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Gagliardini G, Pandolfi G, Colli A. Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients. J Nerv Ment Dis 2024; 212:370-377. [PMID: 38704653 DOI: 10.1097/nmd.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z -scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.
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Lakritz C, Iceta S, Duriez P, Makdassi M, Masetti V, Davidenko O, Lafraire J. Measuring implicit associations between food and body stimuli in anorexia nervosa: a Go/No-Go Association Task. Eat Weight Disord 2023; 28:93. [PMID: 37917374 PMCID: PMC10622378 DOI: 10.1007/s40519-023-01621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
PURPOSE The present study aimed to explore the implicit associations between food and bodily stimuli in patients with anorexia nervosa (AN) and control subjects (HC). METHODS A Go/No-Go Association Task was administrated to 55 participants (28 AN and 27 HC), using food stimuli (low-calorie food vs. high-calorie food) and body stimuli (underweight vs. overweight bodies). RESULTS We evidenced an implicit association between food and body stimuli in the AN group, whereas the HC group only showed a tendency. AN and HC groups also exhibited different categorization strategies: the AN group tended to categorize stimuli as low-calorie foods and underweight bodies less than the HC group, and they tended to categorize stimuli as high-calorie foods and overweight bodies more than the HC group. CONCLUSION The present study revealed for the first time specificities of the AN population's implicit association between food and body stimuli in terms of association strength and categorization strategy. Furthermore, the results suggest that combining implicit methodologies with other methods could contribute to a better characterization of the physiopathology of AN. LEVEL OF EVIDENCE Level I, experimental study.
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Affiliation(s)
- Clara Lakritz
- Centre de Recherche de l'Institut Paul Bocuse, Ecully, France
- Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
| | - Sylvain Iceta
- Département de Psychiatrie et de Neurosciences, Université Laval, Québec, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, QC, Canada
| | - Philibert Duriez
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, 75014, Paris, France
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 75014, Paris, France
| | - Maxime Makdassi
- GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 75014, Paris, France
| | | | - Olga Davidenko
- Université Paris-Saclay, AgroParisTech, INRAE, UMR PNCA, 91120, Palaiseau, France
| | - Jérémie Lafraire
- Centre de Recherche de l'Institut Paul Bocuse, Ecully, France.
- Laboratoire CHArt, Cognitions Humaine et ARTificielle,, EPHE - PSL, École Pratique des Hautes Études - Paris Sciences Lettres, Campus Condorcet, Aubervilliers, France.
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Fithall K, Gray IE, Linardon J, Phillipou A, Donaldson PH, Albein-Urios N, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Exploring the role of autistic traits and eating disorder psychopathology on mentalising ability in the general population. BMC Psychol 2023; 11:269. [PMID: 37674242 PMCID: PMC10483798 DOI: 10.1186/s40359-023-01306-z] [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: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study evaluated the role of overlapping traits and characteristics related to autism spectrum disorder (autism) and anorexia nervosa (AN) in the general population, and the impact of these traits on mentalising ability. METHODS A sample of young adults (N = 306), aged 18-25 years, was recruited to complete an online study that consisted of 4 measures: the Autism-Spectrum Quotient, Eating Disorder Examination Questionnaire, the Mentalization Scale, and the Reading the Mind in the Eyes task. RESULTS Higher levels of autistic traits, particularly difficulty with attention switching, were associated with increased eating disorder psychopathology. Overall, autistic traits and eating disorder psychopathology were related among females, but not males. Difficulty with attention switching, however, was related to eating disorder psychopathology among both females and males. Autistic traits also appear to have a greater role in mentalising ability than does eating disorder psychopathology. CONCLUSION The role of attention switching in overlapping traits of autism and eating disorder psychopathology needs to be more comprehensively evaluated by future research, as does the role of biological sex. Expanded knowledge in this field will help to better understand and evaluate symptoms at presentation, leading to clearer diagnoses and potentially better treatment outcomes.
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Affiliation(s)
- Kate Fithall
- School of Psychology, Deakin University, Geelong, Australia
| | - Indigo E Gray
- School of Psychology, Deakin University, Geelong, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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Dell'Osso L, Carpita B, Nardi B, Benedetti F, Dell'Oste V, Massimetti G, Cremone IM, Barlati S, Castellini G, Luciano M, Bossini L, Rocchetti M, Signorelli MS, Ricca V, Aguglia E, Fagiolini A, Vita A, Politi P, Maj M. Autistic traits distribution in different psychiatric conditions: A cluster analysis on the basis of the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire. Psychiatry Res 2023; 326:115270. [PMID: 37320989 DOI: 10.1016/j.psychres.2023.115270] [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: 06/20/2022] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023]
Abstract
Increasing interest is being paid on full-threshold and sub-threshold autism spectrum conditions among adults. Sub-threshold autistic traits (AT) seem to be distributed in a continuum from the clinical to the general population, being particularly higher among subjects with other psychiatric disorders. The aim of the present study was to evaluate the distribution of AT in a sample of subjects with different psychiatric conditions by means of a cluster analysis on the basis of the score reported to the AdAS Spectrum instrument. A total of 738 subjects recruited by seven Italian Universities were divided in 5 groups depending on the clinical diagnosis: Autism spectrum disorder (ASD), subthreshold ASD symptoms (partial ASD), Bipolar disorder (BD), Feeding and eating disorders (FED), and controls (CTLs). All subjects were assessed with the AdAS Spectrum. The cluster analysis identified 3 clusters: the high, medium and low autism clusters. The Restricted interests and rumination domain reported the highest influence in forming the clusters. The high, medium and low autism clusters were respectively more represented in the ASD, partial ASD and CTL groups. The clusters were represented intermediately in the FED and BD groups, confirming the presence of intermediate levels of AT in these clinical populations.
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Affiliation(s)
- Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy.
| | - Bendetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Valerio Dell'Oste
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa 56127, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giovanni Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Letizia Bossini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Eugenio Aguglia
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Fagiolini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Abstract
BACKGROUND Orthorexia nervosa (ON) is an emerging condition featuring restrictive eating behaviors on the basis of subjective beliefs about food healthiness. Many authors have stressed the similarities between ON and anorexia nervosa (AN) in both cognitive and behavioral patterns. Despite that, while the link between AN and female autism presentations is well known in the literature, no study has yet investigated the relationship between ON and autism spectrum. This work aims to investigate the relationship between ON and autistic traits in a university population. METHODS An e-mail invitation was sent to all the students and University workers of University of Pisa. Subjects were asked to fulfill the ORTO-15 and the Adult Autism Subthreshold spectrum (AdAS spectrum) questionnaires. RESULTS A total of 2426 subjects joined the survey: 623 subjects (26.3%) reported a score associated with significant orthorexic symptoms according to ORTO-15 (ON group), while 1789 subjects (73.7%) did not report ON symptomatology and were considered as healthy controls (HC). The ON group scored significantly higher on almost all AdAS spectrum domains. Moreover, being female and scoring higher on AdAS spectrum were statistically predictive factors for the presence of ON symptomatology. Among AdAS spectrum domains, higher scores on AdAS spectrum inflexibility and adherence to routine and restricted interests and rumination domains, as well as lower scores on verbal communication domain, were statistically predictive of orthorexic symptoms. CONCLUSIONS Our findings highlight an overlap between ON and autism spectrum psychopathology. Further studies are needed to clarify the relationship between restrictive eating disorders and female autism phenotypes.
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Abstract
In the last decades, increasing attention has been provided to socio-cultural and neurobiological factors involved in the psychopathology of feeding and eating disorders (FED), encouraging a multifactorial approach. In this framework, several authors stressed an association between FED and other kinds of psychiatric disorders from both a psychopathological and a neurobiological point of view. In particular, many promising contributions are focusing on the possible link between FED and autism spectrum disorder (ASD). Growing interest about this association rose from the frequently reported evidence of ASD-like traits amongst FED patients and abnormal eating behaviors amongst patients with ASD. This narrative review overview aims to summarize the most relevant findings about the overlap between different kinds of FED and the autism spectrum, taking into account the most recent hypotheses about the psychopathology of both these conditions. While most of the studies focused on anorexia nervosa, both ASD and autistic traits seem to be detectable also in other kinds of FED. In addition, the recently increased interest toward a dimensional approach to psychopathology led to progressively broadening the concept of ASD, focusing on its subthreshold and gender-specific manifestations and on its link with other psychiatric conditions, including FED. Globally the studies summarized here provide further support to theoretical models featuring a neurodevelopmental approach for mental disorders. In particular, FED have been conceptualized as a possible psychopathological trajectory of a neurodevelopmental alteration, toward which female gender would act as one of many predisposing factors.
