1
|
Mammì A, Bova V, Martino I, Sammarra I, Ferlazzo E, Pascarella A, Abelardo D, Marsico O, Torino C, Cianci V, Viola G, Pecoraro V, Beghi M, Gambardella A, Pujia A, Aguglia U, Gasparini S. Functional seizures and binge eating disorder: A cross-sectional study. Epilepsy Behav 2024; 158:109943. [PMID: 39002280 DOI: 10.1016/j.yebeh.2024.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVE Functional seizures (FS) are brief, involuntary changes in behaviour or consciousness, distinct from epileptic seizures, potentially associated with psychological dissociation. Binge eating disorder (BED) was linked to psychological and somatic dissociation also. However, any connection between FS and BED is insufficiently explored. We aimed to assess BED prevalence in individuals with FS, anxiety/depression (AD), and healthy subjects (HS), to investigate dissociation's link to binge eating, and to explore psychological characteristics of FS individuals. METHOD Participants underwent evaluations based on ILAE guidelines and DSM-5 criteria, including questionnaires assessing binge eating, dissociation, anxiety, depression and personality traits. Inclusion criteria were age > 18 years, no history of substance abuse, no history of epilepsy, and no use of medications inducing eating disorders. RESULTS We found significantly more frequent and severe binge-eating symptoms in individuals with FS and AD compared to HS. Depression and dissociation correlated with binge-eating symptoms in both AD and FS groups. The PID-5 facet 'Perseveration' predicted binge-eating attitudes only in FS individuals; they reported more childhood emotional neglect and increased disinhibition compared do AD people. DISCUSSION This study underscores the commonality of binge-eating symptoms in FS individuals, emphasizing its association with dissociation symptoms. This finding support the hypothesis of a link between dissociation and eating disorders. Unique clinical characteristics in individuals with FS were identified, as a compulsive dimension related to binge-eating symptoms, providing a comprehensive understanding of their psychological profile and guiding targeted therapeutic interventions.
Collapse
Affiliation(s)
- Anna Mammì
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Valentina Bova
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Iolanda Martino
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Ilaria Sammarra
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Domenico Abelardo
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Oreste Marsico
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Claudia Torino
- IFC-CNR, National Research Council - Institute of Clinical Physiology, Reggio Calabria, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Giulia Viola
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Valeria Pecoraro
- Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Antonio Gambardella
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy.
| | - Sara Gasparini
- Department of Medical and Surgical Sciences, "Magna Græcia" University of Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
| |
Collapse
|
2
|
Johnsen KM, Nielsen KF, Nilsson KK, Kjaersdam Telléus G. Non-interpersonal traumatic events in patients with eating disorders: a systematic review. Front Psychol 2024; 15:1397952. [PMID: 38952827 PMCID: PMC11216314 DOI: 10.3389/fpsyg.2024.1397952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/07/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives The purpose of the systematic review was to synthesize literature on eating disorders (ED) and non-interpersonal traumatic events (NTE) and consolidate the reported prevalence of NTE in patients with an ED. Methods The literature search was performed in Embase, PsycInfo, and PubMed. The keywords in the search were "eating disorder," "trauma" and "non-interpersonal," using index-terms and free-search keywords related to NTE and ED. The PRISMA guidelines were followed. Relevant studies were screened using Rayyan. Results Of the 16 studies included in the quantitative synthesis, five overall types of NTE were identified: accidents, illness, injury, natural disaster and war. Findings provided tentative evidence for illness and injury being more prevalent in patients suffering from an ED compared to controls. The remaining subtypes of NTE did not show a higher prevalence in patients with an ED when compared to controls. Findings also suggest that those with binge/purge subtype of anorexia nervosa (AN) had a higher prevalence of non-interpersonal traumatic events compared to the restrictive subtype of AN. Discussion This systematic review provided a clear synthesis of previous findings related to NTE among patients with an ED. Noteworthy, is that many studies do not take into account if the trauma happened prior or after to ED onset, which may affect the association. Furthermore, the body of research on NTE in patients with ED is exceedingly limited, and more research is needed.
