The relationship between dissociation and binge eating

Brain Correlates of Eating Disorders in Response to Food Visual Stimuli: A Systematic Narrative Review of FMRI Studies

This article summarizes the results of studies in which functional magnetic resonance imaging (fMRI) was performed to investigate the neurofunctional activations involved in processing visual stimuli from food in individuals with anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). A systematic review approach based on the PRISMA guidelines was used. Three databases—Scopus, PubMed and Web of Science (WoS)—were searched for brain correlates of each eating disorder. From an original pool of 688 articles, 30 articles were included and discussed. The selected studies did not always overlap in terms of research design and observed outcomes, but it was possible to identify some regularities that characterized each eating disorder. As if there were two complementary regulatory strategies, AN seems to be associated with general hyperactivity in brain regions involved in top-down control and emotional areas, such as the amygdala, insula and hypothalamus. The insula and striatum are hyperactive in BN patients and likely involved in abnormalities of impulsivity and emotion regulation. Finally, the temporal cortex and striatum appear to be involved in the neural correlates of BED, linking this condition to use of dissociative strategies and addictive aspects. Although further studies are needed, this review shows that there are specific activation pathways. Therefore, it is necessary to pay special attention to triggers, targets and maintenance processes in order to plan effective therapeutic interventions. Clinical implications are discussed.

Anorexia Nervosa and Somatoform Dissociation: A Neglected Body-Centered Perspective

Dissociation in anorexia nervosa (AN) is common (literature reported 29% of dissociative disorders in eating disorders) and higher in patients with binge-purging AN (BP-AN) than in those with restricter AN (R-AN). However, the distinction between somatoform (SomD) and psychoform dissociation (PsyD) is understudied. We aimed to assess the differences in PsyD and SomD, eating-related, general, and body-related psychopathology, and childhood trauma between subtypes of AN. Then, we attempted to describe a subgroup of patients with AN with marked SomD comparing them to patients without SomD, also controlling the results for PsyD and AN subtypes. Inpatients with AN (n = 111; 109 women and 2 men) completed self-reported questionnaires evaluating dissociation, eating-related, body-related, and general psychopathology, and childhood abuses. Patients with BP-AN reported higher SomD and PsyD and a more severe clinical picture than those with R-AN. The SomD-group (n = 41) showed higher eating concerns, trait-anxiety, body-related variables, and sexual/physical abuse compared to the no-SomD group (n = 70), independently of AN subtype and PsyD symptoms. Results described particular features of patients with AN and SomD. Data, clinically, suggest a careful assessment, for both SomD and PsyD, especially when a history of bodily-impacting trauma is present, potentially fostering dissociation-informed interventions.

Absorption and dissociation mediate the relationship between direct verbal suggestibility and impulsivity/compulsivity

Direct verbal suggestibility refers to the capacity for an individual to experience perceptual, motor, affective and cognitive changes in response to verbal suggestions. Suggestibility is characterized by pronounced, yet reliable, inter-individual differences. Previous research and theoretical considerations suggest that greater impulsivity and compulsivity is associated to higher suggestibility, but the characteristics and mediating factors of this association are poorly understood. Using established psychometric measures in an online sample, we found positive correlations between the domain comprising impulsivity, compulsivity and behavioural activation, and the domain of suggestibility, dissociation and absorption. We also observed that dissociation and absorption mediated the link between suggestibility and impulsivity, and between suggestibility and behavioural activation, respectively. These results confirm the positive link between suggestibility and the impulsivity/compulsivity domain and shed new light on the characterisation of traits associated with suggestibility.

Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review

Background: Many people with eating disorders often report having suffered some kind of childhood trauma. For this reason, many studies have attempted to explore the mediating factors between traumatic experiences and the development of eating disorders. The aim of our study is to conduct a systematic review of published works on the mediating factors between childhood trauma and the development of eating disorders. Method: This review was carried out up to 5 December, 2020, using the databases PsycInfo and PubMed, combining the keywords, and applying a set of inclusion and exclusion criteria. Results: A total of 18 articles were retrieved. After the articles were analyzed, a set of mediating factors between childhood trauma and the development of eating disorders was established, including pathological dissociation, difficulty with emotion self-regulation, body dissatisfaction, negative affect/depression, anxiety, general distress, self-criticism, and alexithymia, among others. Conclusions: In addition to evaluating trauma in eating disorders, these results highlight the importance of paying special attention to the presence of various possible mediating factors, which must be taken into account in the planning of therapeutic treatment. Identifying symptoms of trauma or eating disorders early on could prevent onset of more severe psychopathology during adulthood.

Child Trauma Experiences and Dissociative Symptoms in Women with Eating Disorders: Case-Control Study

Background: many people with different diagnoses, including eating disorders, have suffered traumatic experiences in childhood. Method: a case-control study was performed. The objective of this study was to evaluate the presence of child trauma and dissociative symptoms in people with eating disorders and compare the results obtained with a control group. Participants were administered the Mini International Neuropsychiatric Interview (MINI) and the Structured Clinical Interview for Personality Disorders (SCID-II) to confirm diagnostic criteria and explore possible comorbidities. Traumatic experiences in childhood were evaluated with the Child Trauma Questionnaire in its abbreviated version (CTQ-SF), psychoform dissociation was measured with the Scale of Dissociative Experiences (DES-II) and somatoform dissociation with the Somatoform Dissociation Scale (SDQ-20). Results: women with eating disorders reported a greater severity and higher prevalence of child trauma than the control group. Significant differences were found by groups in dissociative symptoms. Conclusions: our results, in a Spanish sample, confirm the findings of previous studies.

Psychoform and somatoform dissociation in anorexia nervosa: A systematic review

Dissociation is a debilitating condition often present as comorbidity in patients with eating disorders, but to date only sparse findings are available on this topic. Additionally, very little data exist on the classification of dissociation, namely, psychoform and somatoform, in anorexia nervosa (AN). This review aimed to provide an updated view on the literature about dissociation in AN, with a focus on AN subtypes (i.e., restricter and binge-purging) as well as dissociation type (i.e., psychoform and somatoform), when available. We screened 304 studies, and after title and abstract selection and full-text reading, 29 of them were included in this review. Most of the studies investigated psychoform dissociation, whereas just four publications considered somatoform dissociation. Dissociation resulted to be present in AN more than in healthy controls and in individuals with other psychiatric disorders, and it was related mostly to the binge-purging subtype of AN. Moreover, dissociation was linked to traumatic events, self-harm and negative treatment outcomes, especially in patients affected by the binge-purging subtype of AN. However, results on these matters are scarce and partially discordant. The methodological assessment we performed revealed an overall fair quality of the included studies, although several flaws emerged as well. The present review reported on one hand the relevance of dissociation in AN, but on the other hand the need to stimulate the scientific debate on (a) a deeper investigation of somatoform dissociation in AN and (b) the relationship between dissociation and both clinical severity and treatment response/resistance in AN.

Psychoform and somatoform dissociation among individuals with eating disorders

Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorder diagnosis groups in extent of dissociation. The validity of a new structural dissociation interview suitable for eating disorder patients was analyzed.Method: Sixty individuals with eating disorder completed three self-report questionnaires: Dissociation Questionnaire Sweden, Somatoform Dissociation Questionnaire and Eating Disorder Examination Questionnaire. The ratings were compared with the scores in a female non-clinical group (N = 245). Twenty patients with eating disorder diagnoses were interviewed with the Interview for Dissociative Disorders and Trauma Related Symptoms. The validity of the interview was tested by comparing the ratings on the interview subscales with the scores on the Dissociation questionnaires and the Somatoform Dissociation Questionnaire.Results: Participants with eating disorders reported a higher extent of both psychoform and somatoform dissociation compared with the non-clinical individuals. Analyses also showed a correlation between degree of dissociation and severity of eating disorder symptoms. No differences in dissociation were found between the ED subgroups. Participants reporting more dissociation got higher ratings on the interview, indicating convergent validity.Discussion: Eating disorders seem to be associated with presence and severity of dissociative symptoms. The extent of dissociation needs to be assessed for these individuals as treatment may benefit from a focus on such symptoms in order to increase its effect.