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Magrini M, Curzio O, Tampucci M, Donzelli G, Cori L, Imiotti MC, Maestro S, Moroni D. Anorexia Nervosa, Body Image Perception and Virtual Reality Therapeutic Applications: State of the Art and Operational Proposal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052533. [PMID: 35270226 PMCID: PMC8909096 DOI: 10.3390/ijerph19052533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/12/2022]
Abstract
Anorexia Nervosa (AN) patients exhibit distorted body representation. The purpose of this study was to explore studies that analyze virtual reality (VR) applications, related to body image issues, to propose a new tool in this field. We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Scopus, and Web of Science databases were explored; the review included 25 studies. Research has increased over the last five years. The selected studies, clinical observational studies (n = 16), mostly concerning patients' population with AN (n = 14) or eating disorders (EDs) diagnosis, presented multiple designs, populations involved, and procedures. Some of these studies included healthy control groups (n = 7). Studies on community sample populations were also selected if oriented toward clinical applications (n = 9). The VR technologies in the examined period (about 20 years) have evolved significantly, going from very complex and bulky systems, requiring very powerful computers, to agile systems. The advent of low-cost VR devices has given a big boost to research works. Moreover, the operational proposal that emerges from this work supports the use of biofeedback techniques aimed at evaluating the results of therapeutic interventions in the treatment of adolescent patients diagnosed with AN.
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Affiliation(s)
- Massimo Magrini
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Olivia Curzio
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
- Correspondence:
| | - Marco Tampucci
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
| | - Gabriele Donzelli
- Department of Health Science, University of Florence, 50134 Florence, Italy;
| | - Liliana Cori
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Maria Cristina Imiotti
- Unit of Environmental Epidemiology, Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (L.C.); (M.C.I.)
| | - Sandra Maestro
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, 56128 Calambrone, Italy;
| | - Davide Moroni
- Institute of Information Science and Technologies “Alessandro Faedo”, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy; (M.M.); (M.T.); (D.M.)
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Ciszewski S, Flood KE, Proctor CJ, Best LA. Exploring the Relationship Between Disordered Eating and Executive Function in a Non-Clinical Sample. Percept Mot Skills 2020; 127:1033-1050. [DOI: 10.1177/0031512520937569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Previous research suggests that individuals diagnosed with eating disorders (ED) may experience executive functioning deficits that help maintain their ED. Although this relationship is reported consistently in clinical samples, it is important to consider whether it holds for individuals with sub-clinical ED symptoms. One hundred eighty-eight university students participated in the present study examining the relationship between executive function (EF) and disordered eating behaviors. Participants completed a demographics questionnaire, self-report questionnaires measuring atypical eating behaviors (EAT-26; EDI-3), and a self-report measure of EF (BRIEF-A). Correlational analyses demonstrated significant positive associations between ED behaviors and problems with emotional control, shifting, inhibition, and self-monitoring. Six hierarchical multiple regressions were conducted, using EF scores to predict scores on EAT-26 subscales (Dieting, Bulimia, Total ED Risk) and EDI-3 scales (Drive for Thinness, Bulimia, Risk Composite). In all regression analyses, BRIEF-A Emotional Control emerged as a significant predictor. As would be expected, EDI-3 Bulimia scores were also predicted by problems with inhibition. These results provide preliminary evidence of an association between non-clinical patterns of disordered eating and executive dysfunction, specifically including the ability to control one’s emotions, suggesting that emotional control problems may help predict ED risk. Future research could examine how these factors predict the development of eating disorders.
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Affiliation(s)
- Stefanie Ciszewski
- Department of Psychology, University of British Columbia, Okanagan Campus
| | | | | | - Lisa A. Best
- Department of Psychology, University of New Brunswick
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Doba K, Nandrino JL. Cognitive and Emotional Empathy in Anorexia Nervosa: The Role of Attachment Insecurity, Intrapersonal, and Interpersonal Emotional Competences. J Nerv Ment Dis 2020; 208:312-318. [PMID: 32221186 DOI: 10.1097/nmd.0000000000001130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.
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Nalbant K, Kalaycı BM, Akdemir D, Akgül S, Kanbur N. Emotion regulation, emotion recognition, and empathy in adolescents with anorexia nervosa. Eat Weight Disord 2019; 24:825-834. [PMID: 31473987 DOI: 10.1007/s40519-019-00768-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/12/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Emotional functions may play an important role in anorexia nervosa (AN). The onset of the disorder generally occurs during adolescence, which is a critical period of emotional development. However, most studies that evaluated emotional functions in AN were conducted in adult patients. The aim of this study was to evaluate emotion regulation, emotion recognition, and empathy skills in adolescent girls with AN by controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security on emotional functions. METHODS Thirty-two adolescent girls with AN and 32 healthy counterparts completed the Difficulties in Emotion Regulation Scale, the Reading the Mind in the Eyes Test, Toronto Alexithymia Scale-20, and the Child and Adolescent KA-SI Empathic Tendency Scale-Adolescent Form. RESULTS The results revealed that adolescents with AN were found to have more difficulties in emotion regulation, higher alexithymic tendencies, and lower empathy skills compared with the control group. However, emotion recognition was not found to be significantly different between the two groups. These results were the same when controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security except for empathy skills. Alexithymia and depressive symptoms were significantly related to emotion regulation difficulties in adolescents with AN. CONCLUSIONS Considering the results, it seems that emotion regulation and alexithymia may play a crucial role in the development and maintenance of AN. Accordingly, it is necessary to focus on the improvement of these skills during the treatment of AN. Furthermore, interventions promoting these skills during adolescence may be preventive. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Kevser Nalbant
- Department of Child and Adolescent Psychiatry, Medical Faculty, Hacettepe University, Ankara, Turkey.
| | - Bilge Merve Kalaycı
- Department of Child and Adolescent Psychiatry, Medical Faculty, Training and Research Hospital, Yildirim Beyazıt University, Ankara, Turkey
| | - Devrim Akdemir
- Department of Child and Adolescent Psychiatry, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Sinem Akgül
- Division of Adolescent Medicine, Department of Pediatrics, Medical Faculty, Hacettepe University, Ankara, Turkey
| | - Nuray Kanbur
- Division of Adolescent Medicine, Department of Pediatrics, Medical Faculty, Hacettepe University, Ankara, Turkey
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11
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Grau A, Magallón-Neri E, Faus G, Feixas G. Cognitive impairment in eating disorder patients of short and long-term duration: a case-control study. Neuropsychiatr Dis Treat 2019; 15:1329-1341. [PMID: 31190837 PMCID: PMC6535667 DOI: 10.2147/ndt.s199927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/11/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Several studies have noted the potentially negative effect of eating disorders (ED) on cognitive performance. Objective: To compare the impact of the duration of abnormal eating behaviors on cognitive performance in a sample of people with short- and long-term eating disorders and in two control groups matched for age. Method: The neuropsychological performance of 82 women diagnosed with an eating disorder were compared with two control groups from the community of 66 healthy women. Time of duration of the disorder was less than two years in half of the clinical sample, and more than 10 years in the other half. The following instruments were used to measure neuropsychological performance: the Matrix Test, the Stroop task, the Trail-Making Test, the Tower of London Test, the Posner Spatial Task, the Rey's Complex Figure, the Wechsler Vocabulary Test, and the Hayling Completion Test. Results: It showed that persons with long-term ED presented more impaired neuropsychological profiles, but not in all areas. In contrast, the short-term ED group presented similar profiles to the control groups. Discussion: This study highlights the positive association between cognitive impairment and time of evolution of ED, above all in perceptual measures and non-verbal memory. Considering the effect of the evolution of ED cognitive performance (especially in long-term patients) may further our understanding of the development of the disorder and the factors that may favor its persistence.
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Affiliation(s)
- Antoni Grau
- ITA Mental Health Specialist, Madrid, Spain.,ITA Foundation, Barcelona, Spain
| | - Ernesto Magallón-Neri
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Gustavo Faus
- ITA Mental Health Specialist, Madrid, Spain.,ITA Foundation, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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12
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Kerr-Gaffney J, Harrison A, Tchanturia K. Cognitive and Affective Empathy in Eating Disorders: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:102. [PMID: 30886590 PMCID: PMC6410675 DOI: 10.3389/fpsyt.2019.00102] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Recent models of eating disorders (EDs) have proposed social and emotional difficulties as key factors in the development and maintenance of the illness. While a number of studies have demonstrated difficulties in theory of mind and emotion recognition, little is known about empathic abilities in those with EDs. Further, few studies have examined the cognitive-affective empathy profile in EDs. The aim of this systematic review and meta-analysis was to provide a synthesis of empathy studies in EDs, and examine whether those with EDs differ from healthy controls (HC) on self-reported total, cognitive, and affective empathy. Methods: Electronic databases were systematically searched for studies using self-report measures of empathy in ED populations. In total, 17 studies were identified, 14 of which could be included in the total empathy meta-analysis. Eight of the 14 studies were included in the cognitive and affective empathy meta-analyses. Results: Meta-analyses showed that while total empathy and affective empathy scores did not differ between those with anorexia nervosa (AN) and HC, those with AN had significantly lower cognitive empathy scores compared to HCs (small effect size). Meta-analyses of Interpersonal Reactivity Index sub-scores revealed that AN had significantly lower Fantasy scores than HC (small effect size), indicating that those with AN have more difficulty in identifying themselves with fictional characters. Only 3 studies examined empathy in those with bulimia nervosa (BN) or binge eating disorder (BED). Conclusions: The lowered cognitive empathy and intact affective empathy profile found in AN is similar to that found in other psychiatric and neurodevelopmental conditions, such as autism spectrum disorder (ASD). These findings add to the literature characterizing the socio-emotional phenotype in EDs. Future research should examine the influence of comorbid psychopathology on empathy in EDs.