Collapse
Affiliation(s)
- Kirstine Marie Johnsen
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | | | - Kristine Kahr Nilsson
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
| | - Gry Kjaersdam Telléus
- Institute of Communication and Psychology, Psychology, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
3
|
Daniels JK, Timmerman ME, Spitzer C, Lampe A. Differential constellations of dissociative symptoms and their association with childhood trauma - a latent profile analysis. Eur J Psychotraumatol 2024; 15:2348345. [PMID: 38739008 PMCID: PMC11095287 DOI: 10.1080/20008066.2024.2348345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/20/2024] [Indexed: 05/14/2024] Open
Abstract
Background: While several studies documented a positive correlation between childhood maltreatment severity and dissociation severity, it is currently unknown whether specific dissociative symptoms cluster together among individuals with childhood trauma histories ranging from none to severe.Objective: We aimed to explore symptom constellations across the whole spectrum of dissociative processing from patients with severe dissociative disorders to healthy controls and relate these to maltreatment severity and sociodemographic characteristics.Methods: We employed latent profile analysis to explore symptom profiles based on five subscales, measuring absorption, depersonalization, derealization, somatoform and identity alteration, based on the 20 items of the German short version of the Dissociative Experiences Scale-II (Fragebogen zu Dissoziativen Symptomen-20) in a large aggregate sample (n = 3,128) overrepresenting patients with trauma-related disorders. We then related these profiles to maltreatment severity as measured by the five subscales of the Childhood Trauma Questionnaire as well as sociodemographic characteristics.Results: Based on the five FDS subscales, six clusters differentiated by symptom severity, but not symptom constellations, were identified. Somatoform dissociation varied in accordance with the remaining symptom clusters. The cluster with the highest overall symptom severity entailed nearly all subjects diagnosed with Dissociative Identity Disorder and was characterized by extreme levels of childhood maltreatment. Both abuse and neglect were predictive of cluster membership throughout.Conclusions: The higher the severity of dissociative processing in a cluster, the more subjects reported high severity and multiplicity of childhood maltreatment. However, some subjects remain resilient to the development of dissociative processing although they experience extreme childhood maltreatment.
Collapse
Affiliation(s)
- Judith K. Daniels
- Department of Psychology, Division of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- Psychologische Hochschule Berlin, Berlin, Germany
| | - Marieke E. Timmerman
- Department of Psychology, Psychometrics and Statistics, University of Groningen, Groningen, the Netherlands
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Astrid Lampe
- Clinic for Rehabilitation Montafon, Schruns, Austria
- Ludwig Boltzmann Institute – Rehabilitation Research, Vienna, Austria
| |
Collapse
|
4
|
Brewerton TD, Perlman MM, Gavidia I, Suro G. The treatment of dissociative identity disorder in an eating disorder residential treatment setting. Int J Eat Disord 2024; 57:450-457. [PMID: 38041242 DOI: 10.1002/eat.24106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. METHOD We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. RESULTS Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. DISCUSSION These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. PUBLIC SIGNIFICANCE EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.
Collapse
Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- LLC, Mt. Pleasant, South Carolina, USA
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA
- Department of Psychiatry and Behavioral Health, Florida International University College of Medicine, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| |
Collapse
|
5
|
Cruz D. Childhood Trauma Questionnaire-Short Form: Evaluation of Factor Structure and Measurement Invariance. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1099-1108. [PMID: 38045834 PMCID: PMC10689687 DOI: 10.1007/s40653-023-00556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 12/05/2023]
Abstract
Childhood trauma is known to put individuals at risk for mental and physical challenges later in life. Retrospective assessment of early abuse and neglect is critical for prevention and intervention efforts targeted at reducing the negative impacts of childhood trauma. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a widely used measure to assess trauma among adolescents and adults, though there are some inconsistencies with regard to its factor structure and psychometric properties. The purpose of the current study was twofold: (1) to evaluate the hypothesized five-factor structure of CTQ-SF and (2) to test measurement invariance (equivalence) of the instrument across gender and race in a large, nationally representative sample of US adults (N = 863). Confirmatory factor analysis results indicate that the five-factor model fit the data well. The results also show that the five-factor model is generally invariant by gender and racial/ethnic groups and that the form's subscales positively correlate with depression, anxiety, and abnormal inflammatory biomarker activity. Assessment is critical for the advocacy and treatment of individuals who have experienced abuse and neglect as children and adolescents. Our findings suggest that the CTQ-SF is a valuable tool for assessing childhood trauma and can be used in advocacy and treatment efforts.