Childhood Traumatic Experiences and Dissociative Phenomena in Eating Disorders: Level and Association with the Severity of Binge Eating Symptoms

The aim of the current study is to evaluate the presence of childhood trauma, psychoform, and somatoform dissociation in eating disorders (ED). Eighty-six ED outpatients participated in this study, 20 of them were diagnosed with restrictive anorexia (AN-R), 10 of them with anorexia nervosa binge-purging subtypes (AN-B), 25 with bulimia nervosa (BN), and 31 with binge eating disorder (BED). They were matched by sex and age with a control group consisting of 86 healthy subjects (HC). Traumatic experiences were assessed by means of the Childhood Trauma Questionnaire (CTQ), psychological, and somatoform dissociation, respectively, by means of the Dissociative Experience Scale (DES-II) and Somatoform Dissociation Questionnaire (SDQ-20), and binge eating symptoms by means of Binge Eating Scale (BES). ED subjects showed higher levels of childhood trauma, and both psychoform and somatoform dissociation compared to HC subjects. ED patients showed higher levels of childhood trauma compared to the HC group. No significant differences were shown between ED subgroups with respect to all forms of childhood trauma. BN and AN-B subgroups showed higher levels of both psychological and somatoform dissociation. Dissociation and childhood trauma predicted the severity of binge eating symptoms. Our results confirm previous studies in the same field.

Muscle dysmorphia and psychopathology: Findings from an Italian sample of male bodybuilders

The aim of this study is to investigate the relationship between the risk of muscle dysmorphia and psychopathological symptoms in an Italian sample of male bodybuilders.

METHOD

The sample was recruited online (145 men with a mean age of 30.0 years) and participants were asked to fill out the Muscle Dysmorphic Disorder Inventory (MDDI), Symptom Cheklist-90-R (SCL-90-R), Dissociative Experiences Scale (DES-II), and to provide other socio-demographic data. Bodybuilders at risk of muscle dysmorphia display greater global psychopathology and present higher scores on all SCL-90-R dimensions when compared to bodybuilders not at risk of muscle dysmorphia. Furthermore, risk of muscle dysmorphia is positively associated to dissociative symptoms. The Competitiveness dimension and anabolic steroid intake were not related to muscle dysmorphia, while age appeared to be more significant. Findings are discussed based upon previous studies and directions for future research are suggested.

Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis

BACKGROUND

Clinical studies describe binge eating as a reaction to hunger, negative affect, or the need to dissociate. However, little is known about the meanings that women with bulimia nervosa and anorexia nervosa associate with binge eating.

AIMS

To examine how women with anorexia nervosa and bulimia nervosa interpret their experiences of binge eating.

METHODS

Sixteen women who engaged in binge eating and had been diagnosed with anorexia nervosa, bulimia nervosa, or their subclinical variants were interviewed about their experiences of eating disorder. Interview data were analyzed using phenomenologically-informed thematic analysis.

RESULTS

Participants described binge eating as a practice through which the self experiences a sense of release, and existential emptiness is replaced by overwhelming fullness.

CONCLUSION

Meaningful experiences of release and fullness are central to binge eating in bulimia nervosa and anorexia nervosa, and may contribute to the long-term maintenance of this practice.

Understanding the link between body image and binge eating: a model comparison approach

PURPOSE

The present study tests several competing, explanatory models-dual pathways, escape from awareness, and objectification theory-for the established link between body dissatisfaction and binge eating.

METHODS

408 women aged between 18 and 40 years completed a survey designed to assess contributions of proposed mediators (dietary restraint and negative affect from the dual pathway model, self-distraction from the escape from awareness model, and interoceptive deficits from objectification theory) for the body dissatisfaction-binge eating relationship.