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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
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, National Eating Disorders Service, London, United Kingdom.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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13
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Hayatbini N, Oberle CD. Are orthorexia nervosa symptoms associated with cognitive Inflexibility? Psychiatry Res 2019; 271:464-468. [PMID: 30544072 DOI: 10.1016/j.psychres.2018.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/03/2023]
Abstract
This study investigated whether symptoms of orthorexia nervosa, a conjectured disorder characterized by obsessive thoughts and compulsive behaviors regarding healthy eating, are associated with cognitive inflexibility. Participants (25 in the orthorexia symptoms group, 25 in the control group) completed the Eating Habits Questionnaire and computerized versions of the Wisconsin Card Sorting Test and the Trail Making Test. Of the 11 variable measurements from these cognitive tests, only one significantly differed between the groups, with the orthorexia symptoms group making more errors than the control group on the first part of the Trail Making Test that does not actually require any set shifting. These results suggest that although orthorexia is associated with inflexible thoughts and behaviors specific to healthy eating, the condition does not seem to be associated with cognitive inflexibility as an executive function deficit.
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Affiliation(s)
- Niki Hayatbini
- Department of Psychology, Texas State University, 601 University Drive, San Marcos, TX, USA
| | - Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Drive, San Marcos, TX, USA.
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14
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Zegarra-Valdivia JA, Chino-Vilca BN. Social Cognition and Executive Function Impairment in Young Women with Anorexia Nervosa. CLÍNICA Y SALUD 2018. [DOI: 10.5093/clysa2018a16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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15
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Green ET, Venta A. Lack of implementation of eating disorder education and prevention programs in high schools: Data from incoming college freshmen. Eat Disord 2018; 26:430-447. [PMID: 29565723 DOI: 10.1080/10640266.2018.1453629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this study was to examine the implementation of eating disorder education and prevention programs in high schools retrospectively, as reported by incoming college freshmen, exploring whether characteristics of the school influenced implementation. The sample, 169 first-year students from a public university, participated in an online survey inquiring about exposure to programs and high school characteristics. Results demonstrated few students exposed to any eating disorder programming (29.0%), with no students reporting exposure to prevention programming. Furthermore, there were no significant differences in the implementation based on school characteristics, suggesting that this is a universal issue across high schools.
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Affiliation(s)
- Emalee T Green
- a Department of Psychology and Philosophy , Sam Houston State University , Huntville , TX , USA
| | - Amanda Venta
- a Department of Psychology and Philosophy , Sam Houston State University , Huntville , TX , USA
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16
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Christensen SS, Bentz M, Clemmensen L, Strandberg‐Larsen K, Olsen EM. Disordered eating behaviours and autistic traits—Are there any associations in nonclinical populations? A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 27:8-23. [DOI: 10.1002/erv.2627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/14/2018] [Accepted: 07/01/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mette Bentz
- Child and Adolescent Mental Health CenterMental Health Services Copenhagen Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health CenterMental Health Services Copenhagen Denmark
- Center for TelepsychiatryMental Health Services Region of Southern Denmark
| | | | - Else Marie Olsen
- Section of Social Medicine, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
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17
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Leppanen J, Sedgewick F, Treasure J, Tchanturia K. Differences in the Theory of Mind profiles of patients with anorexia nervosa and individuals on the autism spectrum: A meta-analytic review. Neurosci Biobehav Rev 2018; 90:146-163. [DOI: 10.1016/j.neubiorev.2018.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/01/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
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18
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Oldershaw A, Lavender T, Schmidt U. Are socio-emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa? EUROPEAN EATING DISORDERS REVIEW 2018; 26:346-359. [PMID: 29744972 DOI: 10.1002/erv.2602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emotional, social, and neurocognitive factors are theorised to maintain anorexia nervosa (AN). Yet whether they predict outcomes or relate to clinical change remains unclear. METHODS Seventy-one consecutive adult outpatient eating disorder service referrals presenting with AN, who participated in a randomised controlled trial comparing 2 psychotherapies, were assessed for emotional processing, social cognition, and neurocognition pretherapy and posttherapy. Intention-to-treat analysis employed maximum-likelihood methods to model missing data. Baseline self-reported emotional processing, social cognitive, or neurocognitive task performance was entered into forward stepwise regression models with posttreatment clinical outcomes (weight, eating disorder psychopathology, psychosocial functioning) as dependent variables. Correlation analyses examined relationships between clinical and self-report/task score change. RESULTS Self-reported emotional avoidance (behavioural/cognitive avoidance, low acceptance) and submissive behaviour predicted clinical outcomes. Social cognitive (emotion recognition, emotional theory of mind) and neurocognitive performance (set-shifting, detail focus) had limited predictive ability. CONCLUSIONS Emotional avoidance and submissiveness may represent maintenance factors for AN.
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Affiliation(s)
- Anna Oldershaw
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Lavender
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
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19
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Dell'Osso L, Carpita B, Gesi C, Cremone IM, Corsi M, Massimetti E, Muti D, Calderani E, Castellini G, Luciano M, Ricca V, Carmassi C, Maj M. Subthreshold autism spectrum disorder in patients with eating disorders. Compr Psychiatry 2018; 81:66-72. [PMID: 29268154 DOI: 10.1016/j.comppsych.2017.11.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
AIM Increasingly data suggest a possible overlap between psychopathological manifestations of eating disorders (EDs) and autism spectrum disorders (ASD). The aim of the present study was to assess the presence of subthreshold autism spectrum symptoms, by means of a recently validated instrument, in a sample of participants with EDs, particularly comparing participants with or without binge eating behaviours. METHODS 138 participants meeting DSM-5 criteria for EDs and 160 healthy control participants (HCs), were recruited at 3 Italian University Departments of Psychiatry and assessed by the SCID-5, the Adult Autism Subthreshold Spectrum (AdAS Spectrum) and the Eating Disorders Inventory, version 2 (EDI-2). ED participants included: 46 with restrictive anorexia (AN-R); 24 with binge-purging type of Anorexia Nervosa (AN-BP); 34 with Bulimia Nervosa (BN) and 34 with Binge Eating Disorder (BED). The sample was split in two groups: participants with binge eating behaviours (BEB), in which were included participants with AN-BP, BN and BED, and participants with restrictive behaviours (AN-R). RESULTS participants with EDs showed significantly higher AdAS Spectrum total scores than HCs. Moreover, EDs participants showed significantly higher scores on all AdAS Spectrum domains with the exception of Non verbal communication and Hyper-Hypo reactivity to sensory input for AN-BP participants, and Childhood/Adolescence domain for AN-BP and BED participants. Participants with AN-R scored significantly higher than participants with BEB on the AdAS Spectrum total score, and on the Inflexibility and adherence to routine and Restricted interest/rumination AdAS Spectrum domain scores. Significant correlations emerged between the Interpersonal distrust EDI-2 sub-scale and the Non verbal communication and the Restricted interest and rumination AdAS Spectrum domains; as well as between the Social insecurity EDI-2 sub-scale and the Inflexibility and adherence to routine and Restricted interest and rumination domains in participants with EDs. CONCLUSIONS Our data corroborate the presence of higher subthreshold autism spectrum symptoms among ED participants with respect to HCs, with particularly higher levels among restrictive participants. Relevant correlations between subthreshold autism spectrum symptoms and EDI-2 Subscale also emerged.
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Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - B Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Corsi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - D Muti
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - E Calderani
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - G Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - V Ricca
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, 50134 Firenze, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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20
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An ecological approach to the behavioral assessment of executive functions in anorexia nervosa. Psychiatry Res 2018; 259:283-288. [PMID: 29091830 DOI: 10.1016/j.psychres.2017.10.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/23/2017] [Accepted: 10/21/2017] [Indexed: 11/21/2022]
Abstract
The use of ecological tests to assess executive functions (EFs) in patients with anorexia nervosa (AN) has not examined extensively. The objective of this study was to analyze and compare the performance of patients with AN and healthy controls (HCs) on standard versus ecologically valid tests on EFs. Sixty-two females aged between 16 and 42 who were diagnosed with AN and 70 matched HCs completed 2 neuropsychological test batteries: standard tests (WCST, TMT, Stroop, ToL, fluency test) and the Behavioral Assessment of Dysexecutive Syndrome (BADS). On the standard tests, patients with AN produced more perseverative response and were slower than HCs in the TMT; in contrast, they scored as well as HCs on tasks that assessed categorization, interference in color naming, planning and semantic fluency. Conversely, there were differences in the ecological tests with patients with AN systematically slower in the resolution of complex tasks. Results demonstrated the power of ecological tests in capturing selective impairments in multifaceted and unstructured tests. Patients with AN experienced systematic deceleration in the resolution of ecological tasks. Also, the increased time needed to solve the tasks, was not reflected in overall improvement in performance. This evidence is further discussed with respect to central coherence.