Collapse
Affiliation(s)
- Daniel Cruz
- The Institute for Trauma-Informed Research, Evaluation, and Training, LLC, Morris Plains, NJ 07950 United States
| |
Collapse
|
6
|
Dissociative experiences of compartmentalization are associated with food addiction symptoms: results from a cross-sectional report. Eat Weight Disord 2023; 28:28. [PMID: 36867281 PMCID: PMC9984353 DOI: 10.1007/s40519-023-01555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/04/2022] [Indexed: 03/04/2023] Open
Abstract
PURPOSE Studies have shown significant associations of dissociative symptoms with both eating and addictive disorders; however, the different forms of dissociation have been relatively understudied in relation to food addiction (FA). The main aim of this study was to investigate the association of certain forms of dissociative experiences (i.e., absorption, detachment and compartmentalization) with FA symptoms in a nonclinical sample. METHODS Participants (N = 755; 543 women; age range: 18-65; mean age: 28.22 ± 9.99 years) were evaluated using self-report measures of FA, dissociation, eating disturbances, and general psychopathology. RESULTS Compartmentalization experiences (defined as pathological over-segregation of higher mental functions) were independently associated with FA symptoms (β = 0.174; p = 0.013; CI = [0.008; 0.064]) even when confounding factors were controlled for. CONCLUSION This finding suggests that compartmentalization symptoms can have a role in the conceptualization of FA, with such two phenomena possibly sharing common pathogenic processes. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
Collapse
|
7
|
Longo P, Marzola E, Martini M, Amodeo L, Abbate-Daga G. Anorexia Nervosa and Somatoform Dissociation: A Neglected Body-Centered Perspective. J Trauma Dissociation 2023; 24:141-156. [PMID: 36052411 DOI: 10.1080/15299732.2022.2119631] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
Collapse
Affiliation(s)
- Paola Longo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Martini
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Amodeo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
8
|
Kovács-Tóth B, Oláh B, Kuritárné Szabó I, Túry F. Adverse childhood experiences increase the risk for eating disorders among adolescents. Front Psychol 2022; 13:1063693. [PMID: 36578685 PMCID: PMC9791097 DOI: 10.3389/fpsyg.2022.1063693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Traumatic events often feature prominently in eating disorders. A questionnaire survey to assess the relation of eating disorder risk to the frequency of adverse childhood experiences (ACEs) and the possible association of eating disorder risk with a particular type of ACE was conducted in a community sample of Hungarian adolescents. Methods Demographic and anthropometric data, risk for eating disorders (by SCOFF questionnaire), and ACEs (by ACE score calculator) were collected from 432 adolescents aged 12-17 years. Results Adolescents who had undergone four or more ACEs were 5.7 times more likely to be in the high eating disorder risk group than those who did not report any ACEs. Cumulative maltreatment showed a greater association with overall risk for eating disorders than cumulative family dysfunction. There is an increased risk of eating disorders from emotional maltreatment (OR = 3.475), physical maltreatment (OR = 3.440), sexual maltreatment (OR = 10.973), and emotional neglect (OR = 3.331). Dysfunctional family circumstances revealed an association with household mental illness (OR = 3.401). Conclusion Our study of the connection between eating disorder risk and ACE is the first of its kind in Central and Eastern Europe. Maltreatments had a greater role than family dysfunctions in increasing the risk of eating disorders. Our findings contribute to a more precise understanding of the role that ACEs play in eating disorders. It is important to bring to clinicians' attention the importance of ACEs in the diagnosis and therapy of eating disorders and their potentially fundamental significance for therapy.
Collapse
Affiliation(s)
- Beáta Kovács-Tóth
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,*Correspondence: Beáta Kovács-Tóth,
| | - Barnabás Oláh
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ildikó Kuritárné Szabó
- Institute of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Ferenc Túry
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| |
Collapse
|
9
|
Transtornos alimentares na infância. PSICO 2022. [DOI: 10.15448/1980-8623.2022.1.38780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Transtornos alimentares são um tema preocupante em qualquer fase de desenvolvimento humano. Essa revisão da literatura teve o objetivo de analisar as produções científicas quanto a transtornos alimentares em crianças, com a busca de artigos publicados entre 2014-2019 nas bases de dados Scielo, Pepsic, BVS (Lilacs) e Periódicos CAPES, utilizando os termos “childhood” AND “eating disorder”, “child” AND “eating disorder”, “children” AND “eating disorder”, “childhood” AND “eating difficulty”. 43 artigos foram selecionados após a aplicação dos critérios de exclusão e inclusão. Os resultados indicaram três tópicos principais discutidos nos estudos: a forma como os cuidadores influenciam na alimentação de crianças, fatores emocionais e psicológicos que influenciam nos transtornos alimentares, e o tratamento de crianças com transtornos alimentares. Concluiu-se que o tema ainda é pouco estudado e o cenário internacional é referência em publicações.
Collapse
|
10
|
Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
Collapse
Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
11
|
Malet-Karas A, Bernard D, Piet E, Bertin E. Disordered eating as a repercussion of sexual assault: a consequence to consider. Eat Weight Disord 2022; 27:2095-2106. [PMID: 35015284 DOI: 10.1007/s40519-021-01356-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE This study aims at clarifying the links between sexual violence and disordered eating (DE). METHODS In a sample of 12,638 victims of self-reported sexual violence, we analyzed the situation of 546 victims that declared having developed DE. We assessed the characteristics of the assault (age, type of aggression) and the medical consequences (PTSD, depression, suicide attempts, anxiety disorders, etc.). RESULTS DE prevalence was 4.3% in the victim sample. The age of the first assault in DE victims was significantly lower than that of the whole population (12 years vs 16 years for median; p < 0.001). A much higher prevalence of sexual assault consequences was present in victims developing DE with odd ratios (OR) for: self-mutilation (OR = 11.5 [8.29-15.95], p < 0.001); depression (OR = 5.7 [4.81-6.86], p < 0.001); self-medication (OR = 5.3 [3.86-7.19], p < 0.001); suicide attempts (OR = 4.5 [3.59-5.67], p < 0.001); post-traumatic stress disorder (OR = 3.8 [2.99-4.78], p < 0.001); anxiety troubles (OR = 5.2 [4.11-6.47], p < 0.001); alcoholism (OR = 4.0 [2.81-5.58], p < 0.001). CONCLUSION This study confirms the link between DE and sexual violence, especially in childhood, leading to severe psychological consequences. In this context, DE should be envisaged as a coping strategy accompanying emotional dysregulation due to traumatic events, and be treated as such. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series analysis such as case studies.
