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Budia JM, Alcover CM, Fernández-Muñoz JJ, Blanco-Fernández A, Félix-Alcántara MP. Attachment, motivational systems and anorexia nervosa: A systematic review and proposed framework for eating disorders. Clin Psychol Psychother 2023; 30:913-930. [PMID: 36861498 DOI: 10.1002/cpp.2845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION There is a direct association between patients with insecure attachment style (IAS), behavioural inhibition (BIS) and behavioural activation (BAS) motivational systems, and anorexia nervosa (AN). However, the possible direct relationships between these three variables have not been studied. OBJECTIVE The main objective of this study is to analyse the relationship between these variables and propose a framework for analysing and understanding these relationships. METHODOLOGY A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching the following terms: 'anorexia', 'attachment' and those related to motivational systems. The final search was limited to publications in English dated between 2014-2022 for 'anorexia and attachment' and 2010-2022 for 'anorexia and BIS/BAS'. RESULTS Of the 587 articles retrieved, 30 were included in this study for the textual data analysis of the relationship between anorexia and attachment (17), anorexia and motivational systems (10) and anorexia, attachment and motivational systems (3). An association between avoidant IAS, AN and hypersensitivity to punishment of the BIS was observed in the analysis. A relationship was also observed with hyperreinforcement sensitivity of the BAS. After reviewing the articles, a possible relationship between the three factors, along with other mediating factors, was found. DISCUSSION AN is directly related to the avoidant IAS and to BIS. Similarly, bulimia nervosa (BN) was directly related with anxious IAS and BAS. However, contradictions were found in the BN-BAS relationship. This study proposes a framework for analysing and understanding these relationships.
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Castellini G, Cassioli E, Rossi E, Mancini M, Ricca V, Stanghellini G. Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eat Weight Disord 2022; 27:2273-2289. [PMID: 35179727 PMCID: PMC9556383 DOI: 10.1007/s40519-022-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 10/29/2022] Open
Abstract
Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for "objective" (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons' lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive-behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since "being anorexic" becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Stanghellini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy.,Centro de Estudios de Fenomenología y Psiquiatría, Diego Portales' University, Santiago, Chile
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Huang C, Yuan Q, Shi S, Ge M, Sheng X, Yang M, Zhang L, Wang L, Zhang K, Zhou X. Associations between alexithymia, parental rearing styles, and frequency of drug use in male methamphetamine dependence patients. BMC Psychiatry 2022; 22:276. [PMID: 35439989 PMCID: PMC9020116 DOI: 10.1186/s12888-022-03897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alexithymia, which is characterized by difficulty identifying and describing feelings, is a stable personality trait and it has been associated with early life experiences. Methamphetamine dependence patients with high level of alexithymia may be particularly vulnerable to engaging in more frequent methamphetamine use. Therefore, we aimed to evaluate whether alexithymia was associated with frequency of methamphetamine use. Additionally, the current study sought to examine early-life factors associated with the development of alexithymia, i.e., parental rearing styles. METHOD Participants were 108 non-injecting methamphetamine dependent patients from a male compulsory detoxification center. The level of alexithymia was assessed by Toronto Alexithymia Scale-20(TAS-20). In addition, we applied Egna Minneu av. Bardndosnauppforstran (EMBU) to assess the parental rearing styles, including the dimensions of warmth, rejection, punishment/strictness, overinvolvement, overprotection, and favoring. RESULTS The total score of TAS-20 was positively correlated with frequency of methamphetamine use (r = 0.26, p < 0.01). Specifically, except for externally oriented thinking, difficulty identifying feelings (r = 0.23, p < 0.05) and difficulty describing feelings (r = 0.25, p < 0.05) were positively correlated with frequency of methamphetamine use. Multiple linear regression showed that more maternal rejection (B = 0.59, p = 0.002), or less maternal warmth (B = -0.22, p = 0.004) was associated with higher levels of alexithymia. Ordinal logistic regression showed that for every 1 score increase in the total score of TAS-20, there was a 1.06 times risk of a one level increase in the level of methamphetamine use frequency (OR = 1.06, p = 0.01). CONCLUSIONS These results have major implications for understanding the role of alexithymia in craving and addiction, while providing a further and explicit entry point for addiction treatment. Moreover, more attention should be focused on parenting in relation to early experiences.
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Affiliation(s)
- Cui Huang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Qiuyu Yuan
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Shengya Shi
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Menglin Ge
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Xuanlian Sheng
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Meng Yang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Ling Zhang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Lei Wang
- grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032 Anhui Province China ,grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000 China ,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000 China
| | - Kai Zhang
- School of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032, Anhui Province, China. .,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000, China. .,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000, China.
| | - Xiaoqin Zhou
- School of Mental Health and Psychological Sciences, Anhui Medical University, 69 Meishan Road, Hefei, 230032, Anhui Province, China. .,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 North Chaohu Road, Chaohu City, Hefei, 238000, China. .,Anhui Psychiatric Center, 64 North Chaohu Road, Anhui Medical University, Hefei, 238000, China.