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21
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Björnsdotter M, Davidovic M, Karjalainen L, Starck G, Olausson H, Wentz E. Grey matter correlates of autistic traits in women with anorexia nervosa. J Psychiatry Neurosci 2017; 43:1-8. [PMID: 29214796 PMCID: PMC5837888 DOI: 10.1503/jpn.170072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 12/27/2022] Open
Abstract
Background Patients with anorexia nervosa exhibit higher levels of behaviours typically associated with autism-spectrum disorder (ASD), but the neural basis is unclear. We sought to determine whether elevated autistic traits in women with anorexia nervosa may be reflected in cortical morphology. Methods We used voxel-based morphometry (VBM) to examine regional grey matter volumes in high-resolution MRI structural brain scans in women with anorexia nervosa and matched healthy controls. The Autism-spectrum Quotient (AQ) scale was used to assess autistic traits. Results Women with anorexia nervosa (n = 25) had higher AQ scores and lower bilateral superior temporal sulcus (STS) grey matter volumes than the control group (n = 25). The AQ scores correlated negatively with average left STS grey matter volume in women with anorexia nervosa. Limitations We did not control for cognitive ability and examined only women with ongoing anorexia nervosa. Conclusion Elevated autistic traits in women with anorexia nervosa are associated with morphometric alterations of brain areas linked to social cognition. This finding provides neurobiological support for the behavioural link between anorexia nervosa and ASD and emphasizes the importance of recognizing autistic traits in preventing and treating anorexia nervosa.
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Affiliation(s)
- Malin Björnsdotter
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Monika Davidovic
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Louise Karjalainen
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Göran Starck
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Håkan Olausson
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Elisabet Wentz
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
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22
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Hirst RB, Beard CL, Colby KA, Quittner Z, Mills BM, Lavender JM. Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning. Neurosci Biobehav Rev 2017; 83:678-690. [PMID: 28851577 DOI: 10.1016/j.neubiorev.2017.08.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/28/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). METHOD Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. RESULTS There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. CONCLUSIONS Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement.
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Affiliation(s)
- Rayna B Hirst
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Charlotte L Beard
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Katrina A Colby
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Zoe Quittner
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Brent M Mills
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Jason M Lavender
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States.
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23
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Lantz EL, Gillberg C, Råstam M, Wentz E, Lowe MR. Premorbid BMI predicts binge-purge symptomatology among individuals with anorexia nervosa. Int J Eat Disord 2017; 50:852-855. [PMID: 28432804 DOI: 10.1002/eat.22718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A finding consistent with the transdiagnostic approach to eating disorders is that about half of those with restricting anorexia nervosa (AN) eventually undergo a transition to the binge/purge (BP) subtype or to bulimia nervosa. Given evidence that individuals with bulimic symptoms exhibit elevated weights premorbidly, we tested the hypothesis that among those with AN, highest premorbid BMI would predict which individuals with AN would develop AN-BP. METHOD The current study used longitudinal data from a community sample of adolescents with AN in Sweden. Premorbid weights were obtained from growth charts, and participants were re-assessed at 6, 10, and 18 years after first presentation with AN. RESULTS A greater highest premorbid BMI z score predicted a greater likelihood of developing binge/purge symptoms over 18 years. DISCUSSION Among individuals who develop an eating disorder, premorbid BMI may be implicated in the type and course of the eating disorder that emerges.
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Affiliation(s)
- Elin L Lantz
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Maria Råstam
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Center, University of Göteborg, Göteborg, Sweden
| | - Michael R Lowe
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania.,The Renfrew Center for Eating Disorders, Philadelphia, Pennsylvania
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24
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Dell'Osso L, Gesi C, Massimetti E, Cremone IM, Barbuti M, Maccariello G, Moroni I, Barlati S, Castellini G, Luciano M, Bossini L, Rocchetti M, Signorelli M, Aguglia E, Fagiolini A, Politi P, Ricca V, Vita A, Carmassi C, Maj M. Adult Autism Subthreshold Spectrum (AdAS Spectrum): Validation of a questionnaire investigating subthreshold autism spectrum. Compr Psychiatry 2017; 73:61-83. [PMID: 27918948 DOI: 10.1016/j.comppsych.2016.11.001] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/25/2016] [Accepted: 11/02/2016] [Indexed: 01/01/2023] Open
Abstract
AIM Increasing literature has shown the usefulness of a dimensional approach to autism. The present study aimed to determine the psychometric properties of the Adult Autism Subthreshold Spectrum (AdAS Spectrum), a new questionnaire specifically tailored to assess subthreshold forms of autism spectrum disorder (ASD) in adulthood. METHODS 102 adults endorsing at least one DSM-5 symptom criterion for ASD (ASDc), 143 adults diagnosed with a feeding and eating disorder (FED), and 160 subjects with no mental disorders (CTL), were recruited from 7 Italian University Departments of Psychiatry and administered the following: SCID-5, Autism-Spectrum Quotient (AQ), Ritvo Autism and Asperger Diagnostic Scale 14-item version (RAADS-14), and AdAS Spectrum. RESULTS The AdAS Spectrum demonstrated excellent internal consistency for the total score (Kuder-Richardson's coefficient=.964) as well as for five out of seven domains (all coefficients>.80) and sound test-retest reliability (ICC=.976). The total and domain AdAS Spectrum scores showed a moderate to strong (>.50) positive correlation with one another and with the AQ and RAADS-14 total scores. ASDc subjects reported significantly higher AdAS Spectrum total scores than both FED (p<.001) and CTL (p<.001), and significantly higher scores on the Childhood/adolescence, Verbal communication, Empathy, Inflexibility and adherence to routine, and Restricted interests and rumination domains (all p<.001) than FED, while on all domains compared to CTL. CTL displayed significantly lower total and domain scores than FED (all p<.001). A significant effect of gender emerged for the Hyper- and hyporeactivity to sensory input domain, with women showing higher scores than men (p=.003). A Diagnosis* Gender interaction was also found for the Verbal communication (p=.019) and Empathy (p=.023) domains. When splitting the ASDc in subjects with one symptom criterion (ASD1) and those with a ASD, and the FED in subjects with no ASD symptom criteria (FED0) and those with one ASD symptom criterion (FED1), a gradient of severity in AdAS Spectrum scores from CTL subjects to ASD patients, across FED0, ASD1, FED1 was shown. CONCLUSIONS The AdAS Spectrum showed excellent internal consistency and test-retest reliability and strong convergent validity with alternative dimensional measures of ASD. The questionnaire performed differently among the three diagnostic groups and enlightened some significant effects of gender in the expression of autistic traits.
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Affiliation(s)
- L Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Gesi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I M Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Barbuti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Maccariello
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Moroni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - M Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - L Bossini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - M Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M Signorelli
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - E Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - A Fagiolini
- Department of Mental Health and Department of Molecular Medicine, University of Siena, Siena, Italy
| | - P Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - V Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - A Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - C Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - M Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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25
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Bentz M, Jepsen JRM, Kjaersdam Telléus G, Moslet U, Pedersen T, Bulik CM, Plessen KJ. Neurocognitive functions and social functioning in young females with recent-onset anorexia nervosa and recovered individuals. J Eat Disord 2017; 5:5. [PMID: 28261479 PMCID: PMC5327534 DOI: 10.1186/s40337-017-0137-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/26/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Young individuals with anorexia nervosa (AN) or recovered from AN display impairments of social function. To date, however, it is not clear whether they differ from controls with respect to neurocognitive performance and whether those functions contribute to the compromised social function observed in individuals with AN. METHODS We included 43 young females with first-episode AN, 28 individuals recovered from adolescent-onset AN, and 41 control individuals (14-22 yr), all without comorbid autism spectrum disorder. We compared the performance of participants across groups in seven neurocognitive functions relevant to social functioning: set-shifting, local processing, processing speed, working memory, sustained attention, verbal memory, and verbal abstraction. Further, we tested the association between neurocognitive function and social function, measured by Autism Diagnostic Observation Schedule (ADOS), with an ordinal logistic regression model. RESULTS First, participants did not differ on any neurocognitive function across groups. Second, only the neurocognitive function "verbal memory" was significantly associated with social function. Higher performance in verbal memory was associated with lower odds of impaired social function. Diagnostic group remained a significant factor, but the absence of an interaction between group and neurocognitive performance indicated that the association between verbal memory and social function was independent of group membership. CONCLUSION Young individuals with AN and those recovered from AN did not differ from controls with respect to neurocognitive performance. Verbal memory was associated with social function in all groups.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Bispebjerg Bakke 30, 2400 København NV, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Moellegaard Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Bispebjerg Bakke 30, 2400 København NV, Denmark.,Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Psychiatric Center Glostrup, Glostrup, Denmark
| | - Gry Kjaersdam Telléus
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Ulla Moslet
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Bispebjerg Bakke 30, 2400 København NV, Denmark
| | - Tine Pedersen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Bispebjerg Bakke 30, 2400 København NV, Denmark.,Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Bispebjerg Bakke 30, 2400 København NV, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Westwood H, Stahl D, Mandy W, Tchanturia K. The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis. Psychol Med 2016; 46:1809-1827. [PMID: 27109830 DOI: 10.1017/s0033291716000581] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.