Collapse
Affiliation(s)
| | - Delphine Bernard
- Association "Le Regard du Miroir", 5 Boulevard Foch BP 62732, 51100, Reims, France
| | - Emmanuelle Piet
- Association "Collectif féministe contre le viol (CFCV)", Paris, France
| | - Eric Bertin
- Clinical Nutrition Transversal Unit (UTNC) of Reims University Hospital and Performance, Health, Metrology, Society Laboratory (PSMS, EA 7507) of Reims Champagne-Ardenne University, Reims, France.
- Hôpital Robert Debré, Unité 63 Nutrition, 45 rue Cognacq Jay, 51092, Reims, France.
| |
Collapse
|
12
|
Kadriu F, Claes L, Witteman C, Vroling M, Norré J, Krans J. Intrusive images, autobiographical memories, and core beliefs of patients with an eating disorder. APPLIED COGNITIVE PSYCHOLOGY 2022. [DOI: 10.1002/acp.3974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fortesa Kadriu
- Behavioural Science Institute Radboud University Nijmegen The Netherlands
- Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium
- Faculty of Medicine and Health Sciences University Antwerp Antwerp Belgium
| | - Cilia Witteman
- Behavioural Science Institute Radboud University Nijmegen The Netherlands
| | - Maartje Vroling
- Behavioural Science Institute Radboud University Nijmegen The Netherlands
- Amarum, Expertise Centre for Eating Disorders GGNet Network for MentalHealth Care Zutphen The Netherlands
| | - Jan Norré
- People Development Leuven Belgium
- Faculty of Psychology and Educational Sciences Free University of Brussels Elsene Belgium
| | - Julie Krans
- Behavioural Science Institute Radboud University Nijmegen The Netherlands
- Faculty of Psychology and Educational Sciences KU Leuven Leuven Belgium
- Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD Nijmegen The Netherlands
| |
Collapse
|
13
|
Quattropani MC, Geraci A, Lenzo V, Sardella A, Schimmenti A. Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: a Study On a Sample of Italian Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:365-374. [PMID: 35600515 PMCID: PMC9120272 DOI: 10.1007/s40653-022-00450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 05/27/2023]
Abstract
Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.
Collapse
Affiliation(s)
| | - Alessandra Geraci
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
| |
Collapse
|
14
|
Serra R, Di Nicolantonio C, Di Febo R, De Crescenzo F, Vanderlinden J, Vrieze E, Bruffaerts R, Loriedo C, Pasquini M, Tarsitani L. The transition from restrictive anorexia nervosa to binging and purging: a systematic review and meta-analysis. Eat Weight Disord 2022; 27:857-865. [PMID: 34091875 PMCID: PMC8964622 DOI: 10.1007/s40519-021-01226-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/24/2021] [Indexed: 11/29/2022] Open
Abstract
Numerous studies addressed the topic of behavioral and symptomatic changes in eating disorders. Rates of transition vary widely across studies, ranging from 0 to 70.8%, depending on the diagnoses taken into account and the study design. Evidence shows that the specific transition from restrictive-type anorexia nervosa (AN-R) to disorders involving binging and purging behaviors (BPB) is related to a worsening of the clinical picture and worse long-term outcomes. The aim of this systematic review and meta-analysis is to focus on this specific transition, review existing literature, and summarize related risk factors. Medline and PsycINFO databases were searched, including prospective and retrospective studies on individuals with AN-R. The primary outcome considered was the rate of onset of BPB. Twelve studies (N = 725 patients) were included in the qualitative and quantitative analysis. A total of 41.84% (95% CI 33.58-50.11) of patients with AN-R manifested BPB at some point during follow-up. Risk factors for the onset of BPB included potentially treatable and untreatable factors such as the family environment, unipolar depression and higher premorbid BMI. These findings highlight that patients with AN-R frequently transition to BPB over time, with a worsening of the clinical picture. Existing studies in this field are still insufficient and heterogeneous, and further research is needed. Mental health professionals should be aware of the frequent onset of BPB in AN-R and its risk factors and take this information into account in the treatment of AN-R. LEVEL OF EVIDENCE: Evidence obtained from a systematic review and meta-analysis, Level I.