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Stramecki F, Misiak B, Gawęda Ł, Prochwicz K, Kłosowska J, Samochowiec J, Samochowiec A, Pawlak E, Szmida E, Skiba P, Cechnicki A, Frydecka D. The Moderating Role of the FKBP5 Gene Polymorphisms in the Relationship between Attachment Style, Perceived Stress and Psychotic-like Experiences in Non-Clinical Young Adults. J Clin Med 2022; 11:jcm11061614. [PMID: 35329940 PMCID: PMC8953491 DOI: 10.3390/jcm11061614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have reported that stressful life experiences increase the risk of psychosis and psychotic-like experiences (PLEs). Common variations of the FKBP5 gene have been reported to impact the risk of psychosis by moderating the effects of environmental exposures. Moreover, anxious and avoidant attachment styles have been shown to increase both the level of perceived stress and the risk for psychosis development. In the present cross-sectional study, we aimed to investigate whether variants of the FKBP5 gene moderate the effects of attachment styles and the level of perceived stress on the development of PLEs. A total of 535 non-clinical undergraduates were genotyped for six FKBP5 single nucleotide polymorphisms (SNPs) (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158). The Psychosis Attachment Measure (PAM), the Perceived Stress Scale-10 (PSS-10) and the Prodromal Questionnaire 16 (PQ-16) were administered to assess attachment styles, the level of perceived stress and PLEs, respectively. Anxious attachment style, lower levels of perceived self-efficacy and higher levels of perceived helplessness were associated with a significantly higher number of PLEs. The main effects of attachment style on the severity of PLEs were significant in models testing for the associations with perceived self-efficacy and three FKBP5 SNPs (rs1360780, rs9296158 and rs9470080). The main effect of rs38003733 on the number of PLEs was observed, with GG homozygotes reporting a significantly higher number of PLEs in comparison to T allele carriers. In individuals with dominant anxious attachment style, there was a significant effect of the interaction between the FKBP5 rs4713902 SNP and self-efficacy on the severity of PLEs. Among rs4713902 TT homozygotes, a low level of perceived self-efficacy was associated with higher severity of PLEs. In subjects with non-dominant anxious attachment, a low level of perceived self-efficacy was associated with a higher number of PLEs, regardless of the genotype. Our results indicate that the FKBP5 gene might moderate the relationship between attachment, perceived stress and PLEs.
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Affiliation(s)
- Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza Street 1, 00-378 Warsaw, Poland;
| | - Katarzyna Prochwicz
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland;
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, 71-017 Szczecin, Poland;
| | - Edyta Pawlak
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla Street 12, 53-114 Wroclaw, Poland;
| | - Elżbieta Szmida
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Paweł Skiba
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Medical College Jagiellonian University, Sikorskiego Place 2, 31-115 Krakow, Poland;
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
- Correspondence:
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Cascino G, Monteleone AM, Marciello F, Pellegrino F, Ruzzi V, Monteleone P. Alexithymia and cortisol awakening response in people with eating disorders. World J Biol Psychiatry 2021; 22:546-551. [PMID: 33135561 DOI: 10.1080/15622975.2020.1844291] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Alexithymia, which is the inability to recognise and describe one's own emotions, is a transdiagnostic feature across eating disorders (EDs) and it has been associated with prolonged stress exposure. Therefore, we evaluated whether alexithymia was associated with hypothalamus-pituitary-adrenal (HPA) axis functioning, the main endogenous stress response system, in patients with anorexia nervosa (AN) or bulimia nervosa (BN). METHODS 26 women with AN and 26 with BN participated in the study. Alexithymia was evaluated by the Toronto Alexithymia Scale-20 and eating-related psychopathology was measured by the Eating Disorder Inventory-2. The activity of the HPA axis was assessed by measuring the salivary cortisol awakening response (CAR). RESULTS The prevalence of alexithymia did not differ significantly between the two diagnostic groups. Alexithymia was associated with more severe eating-related psychopathology in AN women but not in BN women. A significant reduction in the magnitude of CAR occurred in alexithymic patients with BN compared to non-alexithymic patients, but not in alexithymic women with AN. CONCLUSIONS These results confirm the presence of a more severe specific psychopathology in alexithymic individuals with AN and show, for the first time, an association between alexithymia and a dampened basal activity of the HPA axis in BN.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
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Cascino G, Marciello F, Monteleone AM, D'Agostino G, Patriciello G, Monteleone P. Perceived parental bonding and cortisol awakening response in people with eating disorders. Eat Behav 2021; 42:101546. [PMID: 34358853 DOI: 10.1016/j.eatbeh.2021.101546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
It is widely acknowledged that early life experiences may have an impact on hypothalamic-pituitary-adrenal (HPA) axis functioning in eating disorders (EDs). Parental bonding is defined as the parental contribution of care and control to parent-child relationships. We evaluated whether perceived care and protection of parental bonding in childhood and adolescence were associated with HPA axis functioning in adult patients with EDs. Sixty-four women with EDs participated in the study, 37 with anorexia nervosa and 27 with bulimia nervosa. Parental care and control (separately for the mother and father) were evaluated by the Parental Bonding Instrument. The activity of the HPA axis was assessed by measuring the salivary cortisol awakening response (CAR). Parental care and control did not differ significantly between the two diagnostic groups. High and low maternal care were associated with significantly different time patterns of CAR without any significant difference in the overall post-awakening production of cortisol. Maternal control, paternal care and paternal control were not associated with any difference in the CAR. Our results showed for the first time an association of perceived maternal care with the time pattern of CAR in female patients with EDs, while perceived parental control was not associated with any CAR feature. These findings support the idea that perceived characteristics of parental bonding in childhood and adolescence may influence the HPA axis activity in adults with EDs.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy.