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Affiliation(s)
- H Westwood
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - D Stahl
- Department of Biostatistics,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - W Mandy
- University College London,Research Department of Clinical, Educational and Health Psychology,London,UK
| | - K Tchanturia
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
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Rose M, Reville MC, Iszatt A, Levinson S, Frampton I, Lask B. Deconstructing Planning Ability in Children and Adolescents with Anorexia Nervosa. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:297-304. [DOI: 10.1080/21622965.2016.1172312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mark Rose
- The Huntercombe Group, Newmarket, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marie-Claire Reville
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Amber Iszatt
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | - Ian Frampton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
| | - Bryan Lask
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
- Care UK, Colchester, UK
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28
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Karjalainen L, Gillberg C, Råstam M, Wentz E. Eating disorders and eating pathology in young adult and adult patients with ESSENCE. Compr Psychiatry 2016; 66:79-86. [PMID: 26995240 DOI: 10.1016/j.comppsych.2015.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Little is known about the prevalence and incidence of traditional eating disorders (EDs, e.g., anorexia nervosa (AN), bulimia nervosa and binge eating disorder (BED)) in individuals with childhood onset neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). The aim of the present study was to examine the prevalence of EDs and eating pathology in young adults and adults with ADHD and/or ASD, and to investigate the relationship between EDs and associated symptoms, on the one hand, and other psychiatric disorders, intelligence, and BMI, on the other hand, in this population. METHODS In an outpatient setting, 228 consecutively referred adults were neuropsychiatrically evaluated and assessed with regard to intelligence (WAIS-III), psychiatric comorbidities (SCID-I), personality disorders (SCID-II), eating disorders (SCID-I) and eating pathology (Eating Attitudes Test (EAT)). RESULTS For the entire sample, a total of 18 individuals (7.9%) had a current or previous eating disorder, with AN and BED being the most frequent. The male:female ratio was 1:2.5. According to EAT, 10.1% of the individuals scored within the range of severely disturbed eating behavior, and 13% moderately disturbed eating behavior. Individuals with ADHD more often affirmed eating pathology such as focusing on thoughts of calories and body dissatisfaction compared to individuals with ASD. CONCLUSIONS Eating disorder symptomatology seems to be overrepresented in adults with neuropsychiatric disorders compared with the general population. The gender ratio for EDs in adults with neuropsychiatric disorders is not nearly as skewed as in the general population.
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Affiliation(s)
- Louise Karjalainen
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden.
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden; Department of Child and Adolescent Psychiatry, Strathclyde University, Yorkhill Hospital, Glasgow, UK; Institute of Child Health, University College London, London, UK
| | - Maria Råstam
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
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29
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Carral-Fernández L, González-Blanch C, Goddard E, González-Gómez J, Benito-González P, Bustamante-Cruz E, Gómez Del Barrio A. Planning Abilities in Patients with Anorexia Nervosa Compared with Healthy Controls. Clin Neuropsychol 2016; 30:228-42. [PMID: 26959649 DOI: 10.1080/13854046.2016.1147603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Altered cognitive functioning could have an important role in the development and maintenance of Anorexia Nervosa (AN). The majority of previous research has focused on flexibility and global-detail processing. The aim of this study was to explore planning abilities in women with AN. METHOD Women with AN (n = 32) were compared to healthy controls (n = 42) using two different types of neuropsychological tasks for the assessment of planning abilities: Tower of London (ToL), a classic measure of planning abilities, and Zoo Map test, a more ecologically valid planning measure. Measures of AN psychopathology, anxiety, depression, and obsessive compulsivity were also collected. RESULTS The AN group did not differ from controls in the ToL (all p-values p > .05), although they performed significantly worse than controls in the main score of the Zoo Map (p = .02). A worse performance in the Zoo Map test More was associated with more eating disorders (rho = -.44, p = .018) and depressive (rho = -.42, p = .026) symptoms in the AN group. CONCLUSIONS Our study suggests the presence of subtle planning difficulties in women with AN which might be better detected using tasks with increased ecological validity.
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Affiliation(s)
- Laura Carral-Fernández
- a Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV) , Santander , Spain.,b Public Health Institute Carlos III, Ministry of Science and Innovation - Government of Spain , Madrid , Spain.,c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - César González-Blanch
- d Mental Health Centre , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Elizabeth Goddard
- e Section of Eating Disorders, Department of Psychological Medicine , King's College London, Institute of Psychiatry , London , UK
| | - Jana González-Gómez
- a Marqués de Valdecilla Public Foundation-Research Institute (FMV-IFIMAV) , Santander , Spain.,c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Pilar Benito-González
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Encarnación Bustamante-Cruz
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain
| | - Andrés Gómez Del Barrio
- c Eating Disorders Unit, Department of Psychiatry , University Hospital "Marqués de Valdecilla" , Santander , Spain.,f CIBERSAM, Centro Investigación Biomédica en Red Salud Mental , Madrid , Spain
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30
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Phillipou A, Gurvich C, Castle DJ, Abel LA, Rossell SL. Comprehensive neurocognitive assessment of patients with anorexia nervosa. World J Psychiatry 2015; 5:404-411. [PMID: 26740932 PMCID: PMC4694554 DOI: 10.5498/wjp.v5.i4.404] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/31/2015] [Accepted: 10/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To utilise a comprehensive cognitive battery to gain a better understanding of cognitive performance in anorexia nervosa (AN).
METHODS: Twenty-six individuals with AN and 27 healthy control participants matched for age, gender and premorbid intelligence, participated in the study. A standard cognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery, was used to investigate performance on seven cognitive domains with the use of 10 different tasks: speed of processing [Brief Assessment Of Cognition In Schizophrenia: Symbol Coding, Category Fluency: Animal Naming (Fluency) and Trail Making Test: Part A], attention/vigilance [Continuous Performance Test - Identical Pairs (CPT-IP)], working memory [Wechsler Memory Scale (WMS®-III): Spatial Span, and Letter-Number Span (LNS)], verbal learning [Hopkins Verbal Learning Test - Revised], visual learning [Brief Visuospatial Memory Test - Revised], reasoning and problem solving [Neuropsychological Assessment Battery: Mazes], and social cognition [Mayer-Salovey-Caruso Emotional Intelligence Test: Managing Emotions]. Statistical analyses involved the use of multivariate and univariate analyses of variance.
RESULTS: Analyses conducted on the cognitive domain scores revealed no overall significant difference between groups nor any interaction between group and domain score [F(1,45) = 0.73, P = 0.649]. Analyses conducted on each of the specific tasks within the cognitive domains revealed significantly slower reaction times for false alarm responses on the CPT-IP task in AN [F(1,51) = 12.80, P < 0.01, Cohen’s d = 0.982] and a trend towards poorer performance in AN on the backward component of the WMS®-III Spatial Span task [F(1,51) = 5.88, P = 0.02, Cohen’s d = -0.665]. The finding of slower reaction times of false alarm responses is, however, limited due to the small number of false alarm responses for either group.
CONCLUSION: The findings are discussed in terms of poorer capacity to manipulate and process visuospatial material in AN.
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31
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Koch SV, Larsen JT, Mouridsen SE, Bentz M, Petersen L, Bulik C, Mortensen PB, Plessen KJ. Autism spectrum disorder in individuals with anorexia nervosa and in their first- and second-degree relatives: Danish nationwide register-based cohort-study. Br J Psychiatry 2015; 206:401-7. [PMID: 25657359 DOI: 10.1192/bjp.bp.114.153221] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/21/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Clinical and population-based studies report increased prevalence of autism spectrum disorders (ASD) in individuals with anorexia nervosa and in their relatives. No nationwide study has yet been published on co-occurrence of these disorders. AIMS To investigate comorbidity of ASD in individuals with anorexia nervosa, and aggregation of ASD and anorexia nervosa in their relatives. METHOD In Danish registers we identified all individuals born in 1981-2008, their parents, and full and half siblings, and linked them to data on hospital admissions for psychiatric disorders. RESULTS Risk of comorbidity of ASD in probands with anorexia nervosa and aggregation of ASD in families of anorexia nervosa probands were increased. However, the risk of comorbid and familial ASD did not differ significantly from comorbid and familial major depression or any psychiatric disorder in anorexia nervosa probands. CONCLUSIONS We confirm aggregation of ASD in probands with anorexia nervosa and in their relatives; however, the relationship between anorexia nervosa and ASD appears to be non-specific.