Collapse
Affiliation(s)
- Riccardo Serra
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy.,Research Group Psychiatry, Department of Neurosciences, KU Leuven University, UZ Gasthuisberg Campus, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosciences, Public Health Psychiatry, KULeuven, Leuven RM, Belgium
| | - Chiara Di Nicolantonio
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy
| | - Riccardo Di Febo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy
| | - Franco De Crescenzo
- Pediatric University Hospital-Department (DPUO), Ospedale Pediatrico Bambino Gesù, Piazza di Sant'Onofrio, 4, 00165, Rome, Italy.,Department of Psychiatry, University of Oxford, Warneford Lane, Headington, Oxford, OX3 7JX, UK
| | - Johan Vanderlinden
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, UZ Gasthuisberg Campus, Herestraat 49, 3000, Leuven, Belgium
| | - Elske Vrieze
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, UZ Gasthuisberg Campus, Herestraat 49, 3000, Leuven, Belgium
| | - Ronny Bruffaerts
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, UZ Gasthuisberg Campus, Herestraat 49, 3000, Leuven, Belgium.,Department of Neurosciences, Public Health Psychiatry, KULeuven, Leuven RM, Belgium
| | - Camillo Loriedo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy
| | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy.
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università, 30, 00185, Rome, RM, Italy
| |
Collapse
|
15
|
Spivak-Lavi Z, Gewirtz-Meydan A. Eating Disorders and Sexual Satisfaction: The Mediating Role of Body Image Self-consciousness during Physical Intimacy and Dissociation. JOURNAL OF SEX RESEARCH 2022; 59:344-353. [PMID: 34269636 DOI: 10.1080/00224499.2021.1948491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Women with eating disorders experience difficulties related to sexual activity, yet little is known about the indirect association between eating disorders and sexual satisfaction. This study examined the indirect association between eating disorders and sexual satisfaction using body image self-consciousness during physical intimacy and dissociation as mediators. Online questionnaires were answered by 985 Israeli women. Of them, 98 were identified as likely to have eating disorders (study group). A matching control group (n = 98) was selected from the remaining respondents. Participants in the study group had significantly higher body image self-consciousness and dissociation than the matched controls, as well as significantly lower sexual satisfaction. The research model revealed that body image self-consciousness during physical intimacy mediates the link between eating disorders and sexual satisfaction, while dissociation does not. Women with eating disorders have higher levels of self-consciousness about their body during sexual activity, which may distract them from their own sexual needs and desires and those of their partners, and this, in turn, is associated with sexual dissatisfaction. Findings highlight the need for improved evidenced-based assessment and management of the sexual satisfaction of women with eating disorders.Abbreviations: ED: eating disorders; AN: anorexia nervosa; BN: bulimia nervosa; BED: binge eating disorder.
Collapse
Affiliation(s)
- Zohar Spivak-Lavi
- Faculty of Social Work & Faculty of Education, Max Stern Yezreel Valley College
| | | |
Collapse
|
16
|
Zinchuk M, Lavrishcheva A, Menshikova A, Voinova N, Artemieva M, Guekht A. Nonsuicidal self-injury in eating disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:70-78. [DOI: 10.17116/jnevro202212209170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
17
|
Visual perception and dissociation during Mirror Gazing Test in patients with anorexia nervosa: a preliminary study. Eat Weight Disord 2021; 26:1541-1551. [PMID: 32757140 PMCID: PMC8128841 DOI: 10.1007/s40519-020-00977-6] [Citation(s) in RCA: 4] [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: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 10/27/2022] Open
Abstract
PURPOSE It has been widely shown that dissociative features might play a fundamental role in producing body image distortions in patients affected by eating disorders. Here, we hypothesize that the Mirror Gazing Test (MGT), a task consisting in mirror exposure in a condition of sensory deprivation, would elicit dissociative symptoms in a group of patients with anorexia nervosa (AN). METHODS Fourteen patients with AN and fourteen healthy controls (HC) underwent a 10 min MGT and completed the Strange Face Questionnaire and a short version of the Clinician-Administered Dissociative States Scale, along with a psychological assessment for eating disorders psychopathology, anxiety and depression. RESULTS AN patients reported a higher number of strange-face apparitions and dissociative sensations than HC during the MGT. Dissociative identity (compartmentalization of two or more identities) and depersonalization (detachment of bodily-self) were much higher in patients with AN than in HC. These findings were correlated with body dissatisfaction and disruption in interoceptive awareness. CONCLUSION Dissociation and body image dysfunction are strongly connected in the pathophysiology of anorexia nervosa. Future research should investigate the same aspects in other psychiatric conditions characterized by body image distortions, such as Body Dysmorphic Disorder. LEVEL OF EVIDENCE I, Experimental studies.
Collapse
|
18
|
Hazzard VM, Crosby RD, Crow SJ, Engel SG, Schaefer LM, Brewerton TD, Castellini G, Trottier K, Peterson CB, Wonderlich SA. Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder. EUROPEAN EATING DISORDERS REVIEW 2021; 29:611-621. [PMID: 33660906 DOI: 10.1002/erv.2823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help. METHOD In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted. RESULTS Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. CONCLUSIONS Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.
Collapse
Affiliation(s)
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,The Emily Program, St. Paul, Minnesota, USA
| | - Scott G Engel
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | | | - Timothy D Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Giovanni Castellini
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Kathryn Trottier
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| |
Collapse
|
19
|
Mediating Factors between Childhood Traumatic Experiences and Eating Disorders Development: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020114. [PMID: 33561984 PMCID: PMC7915652 DOI: 10.3390/children8020114] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
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.
