted emotion recognition abilities. The films expressions task was administered to 148 participants (46 AN, 51 recovered AN, 51 HC) to assess emotion recognition, during which attention to faces was recorded using eye-tracking. Comorbid psychopathology was assessed using self-report questionnaires and the Autism Diagnostic Observation Schedule-2nd edition (ADOS-2). No significant differences in emotion recognition abilities or attention to faces were found between groups. However, individuals with a lifetime history of AN who scored above the clinical cut-off on the ADOS-2 displayed poorer emotion recognition performance than those scoring below cut-off and HCs. ADOS-2 scores significantly predicted emotion recognition abilities while controlling for group membership and intelligence. Difficulties in emotion recognition appear to be associated with high autism spectrum disorder (ASD) traits, rather than a feature of AN. Whether individuals with AN and high ASD traits may require different treatment strategies or adaptations is a question for future research.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK;
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London WC1E 7JL, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London WC1E 7JL, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Jumana Ahmad
- School of Human Sciences, University of Greenwich, London SE10 9LS, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London WC1H 0AA, UK
- South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London SE5 8AZ, UK
| | - Eva Loth
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AB, UK;
- South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London SE5 8AZ, UK
- Department of Psychology, Ilia State University, Tbilisi 0162, Georgia
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