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Affiliation(s)
- Susanne V Koch
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janne T Larsen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svend E Mouridsen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Bentz
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Petersen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cynthia Bulik
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben B Mortensen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin J Plessen
- Susanne V. Koch, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Janne T. Larsen, MSc, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Svend E. Mouridsen, MScPsych, Mette Bentz, MScPsych, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Denmark; Liselotte Petersen, MSc, PhD, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Cynthia Bulik, PhD, FAED, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Preben B. Mortensen, MD, DMSci, National Center for Register-based Research, School of Business and Social Sciences, University of Aarhus, Aarhus, and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPsych, Department of Biomedicine, Faculty of Health, Aarhus University, Denmark; Kerstin J. Plessen, MD, PhD, Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region and Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Nielsen S, Anckarsäter H, Gillberg C, Gillberg C, Råstam M, Wentz E. Effects of autism spectrum disorders on outcome in teenage-onset anorexia nervosa evaluated by the Morgan-Russell outcome assessment schedule: a controlled community-based study. Mol Autism 2015; 6:14. [PMID: 25774282 PMCID: PMC4359566 DOI: 10.1186/s13229-015-0013-4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/16/2015] [Indexed: 12/02/2022] Open
Abstract
Background The purpose of the study was to evaluate time trends and effects of co-existing autism spectrum disorders (ASD) on outcome in an ongoing long-term follow-up study of anorexia nervosa (AN). Methods The Morgan-Russell Outcome Assessment Schedule (MROAS) was used at 6-, 10- and 18-year follow-up of a representative sample of 51 individuals with teenage-onset AN and a matched group of 51 healthy comparison cases. The full multinomial distribution of responses for the full scale and each of the subscales was evaluated using exact nonparametric statistical methods. The impact of diagnostic stability of ASD on outcome in AN was evaluated in a dose–response model. Results There were no deaths in either group. Food intake and menstrual pattern were initially poor in the AN group but normalised over time. MROAS ‘mental state’ was much poorer in the AN group and did not improve over time. The psychosexual MROAS domains ‘attitudes’ and ‘aims’ showed persistent problems in the AN group. In the MROAS socioeconomic domain, the subscales ‘personal contacts’, ‘social activities’ and ‘employment record’ all showed highly significant between-group differences at all three follow-ups. A statistically significant negative dose–response relationship was found between a stable diagnosis of ASD over time and the results on the subscales ‘mental state’, ‘psychosexual state’ and ‘socio-economic state’. Conclusions Outcome of teenage-onset AN is favourable with respect to mortality and persisting eating disorder, but serious problems remain in the domains ‘mental state’, ‘psychosexual function’ and ‘socioeconomic state’. Outcome is considerably worse if ASD is present. Treatment programmes for AN need to be modified so as to accommodate co-existing ASD.
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Affiliation(s)
- Søren Nielsen
- Department of Child and Adolescent Psychiatry, Region Sjælland, Child Psychiatric Clinic, Næstved, Denmark
| | - Henrik Anckarsäter
- Forensic Psychiatry, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
| | - Carina Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE- 411 19 Göteborg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE- 411 19 Göteborg, Sweden ; Department of Child and Adolescent Psychiatry, Strathclyde University, Yorkhill Hospital, Glasgow, UK ; Institute of Child Health, University College, London, UK
| | - Maria Råstam
- Department of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Elisabet Wentz
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE- 411 19 Göteborg, Sweden
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Farahmand Z, Tehrani-Doost M, Amini H, Mohammadi A, Mirzaei M, Mohamadzadeh A. Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e209. [PMID: 26251656 PMCID: PMC4525445 DOI: 10.17795/ijpbs209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/05/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
Background: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. Objectives: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. Patients and Methods: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. Results: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. Conclusion: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder.
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Affiliation(s)
- Zahra Farahmand
- Department of Clinical Psychology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mehdi Tehrani-Doost
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Homayoun Amini
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abolfazl Mohammadi
- Department of Clinical Psychology, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mosleh Mirzaei
- Mental Health Research Centre, Tehran Psychiatric Institute, Faculty of Behavioral Science and Mental Health, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azar Mohamadzadeh
- Department of Psychiatry, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
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Calderoni S, Fantozzi P, Balboni G, Pagni V, Franzoni E, Apicella F, Narzisi A, Maestro S, Muratori F. The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa. Neuropsychiatr Dis Treat 2015; 11:75-85. [PMID: 25609969 PMCID: PMC4294691 DOI: 10.2147/ndt.s73235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although previous studies indicated a positive association between restrictive anorexia-nervosa (AN-R) and autistic traits, the potential interference of psychiatric internalizing comorbidity on this association is not yet fully investigated. MATERIALS AND METHODS The aim of this study was to explore autistic traits and internalizing psychopathology in adolescents (age range: 11.7-17.2 years) with AN-R. Twenty-five patients referred to two tertiary-care hospitals were compared to a large control group (N=170) with no differences in age and sex. AN-R patients and controls filled out instruments assessing autistic traits (autism spectrum quotient [AQ]), psychopathology (youth self-report [YSR] 11-18), and eating patterns (eating attitude test [EAT]). In order to disentangle the possible mediating role of internalizing symptoms on autistic traits, two separate control groups (called True and False healthy control, both composed of 25 eating-problem-free participants) were derived from the whole control group on the basis of the presence or absence of internalizing problems in the YSR. RESULTS AN-R patients scored significantly higher on AQ compared to the whole control group and to controls without internalizing problems (True HC), but these differences disappeared when only controls with internalizing problems (False HC) were considered. CONCLUSION Autistic traits in AN-R individuals may have been overestimated and may partly be due to comorbid internalizing symptoms in investigated patients.
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Affiliation(s)
- Sara Calderoni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Pamela Fantozzi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Giulia Balboni
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Veronica Pagni
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Emilio Franzoni
- Child Neuropsychiatric Unit, Women, Children and Adolescents Health Department, University Hospital S Orsola-Malpighi, Bologna, Italy
| | - Fabio Apicella
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Antonio Narzisi
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Sandra Maestro
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, University of Pisa, Pisa, Italy ; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Herpertz-Dahlmann B. Adolescent eating disorders: update on definitions, symptomatology, epidemiology, and comorbidity. Child Adolesc Psychiatr Clin N Am 2015; 24:177-96. [PMID: 25455581 DOI: 10.1016/j.chc.2014.08.003] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of eating disorders among adolescents continues to increase. The starvation process itself is often associated with severe alterations of central and peripheral metabolism, affecting overall health during this vulnerable period. This article aims to convey basic knowledge on these frequent and disabling disorders, and to review new developments in classification issues resulting from the transition to DSM-5. A detailed description is given of the symptomatology of each eating disorder that typically manifests during adolescence. New data on epidemiology, and expanding knowledge on associated medical and psychiatric comorbidities and their often long-lasting sequelae in later life, are provided.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, RWTH Aachen University, Neuenhofer Weg 21, Aachen 52074, Germany.
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Zwipp J, Hass J, Schober I, Geisler D, Ritschel F, Seidel M, Weiss J, Roessner V, Hellweg R, Ehrlich S. Serum brain-derived neurotrophic factor and cognitive functioning in underweight, weight-recovered and partially weight-recovered females with anorexia nervosa. Prog Neuropsychopharmacol Biol Psychiatry 2014; 54:163-9. [PMID: 24859292 DOI: 10.1016/j.pnpbp.2014.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 05/12/2014] [Indexed: 12/11/2022]
Abstract
Several studies support the assumption that the brain-derived neurotrophic factor (BDNF) plays an important role in the pathophysiology of eating disorders. In the present cross-sectional and longitudinal study, we investigated BDNF levels in patients with anorexia nervosa (AN) at different stages of their illness and the association with cognitive functioning. We measured serum BDNF in 72 acutely underweight female AN patients (acAN), 23 female AN patients who successfully recovered from their illness (recAN), and 52 healthy control women (HCW). Longitudinally, 30 acAN patients were reassessed after short-term weight gain. The association between BDNF levels and psychomotor speed was investigated using the Trail Making Test. BDNF serum concentrations were significantly higher in recAN participants if compared to acAN patients and increased with short-term weight gain. In acAN patients, but not HCW, BDNF levels were inversely associated with psychomotor speed. AcAN patients with higher BDNF levels also had lower life time body mass indexes. Taken together, our results indicate that serum BDNF levels in patients with AN vary with the stage of illness. Based on the pleiotropic functions of BDNF, changing levels of this neurotrophin may have different context-dependent effects, one of which may be the modulation of cognitive functioning in acutely underweight patients.
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Affiliation(s)
- Johannes Zwipp
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Johanna Hass
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ilka Schober
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Geisler
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Ritschel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jessika Weiss
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Rainer Hellweg
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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Bolton HM, Burgess PW, Gilbert SJ, Serpell L. Increased set shifting costs in fasted healthy volunteers. PLoS One 2014; 9:e101946. [PMID: 25025179 PMCID: PMC4099008 DOI: 10.1371/journal.pone.0101946] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
We investigated the impact of temporary food restriction on a set shifting task requiring participants to judge clusters of pictures against a frequently changing rule. 60 healthy female participants underwent two testing sessions: once after fasting for 16 hours and once in a satiated state. Participants also completed a battery of questionnaires (Hospital Anxiety and Depression Scale [HADS]; Persistence, Perseveration and Perfectionism Questionnaire [PPPQ-22]; and Eating Disorders Examination Questionnaire [EDE-Q6]). Set shifting costs were significantly increased after fasting; this effect was independent of self-reported mood and perseveration. Furthermore, higher levels of weight concern predicted a general performance decrement under conditions of fasting. We conclude that relatively short periods of fasting can lead to set shifting impairments. This finding may have relevance to studies of development, individual differences, and the interpretation of psychometric tests. It also could have implications for understanding the etiology and maintenance of eating disorders, in which impaired set shifting has been implicated.