Collapse
|
20
|
Longo P, Marzola E, De Bacco C, Demarchi M, Abbate-Daga G. Young Patients with Anorexia Nervosa: The Contribution of Post-Traumatic Stress Disorder and Traumatic Events. ACTA ACUST UNITED AC 2020; 57:medicina57010002. [PMID: 33375161 PMCID: PMC7822187 DOI: 10.3390/medicina57010002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Anorexia nervosa (AN) is a complex disorder whose etiopathogenesis involves both biological and environmental factors. The aims of the present study were to retrospectively analyze risk factors in young patients with AN and to assess differences in clinical and eating-related symptoms between patients with and without a diagnosis of post-traumatic stress disorder (PTSD) and with or without a history of acknowledged risk factors. Materials and Methods: Sixty-four patients with AN (<25 years old) were recruited and completed an anamnestic evaluation and the following self-report measures: Eating Disorder Examination Questionnaire (EDE-Q), Childhood Trauma Questionnaire (CTQ), State-Trait Anxiety Inventory (STAI-Y), Beck Depression Inventory (BDI), Life Events Checklist (LEC), and Dissociative Experience Scale (DES). The PTSD diagnosis was assigned according to the Structured Clinical Interview for the DSM-5 (SCID-5). Results: The most frequent risk factors were those associated with relational traumatic events and familiarity for psychiatric disorders. Higher severity of body-related symptoms (i.e., those symptoms impacting on body image and perception and leading to body concerns) emerged in patients with PTSD, versus patients without PTSD diagnosis; however, after controlling for dissociative symptoms, only differences in BMI remained significant. Concerning other risk factors, those with a history of childhood trauma were more depressed than patients without such history and those with familiarity with eating disorders reported more AN-related hospitalizations in the past than those individuals without familiarity. Conclusion: These results suggest the importance of investigating the presence of risk factors and PTSD diagnosis in patients with AN, and to treat post-traumatic symptoms in young patients in order to decrease the risk of developing severe forms of AN. Moreover, a particular focus on those patients with a family member affected by an eating disorder could be of clinical utility.
Collapse
|
21
|
Child Trauma Experiences and Dissociative Symptoms in Women with Eating Disorders: Case-Control Study. CHILDREN-BASEL 2020; 7:children7120274. [PMID: 33291436 PMCID: PMC7762173 DOI: 10.3390/children7120274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
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.
Collapse
|
22
|
Longo P, Panero M, Amodeo L, Demarchi M, Abbate-Daga G, Marzola E. Psychoform and somatoform dissociation in anorexia nervosa: A systematic review. Clin Psychol Psychother 2020; 28:295-312. [PMID: 32918777 DOI: 10.1002/cpp.2517] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- Paola Longo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Panero
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Amodeo
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matilde Demarchi
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
23
|
Beato‐Fernandez L, Muñoz‐Martinez V, Mata‐Saenz B, Gimeno‐Clemente N, Rojo‐Moreno L, Vaz‐Leal FJ, Rodriguez‐Cano T. Attitudes towards change mediate the effect of dissociation on psychopathological outcome in the treatment of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:724-738. [DOI: 10.1002/erv.2774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/09/2020] [Accepted: 07/13/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Luis Beato‐Fernandez
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | - Victoria Muñoz‐Martinez
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | - Beatriz Mata‐Saenz
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| | | | - Luis Rojo‐Moreno
- Department of Psychiatry, Faculty of Medicine University of Valencia Valencia Spain
| | - Francisco J. Vaz‐Leal
- Department of Psychiatry, Faculty of Medicine University of Extremadura Badajoz Spain
| | - Teresa Rodriguez‐Cano
- Eating Disorders Unit General Hospital of Ciudad Real C/ Obispo Rafael Torija s/n Ciudad Real Spain
| |
Collapse
|
24
|
Serra R, Kiekens G, Vanderlinden J, Vrieze E, Auerbach RP, Benjet C, Claes L, Cuijpers P, Demyttenaere K, Ebert DD, Tarsitani L, Green JG, Kessler RC, Nock MK, Mortier P, Bruffaerts R. Binge eating and purging in first-year college students: Prevalence, psychiatric comorbidity, and academic performance. Int J Eat Disord 2020; 53:339-348. [PMID: 31868255 DOI: 10.1002/eat.23211] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Binge eating and purging behaviors (BPB) are common among college students, but evidence is scant on prevalence and associations of BPB with mental health problems and objective academic performance. This study aims to investigate: (a) 12-month prevalence of BPB among college first-year students, (b) comorbidity patterns of BPB with various mental health problems, and (c) the association of BPB with objective academic functioning. METHODS Using data from the Leuven College Surveys (Belgium), as part of the World Mental Health Surveys International College Student initiative, we cross-sectionally assessed 12-month BPB and mental health problems among college first-year students (n = 4,889; response rate = 73.2%) at the beginning of the academic year. Objective measures of academic functioning (final grades, expressed in academic year percentage "AYP" [0-100%] and academic failure) were obtained from administrative records at the end of the academic year. RESULTS Twelve-month prevalence of BPB was 7.6% (7.3%binge eating and 1.0%purging), with higher rates among females than males. Bivariate models showed an association between BPB and numerous mental health problems (ORs = 3.4-18.4). Multivariate models showed associations with non-suicidal self-injury, post-traumatic stress, internalizing/externalizing problems and suicidal ideation. After controlling for sociodemographic characteristics and comorbid mental health problems, BPB were still associated with lower AYP (-4.1 to -11.2% range) and elevated odds of academic year failure (ORs = 1.4-4.2). CONCLUSIONS BPB (especially binge eating) are relatively common and associated with mental health problems, comparatively low academic performance, and higher risk of academic failure among college first-year students. Further study is needed to examine the causal dynamics underlying these associations.