RESULTS

Although mediation analyses supported the dual pathway model and objectification theory when tested separately, the dual pathway model most strongly predicted the body dissatisfaction-binge eating relationship. Both model-implied mediators (dietary restraint and negative affect) made significant unique contributions, accounting for roughly one-quarter of the shared variance between body dissatisfaction and binge eating when tested separately from other mediators. Improvements in variance explained were negligible once other proposed mediators were included in a test of models combined.

CONCLUSIONS

Collectively, these findings suggest the superiority of the dual pathway model over objectification theory and the escape model, but the remaining unaccounted for covariance suggests need to consider alternative mechanisms that may also account for the relationship between body dissatisfaction and binge eating.

Tests of an extension of the dual pathway model of bulimic symptoms to the state-based level

The dual pathway model proposes that trait body dissatisfaction leads to bulimic symptoms via two distinct pathways: dieting and trait negative affect. As many of these modelled variables have state-based equivalents, the present study evaluated the generalisability of this model to predict associations between state body dissatisfaction and instances of disordered eating. 124 women aged 18 to 40 years completed an online survey (accessed via a mobile phone device with web access) over a 7-day period. The mobile phone device prompted participants at random intervals seven times daily to self-report their state body dissatisfaction, current mood experiences, dieting attempts, and disordered eating practices. Multi-level mediation modelling revealed that both negative mood states and dieting significantly mediated the state body dissatisfaction-disordered eating relationships, although the strength of these associations depended on the aspect of disordered eating measured and individual differences in trait body dissatisfaction, internalization of appearance standards, tendency towards dieting, and BMI. Collectively, these results not only support adapting the dual pathway model to the state-level, but also suggest that several of the model implied pathways may be more relevant for individuals with more pathological eating- and body-related concerns and behaviours.

The role of impulsivity in the association between childhood trauma and dissociative psychopathology: mediation versus moderation

Previous studies on survivors of childhood trauma documented associations between psychological dysregulation, impulsivity, and both behavioral and emotional manifestations of distress. Yet, the mechanism that links these variables remains unclear. The current study aims to examine the pattern of relations between a history of child abuse, impulsivity and dissociation. More specifically, it examines whether impulsivity serves as a moderator or mediator in the association between childhood trauma and dissociation. Eighty-one inpatients from the acute wards of two psychiatric hospitals participated in this study. Data were collected by clinician-administered questionnaires. A highly significant linear hierarchical regression analysis revealed that both psychiatric comorbidity and childhood trauma made unique contributions to the variance of dissociation. Yet, the significant association between childhood trauma and dissociation decreased when impulsivity was entered into the regression model. Our findings suggest that impulsivity mediates the association between childhood trauma and dissociative psychopathology and imply that the identification and treatment of impulsivity could be a potentially valuable clinical target in individuals with dissociative disorders.

Self-reported vs. actual energy intake in youth with and without loss of control eating

Episodes of loss of control over eating (LOC) in children and adolescents--often characterized by the consumption of highly palatable dessert and snack-type foods--have been associated with a lack of awareness while eating that could lead to under- or over-estimation of how much food is consumed. However, little is known about the reporting accuracy of food intake in youth with and without LOC eating. One hundred fifty-six girls and boys were administered the Eating Disorder Examination to assess for the presence of LOC eating. Youth were queried regarding the amounts of foods consumed directly following a multi-item, laboratory buffet test meal. Children with LOC (n=42) did not differ significantly from youth without LOC (n=114) in reporting accuracy of total food intake (reported minus actual energy intake: 153.0 ± 59.6 vs. 96.9 ± 36.0 kcal; p=0.42). However, compared to those without LOC, children with LOC were less accurate at reporting percentage of energy intake from carbohydrate (p=0.01). Youth with LOC were also less accurate at reporting their intake of desserts (p=0.04). Findings point to the possibility that youth with LOC may have poorer recall of sweet food consumption. Future research is required to examine whether poorer recall reflects a lack of awareness while eating palatable, sweet foods.