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Affiliation(s)
- Heather M. Bolton
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Paul W. Burgess
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Sam J. Gilbert
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Lucy Serpell
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
- North East London NHS Foundation Trust, Porters Avenue Health Centre, Dagenham, Essex, United Kingdom
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Allen KL, Byrne SM, Hii H, van Eekelen A, Mattes E, Foster JK. Neurocognitive functioning in adolescents with eating disorders: a population-based study. Cogn Neuropsychiatry 2014; 18:355-75. [PMID: 22803827 DOI: 10.1080/13546805.2012.698592] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Neurocognitive deficits have been identified in eating disorders, including anorexia nervosa and bulimia nervosa. However, current data do not allow for firm conclusions regarding the nature or extent of these deficits. The current study aimed to evaluate neurocognitive functioning in a population-based sample of adolescents with and without eating disorders. METHODS Participants (N=669) were drawn from the Western Australian Pregnancy Cohort (Raine) Study. Cognitive testing was conducted using the computerised CogState assessment battery. Eating disorder symptoms were assessed using questions adapted from the Child Eating Disorder Examination and Eating Disorder Examination-Questionnaire. Adolescents who met full or partial criteria for a DSM-IV eating disorder (n=58) were compared to adolescents with no significant eating pathology (n=592). RESULTS The eating disorder sample showed impaired performance on measures of executive functioning, including global processing and set shifting, but performed better than control participants on measures of visual attention and vigilance. CONCLUSIONS This is the first study to evaluate neurocognitive functioning in a population-based sample of adolescents with eating disorders. Support is provided for weak central coherence and set-shifting difficulties early in the course of eating disorders. Research is needed to determine if these deficits precede and predict eating disorder onset.
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Affiliation(s)
- Karina L Allen
- a Telethon Institute for Child Health Research, Centre for Child Health Research , University of Western Australia , Subiaco , Western Australia
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Caglar-Nazali HP, Corfield F, Cardi V, Ambwani S, Leppanen J, Olabintan O, Deriziotis S, Hadjimichalis A, Scognamiglio P, Eshkevari E, Micali N, Treasure J. A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42:55-92. [PMID: 24333650 DOI: 10.1016/j.neubiorev.2013.12.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/08/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
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40
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Galioto R, King WC, Bond DS, Spitznagel MB, Strain G, Devlin M, Cohen R, Crosby RD, Mitchell JE, Gunstad J. Physical activity and cognitive function in bariatric surgery candidates. Int J Neurosci 2014; 124:912-8. [DOI: 10.3109/00207454.2014.895344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Benau EM, Orloff NC, Janke EA, Serpell L, Timko CA. A systematic review of the effects of experimental fasting on cognition. Appetite 2014; 77:52-61. [PMID: 24583414 DOI: 10.1016/j.appet.2014.02.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 01/14/2014] [Accepted: 02/17/2014] [Indexed: 11/27/2022]
Abstract
Numerous investigations have been conducted on the impact of short-term fasting on cognition in healthy individuals. Some studies have suggested that fasting is associated with executive function deficits; however, findings have been inconsistent. The lack of consensus regarding the impact of short-term fasting in healthy controls has impeded investigation of the impact of starvation or malnutrition in clinical groups, such as anorexia nervosa (AN). One method of disentangling these effects is to examine acute episodes of starvation experimentally. The present review systematically investigated the impact of short-term fasting on cognition. Studies investigating attentional bias to food-related stimuli were excluded so as to focus on general cognition. Ten articles were included in the review. The combined results are equivocal: several studies report no observable differences as a result of fasting and others show specific deficits on tasks designed to test psychomotor speed, executive function, and mental rotation. This inconsistent profile of fasting in healthy individuals demonstrates the complexity of the role of short-term fasting in cognition; the variety of tasks used, composition of the sample, and type and duration of fasting across studies may also have contributed to the inconsistent profile. Additional focused studies on neuropsychological profiles of healthy individuals are warranted in order to better develop an understanding of the role of hunger in cognition.
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Affiliation(s)
- Erik M Benau
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - Natalia C Orloff
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - E Amy Janke
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA
| | - Lucy Serpell
- Division of Psychology and Language Sciences, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; North East London Foundation Trust, Trust Head Office, Goodmayes Hospital, Barley Lane, Ilford Essex IG3 8XJ, UK
| | - C Alix Timko
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19107, USA.
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Courty A, Maria AS, Lalanne C, Ringuenet D, Vindreau C, Chevallier C, Pouga L, Pinabel F, Philippe A, Adrien JL, Barry C, Berthoz S. Levels of autistic traits in anorexia nervosa: a comparative psychometric study. BMC Psychiatry 2013; 13:222. [PMID: 24015680 PMCID: PMC3848448 DOI: 10.1186/1471-244x-13-222] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of characteristics associated with Autism Spectrum Disorders (ASD) are over-represented among patients with Anorexia Nervosa (AN) as well as among relatives of these patients. Yet the co-occurrence of autistic traits in AN has not been fully explored and no previous study has directly compared self-reported evaluations of cognitive and socio-affective skills in AN and ASD. METHODS We aimed to determine the degree of overlap between AN and ASD from scores on questionnaires classically used to measure ASD impairments. Fifteen AN participants, 15 ASD participants and two groups of matched controls completed a battery of self-reports measuring: autistic traits (Autism-Spectrum Quotient), empathy (Empathy Quotient-short and Interpersonal Reactivity Index), systemizing (Systemizing Quotient-short) and alexithymia (Bermond-Vorst Alexithymia Questionnaire-B). Univariate comparisons of mean totalled scores were performed on each measure (patients vs. controls, and AN vs. ASD), and a Principal Component Analysis was used to study subject proximities in a reduced-factor space constructed from AQ, BVAQ-B and IRI subscales. RESULTS These analyses revealed similarities in a few cognitive domains (Attention Switching, Perspective Taking and Fantasy, lack of emotional introspection) and in some nonspecific affective dimensions (depression and feelings of distress), but also marked dissimilarities in social skills (the ability to communicate emotions to others, empathizing). CONCLUSION The AN and ASD participants reported similar needs for sameness, and similar difficulties understanding their emotions and taking the perspective of another, but contrasting abilities to feel concerned in interpersonal situations. Our mixed findings encourage further exploration of transdiagnostic similarities and associations between these disorders.
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Affiliation(s)
- Annaig Courty
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Anne Solène Maria
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Christophe Lalanne
- AP-HP, Department of Clinical Research, Saint-Louis Hospital, Paris, France
- Inserm Unit UMR-SO 669, University Paris Sud, Paris Descartes, Paris, France
| | - Damien Ringuenet
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Christine Vindreau
- Department of Psychiatry and Addictology, Eating disorders unit, AP-HP, Hôpital Paul Brousse, Paris Sud University, Villejuif, France
| | - Coralie Chevallier
- Inserm U960 – LNC, Paris, France
- Center for Autism Research, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - François Pinabel
- Department of Child and Adolescent Psychiatry, AP-HP, Hôpital Pitié-Salpétrière, Paris Descartes University, Paris, France
- Private Practice, 6 avenue de Tourville, Paris 75007, France
| | - Anne Philippe
- Inserm U781 & Department of Genetic, AP-HP, Hôpital Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - Jean-Louis Adrien
- LPPS - EA 4057, Institut de Psychologie, Paris Descartes University, Paris, France
| | - Caroline Barry
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
| | - Sylvie Berthoz
- Department of Adolescent and Young Adult Psychiatry, Service de Psychiatrie Institut Mutualiste Montsouris, 42 Bd Jourdan, Paris 75014, France
- Inserm U669 – Maison de Solenn, Paris Descartes and Paris Sud Universities, Paris, France
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Fonville L, Lao-Kaim NP, Giampietro V, Van den Eynde F, Davies H, Lounes N, Andrew C, Dalton J, Simmons A, Williams SC, Baron-Cohen S, Tchanturia K. Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study. PLoS One 2013; 8:e63964. [PMID: 23691129 PMCID: PMC3653828 DOI: 10.1371/journal.pone.0063964] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/08/2013] [Indexed: 01/12/2023] Open
Abstract
The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.
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Affiliation(s)
- Leon Fonville
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Nick P. Lao-Kaim
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Frederique Van den Eynde
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
- Eating Disorders Program, Douglas University Institute, Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Helen Davies
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Naima Lounes
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Christopher Andrew
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Jeffrey Dalton
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Andrew Simmons
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Steven C.R. Williams
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Centre, University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
| | - Kate Tchanturia
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
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Hartmann AS, Greenberg JL, Wilhelm S. The relationship between anorexia nervosa and body dysmorphic disorder. Clin Psychol Rev 2013; 33:675-85. [PMID: 23685673 DOI: 10.1016/j.cpr.2013.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 04/10/2013] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are severe body image disorders that highly impair individuals in their daily functioning. They are discrete but overlapping nosological entities. In this review, we examine similarities between AN and BDD with regard to clinical, personality and demographic aspects, such as comorbidity, phenomenology, and treatment outcome. The review suggests that the two disorders are highly comorbid, and show similar ages of onset, illness trajectories, and comparable clinical and personality characteristics. However, important differences emerge in their responsiveness to psychosocial and psychopharmacological treatment, which are discussed. Clinical implications of these findings are summarized and directions for future research are delineated, with a focus on how current treatment components from each disorder may inform new interventions for both disorders.