Collapse
Affiliation(s)
- Riccardo Serra
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | - Glenn Kiekens
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | | | - Elske Vrieze
- Universitair Psychiatrisch Centrum KU Leuven, Leuven, Belgium
| | - Randy P Auerbach
- Division of Child and Adolescent Psychiatry, Columbia University, New York, New York.,Division of Clinical Developmental Neuroscience, Sackler Institute, New York, New York
| | - Corina Benjet
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Koen Demyttenaere
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium
| | - David D Ebert
- Department for Psychology, Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen Nuremberg, Erlangen, Germany
| | - Lorenzo Tarsitani
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | - Jennifer Greif Green
- Wheelock College of Education and Human Development, Boston University, Boston, Massachusetts
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Phillippe Mortier
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en Epidemiología y SaludPública (CIBERESP), Madrid, Spain
| | - Ronny Bruffaerts
- Department of Neurosciences, Center for Public Health Psychiatry, KU Leuven, Leuven, Belgium.,Institute for Social Research, Population Studies Center, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
25
|
Serra R, Kiekens G, Tarsitani L, Vrieze E, Bruffaerts R, Loriedo C, An A, Vanderlinden J. The effect of trauma and dissociation on the outcome of cognitive behavioural therapy for binge eating disorder: A 6-month prospective study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:309-317. [PMID: 32080958 DOI: 10.1002/erv.2722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is commonly associated with a history of trauma. Yet, there is little insight into the potential effect that trauma, dissociation, and depressive symptoms may have on the outcome of treatment interventions. METHODS A total of 142 treatment-seeking patients admitted with a diagnosis of DSM-5 BED (88% female; mean age = 38.7; SD = 10.8) took part in a 6-month, protocolized, group cognitive behavioural therapy (CBT). Self-report questionnaires were administered to assess lifetime traumatic experiences, dissociation, and depression. Body mass index and the number of binges per week (BPW) were measured throughout treatment. The main outcomes were the percentage reduction in BPW and remission (i.e., less than one BPW; cf. DSM-5). RESULTS Most BED patients (91.5%) reported a history of trauma, with two in three patients reporting three or more traumatic experiences. Whereas the number of traumatic experiences was not significantly associated with a reduction in BPW or remission, a higher traumatic impact score significantly decreased the likelihood of obtaining remission at the end of treatment (OR = 0.96; 95% CI [0.92, 0.99]). Higher levels of dissociative symptoms partially mediated this prospective association. CONCLUSIONS The impact of traumatic experiences, as opposed to the number of traumatic experiences experienced, negatively predicts remission after 6 months of CBT. These findings highlight the importance of addressing trauma and dissociative features in the CBT treatment of BED.
Collapse
Affiliation(s)
- Riccardo Serra
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy.,Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Glenn Kiekens
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Lorenzo Tarsitani
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | - Elske Vrieze
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Ronny Bruffaerts
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Camillo Loriedo
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | | | - Johan Vanderlinden
- Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven University, Leuven, Belgium
| |
Collapse
|
26
|
Belli H, Ural C, Akbudak M, Sagaltıcı E. Levels of childhood traumatic experiences and dissociative symptoms in extremely obese patients with and without binge eating disorder. Nord J Psychiatry 2019; 73:527-531. [PMID: 31502911 DOI: 10.1080/08039488.2019.1662085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma. Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED. Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared. Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05). Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.