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45
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Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 2013; 1:13. [PMID: 24999394 PMCID: PMC4081714 DOI: 10.1186/2050-2974-1-13] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/03/2013] [Indexed: 12/12/2022] Open
Abstract
AIM To describe the evidence base relating to the Cognitive-Interpersonal Maintenance Model for anorexia nervosa (AN). BACKGROUND A Cognitive-Interpersonal Maintenance Model maintenance model for anorexia nervosa was described in 2006. This model proposed that cognitive, socio-emotional and interpersonal elements acted together to both cause and maintain eating disorders. METHOD A review of the empirical literature relating to the key constructs of the model (cognitive, socio-emotional, interpersonal) risk and maintaining factors for anorexia nervosa was conducted. RESULTS Set shifting and weak central coherence (associated with obsessive compulsive traits) have been widely studied. There is some evidence to suggest that a strong eye for detail and weak set shifting are inherited vulnerabilities to AN. Set shifting and global integration are impaired in the ill state and contribute to weak central coherence. In addition, there are wide-ranging impairments in socio-emotional processing including: an automatic bias in attention towards critical and domineering faces and away from compassionate faces; impaired signalling of, interpretation and regulation of emotions. Difficulties in social cognition may in part be a consequence of starvation but inherited vulnerabilities may also contribute to these traits. The shared familial traits may accentuate family members' tendency to react to the frustrating and frightening symptoms of AN with high expressed emotion (criticism, hostility, overprotection), and inadvertently perpetuate the problem. CONCLUSION The cognitive interpersonal model is supported by accumulating evidence. The model is complex in that cognitive and socio-emotional factors both predispose to the illness and are exaggerated in the ill state. Furthermore, some of the traits are inherited vulnerabilities and are present in family members. The clinical formulations from the model are described as are new possibilities for targeted treatment.
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Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK
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Gicquel L. Anorexia nervosa during adolescence and young adulthood: towards a developmental and integrative approach sensitive to time course. ACTA ACUST UNITED AC 2013; 107:268-77. [PMID: 23542549 DOI: 10.1016/j.jphysparis.2013.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Anorexia nervosa is situated at the junction between two time scales, the time scale of adolescence, in which intense physiological and psychological upheavals are occurring over a relatively short period of time, and the time scale of the potentially chronic evolution of the disease over the course of the patient's lifespan. This second time scale links the critical period of adolescence with the pre-morbid period, during which a complex state of vulnerability, often unseen and unheard, combines with different risk factors, which may be isolated, associated, dissociated or concomitant, to produce the emergence of anorexia; it ushers also adolescence into the period of adulthood, flagged with the reorganization that occurs in the course of the healing process (in case of recovery), or pervaded by somatic and mental distress (in cases where the condition becomes chronic). Given the lifespan nature of the disease, it is difficult to differentiate premorbid pathogenic factors from changes resulting from the acute or chronic phases of the illness. It is also difficult to establish straightforward correlations between physiological disturbances and their clinical consequences, or conversely to assume that the restoration of physiological parameters means the disappearance of the underlying mental disorder. Taken together, these observations support an approach to anorexia nervosa that is both developmental and integrative, taking into account both the complexity of the pathways involved and the developmental timescales of these pathways. This type of approach can help to adjust therapeutic strategies and thus enhance prognosis, in particular by integrating the temporal parameter into the dynamics of care plans.
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Affiliation(s)
- Ludovic Gicquel
- INSERM U 894 Team 1, Centre de Psychiatrie et de Neurosciences, Paris, France.
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Martinez G, Cook-Darzens S, Chaste P, Mouren MC, Doyen C. [Anorexia nervosa in the light of neurocognitive functioning: New theoretical and therapeutic perspectives]. Encephale 2013; 40:160-7. [PMID: 23541918 DOI: 10.1016/j.encep.2012.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/26/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Anorexia nervosa is a serious psychiatric disorder, for which very few validated therapeutic strategies exist. The specific sociocognitive style of anorexic patients has already been described in the 1960s: it involves a concrete style with abstraction difficulties. Current neuropsychological tests have contributed to a more precise definition of these difficulties. NEUROPSYCHOLOGICAL DATA IS THERE A SPECIFIC COGNITIVE PROFILE?: Contrary to common beliefs, these patients' intellectual performances are not superior to those of the general population. However, detailed comparisons of profiles on the Weschler Scales suggest difficulties in synthesizing information and better abilities in concrete problem solving. EXCESSIVE ATTENTION TO DETAILS The dominant hypothesis concerning the attentional dimension is the existence of a weakness in central coherence, resulting in superior detail processing and a weakness in global integration. This trend appears to be stable even after the normalization of nutritional status. IMPAIRED COGNITIVE FLEXIBILITY The impairment of set-shifting abilities leads to rigidity, expressed by inflexibility and perseveration, both in reasoning and behaviour. This reduced cognitive flexibility appears to persist after recovery, and may constitute a familial trait. In addition, this likely endophenotype seems to be independent from obsessional traits. CONTROVERSIAL SOCIAL SKILL Alexithymia is frequently described in anorexic individuals. It is the verbal description of feelings which seems to be particularly impaired. It may explain underlying difficulties in empathy. Indeed, these subjects have lower scores on emotional tests drawn from the theory of mind. These cognitive abnormalities are well documented in pervasive developmental disorders. NEUROANATOMICAL DATA: NEUROIMAGING IN SUPPORT OF LIMBIC AND FRONTO-STRIATAL ABNORMALITIES: Evidence from neuroimaging suggests abnormalities in cortical and subcortical structures, involving the temporal and orbito-frontal lobes. Various functional hypotheses are formulated, involving fronto-striatothalamic circuits, amygdala or insula. IS ANOREXIA NERVOSA A DEVELOPMENTAL DISORDER?: Pervasive developmental disorders are over-represented among anorexic subjects in comparison to the general population. Conversely, restrictive and selective eating disorders are more frequent among individuals presenting an autistic spectrum disorder. THERAPEUTIC IMPLICATIONS AND FUTURE DIRECTIONS In view of the common cognitive and neuroanatomical data that are found in anorexia nervosa and neurodevelopmental disorders, we adhere to the hypothesis that anorexia nervosa may be similar to a neurodevelopmental disorder. Clinical observations suggest that this hypothesis may be especially relevant in the early forms of anorexia nervosa. These cognitive data confirm the potential relevance of new therapeutic modalities such as cognitive remediation. Initial results from its application to anorexia nervosa seem promising. CONCLUSION A review of the recent literature highlights the possible existence of a developmental impairment of cortical and subcortical structures, associated with specific abnormalities in cognitive development such as a weakness in central coherence, reduced set-shifting ability and poor social skills. On this basis, cognitive remediation may be a promising therapeutic innovation.
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Affiliation(s)
- G Martinez
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - S Cook-Darzens
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - P Chaste
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - M-C Mouren
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - C Doyen
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Treasure J. Coherence and other autistic spectrum traits and eating disorders: building from mechanism to treatment. The Birgit Olsson lecture. Nord J Psychiatry 2013; 67:38-42. [PMID: 22468644 DOI: 10.3109/08039488.2012.674554] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To revisit Gillberg's hypothesis proposed in 1992, which was that anorexia nervosa should be considered within the spectrum of autistic disorders. METHOD A search was made of the literature relating to the behavioural traits, and cognitive, emotional and neuroanatomical intermediate phenotypes that are shared between autistic spectrum disorders (ASD) and anorexia nervosa. RESULTS People with eating disorders in the acute phase (less so after recovery) share some behavioural traits (social impairment and restricted and repetitive behaviours) and intermediate phenotypes (weak central coherence, and impaired set shifting and theory of mind) with people in the autistic spectrum. CONCLUSION Behavioural and intermediate neuropsychological traits are shared between eating disorders and ASD. In part, these are familial but also they are accentuated by the illness state and may be secondary to starvation. These traits have implications for prognosis and treatment.
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Affiliation(s)
- Janet Treasure
- Kings College London Institute of Psychiatry, Department Academic Psychiatry, Denmark Hill, London, UK.
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Calderoni S, Muratori F, Leggero C, Narzisi A, Apicella F, Balottin U, Carigi T, Maestro S, Fabbro F, Urgesi C. Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: An in-depth investigation with NEPSY–II. J Clin Exp Neuropsychol 2013; 35:167-79. [DOI: 10.1080/13803395.2012.760536] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Eating disorders are considered psychiatric pathologies that are characterized by pathological worry related to body shape and weight. The lack of progress in treatment development, at least in part, reflects the fact that little is known about the pathophysiologic mechanisms that account for the development and persistence of eating disorders. The possibility that patients with eating disorders have a dysfunction of the central nervous system has been previously explored; several studies assessing the relationship between cognitive processing and certain eating behaviors have been conducted. These studies aim to achieve a better understanding of the pathophysiology of such diseases. The aim of this study was to review the current state of neuropsychological studies focused on eating disorders. This was done by means of a search process covering three relevant electronic databases, as well as an additional search on references included in the analyzed papers; we also mention other published reviews obtained by handsearching.
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