Collapse
Affiliation(s)
- Hasan Belli
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Cenk Ural
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
| | - Mahir Akbudak
- Department of Psychiatry, Mardin State Hospital , Mardin , Turkey
| | - Eser Sagaltıcı
- Department of Psychiatry, Bagcilar Education and Research Hospital, University of Health Sciences , Istanbul , Turkey
| |
Collapse
|
27
|
Longo P, Bertorello A, Panero M, Abbate-Daga G, Marzola E. Traumatic events and post-traumatic symptoms in anorexia nervosa. Eur J Psychotraumatol 2019; 10:1682930. [PMID: 31723378 PMCID: PMC6830292 DOI: 10.1080/20008198.2019.1682930] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 09/09/2019] [Accepted: 10/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Traumatic Events (TEs) are often seen as risk factors not only for the development of eating disorders (EDs) but also for their impact on the severity of clinical presentation and psychiatric comorbidities. Objective: This study aimed to assess the prevalence and time of occurrence of TEs in the two subtypes of anorexia nervosa (AN; restricting [RAN] and binge-purging [BPAN]) and to investigate differences in TEs (number, type, frequency) as well as clusters of post-traumatic symptoms and emotional dysregulation between the two groups. Method: Seventy-seven hospitalized women were recruited and divided into two subgroups according to their AN subtype. Participants completed the following self-reported measures: Eating Disorder Inventory-2 (EDI-2), Life Events Checklist (LEC), Impact of Events Scale-Revised (IES-R) and the Difficulties in Emotion Regulation Scale (DERS). Results: A higher occurrence of TEs was found in patients with BPAN than in those with RAN. In particular, there were significantly more women in the BPAN group than in the RAN group who had been sexually assaulted. Exposure to TEs happened before the onset of illness in most patients, regardless of the AN subtype. Finally, the BPAN group had significantly higher scores in terms of post-traumatic symptoms and emotional dysregulation than RAN patients. Conclusions: Patients with BPAN showed a higher occurrence of TEs, post-traumatic symptom clusters, and emotional dysregulation than those with RAN. These findings are of interest as treatments could benefit from trauma-informed interventions for those affected by AN, and particularly for those with the binge-purging subtype.
Collapse
Affiliation(s)
- Paola Longo
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Turin, Italy
| | - Antonella Bertorello
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Panero
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Centre, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
28
|
Palmisano GL, Innamorati M, Sarracino D, Bosco A, Pergola F, Scaltrito D, Giorgio B, Vanderlinden J. Trauma and dissociation in obese patients with and without binge eating disorder: A case – control study. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1470483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Giovanni Luca Palmisano
- Department of Psychology of the University of Bari “Aldo Moro”, Piazza Umberto I, 70121 Bari, BA, Italy
| | - Marco Innamorati
- Department of History, Cultural Heritage, Education and Society of the University of Rome “Tor Vergata”, Via Columbia 1, 00133 Roma, Italy
| | - Diego Sarracino
- Department of Psychology, University of Milan “Bicocca”, Piazza dell’Ateneo Nuovo 1, CP 20126 Milan, MI, Italy
| | - Andrea Bosco
- Department of Psychology of the University of Bari “Aldo Moro”, Piazza Umberto I, 70121 Bari, BA, Italy
| | - Filippo Pergola
- Department of History, Cultural Heritage, Education and Society of the University of Rome “Tor Vergata”, Via Columbia 1, 00133 Roma, Italy
| | - Daniela Scaltrito
- Department of Psychiatry of "Santa Maria Del Piede" Hospital, Eating Disorder Center “Salvatore Cotugno”, Gravina in Puglia, Via S Maria Del Piede 5, Bari, CP 70024, Italy
| | - Bartolomeo Giorgio
- Department of Psychiatry of "Santa Maria Del Piede" Hospital, Eating Disorder Center “Salvatore Cotugno”, Gravina in Puglia, Via S Maria Del Piede 5, Bari, CP 70024, Italy
| | - Johan Vanderlinden
- Eating Disorder Unit, University Psychiatric Center K.U. Leuven, Campus Kortenberg, Leuvense Steenweg 517, B-3070 Kortenberg, Belgium
| |
Collapse
|
29
|
Seubert A. Becoming Known: A Relational Model Utilizing Gestalt and Ego State-Assisted EMDR in Treating Eating Disorders. JOURNAL OF EMDR PRACTICE AND RESEARCH 2018. [DOI: 10.1891/1933-3196.12.2.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eating disorders (EDs) require a multidisciplinary approach, rather than a hammer-and-nail perspective. Based upon recent research and more than a decade of clinical experience, this article highlights the need to include a trauma-informed and dissociation-sensitive treatment of EDs. The emphasis is on EDs as a dissociative coping strategy, created in many cases to tolerate the intolerable. Ego state therapy, Gestalt principles, and empty chair technique support the adaptive information processing (AIP) of eye movement desensitization and reprocessing (EMDR) in both metabolizing painful experiences that give rise to EDs and in loosening the stranglehold of anxiety and shame. The acronym RUG-C introduces four universal principles in working with ego states: recognition, understanding, gratitude and goal setting, and collaboration. Relational ruptures between ego states/parts of the client (intrapsychic) and between the client and the world (interpersonal) are created in the client’s efforts to deal with painful experiences both large and small. They are repaired in the therapeutic relationship, in the processing of past trauma, and in the rescue of body image from the power of shame. Three case reports, with transcripts, are provided to illustrate conceptualization and its application.
Collapse
|