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Giulia D'Agostino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
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Monteleone AM, Cascino G, Martini M, Patriciello G, Ruzzi V, Delsedime N, Abbate-Daga G, Marzola E. Confidence in one-self and confidence in one's own body: The revival of an old paradigm for anorexia nervosa. Clin Psychol Psychother 2020; 28:818-827. [PMID: 33283906 DOI: 10.1002/cpp.2535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022]
Abstract
Impaired interoceptive function represents an important variable in the psychopathology of anorexia nervosa (AN) and is thought to be influenced by maladaptive schemas grounded on early intimate interactions. However, the role of the different psychological processes involved in the interoceptive function has been poorly assessed in AN. We aimed to investigate the associations between adult insecure attachment, interoceptive processes, and psychopathology. One hundred and fifty participants with AN completed self-report questionnaires: the Multidimensional Assessment of Interoceptive Awareness, which measures interoception dimensions; the Attachment Style Questionnaire, assessing adult attachment styles, and the Eating Disorder Inventory-2, exploring eating-related core symptoms. Pearson's correlations were employed to assess the relationships between MAIA and EDI-2 subscores. Structural equation models (SEM) were performed to investigate the relationships between insecure attachment dimensions, interoception, and AN core symptoms as latent variables. Body listening, self-regulating, and trusting were interoceptive dimensions associated with eating psychopathology. As confirmed by an exploratory factor analysis, these interoceptive dimensions are included in a latent variable which points to "confidence" in body sensations. SEM showed that insecure, in particular anxious, attachment predicts body "confidence" and, in turn, AN core symptoms. Confidence in body sensations as a trustworthy source of knowledge represents the specific interoceptive dimension associated with psychopathology in AN. In accordance with Bruch's model of AN, insecure attachment patterns may promote a need to validate inner experiences by external sources conferring vulnerability to symptomatology. These psychopathological pathways could be addressed in clinical interventions.
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Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Matteo Martini
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
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Abstract
OBJECTIVE Amenorrhea is a disabling medical consequence of anorexia nervosa (AN); therefore, resumption of menses (ROM) represents an important goal in the treatment for these patients. The aim of the present study was to evaluate possible clinical, psychopathological, and biological predictors of ROM, including age, body mass index (BMI), AN subtype, childhood abuse, duration of illness, general and eating disorder (ED)-specific psychopathology, and sex hormones. METHODS Fifty amenorrheic patients with AN were enrolled. Baseline clinical data and information on childhood abuse were collected. Questionnaires to evaluate general and ED-specific psychopathology were administered, and blood samples were drawn. All patients received treatment as usual and underwent regular follow-up visits for 4 years or until ROM. Time to ROM, BMI at last evaluation, and data regarding diagnostic crossover into bulimia nervosa were collected. RESULTS Twenty-nine (58.0%) patients recovered menses. Diagnostic crossover was associated with a higher probability of ROM (odds ratio = 10.3, p = .030). Time-to-event analysis showed that a shorter duration of illness (χ(1) = 11.00, p = .001), binge-eating/purging subtype (χ(1) = 7.01, p = .008), and history of childhood abuse (χ(1) = 4.03, p = .045) were associated with an earlier ROM. Furthermore, higher baseline ED-specific psychopathology was associated with a reduced likelihood for ROM, whereas higher general psychopathology and follicle-stimulating hormone levels predicted an earlier ROM (all, p < .050). Age, BMI, luteinizing hormone, and estrogen hematic levels had no predictive value with respect to ROM. CONCLUSIONS The present study provides data in support of an integrated model, emphasizing the importance of duration of illness, childhood abuse, and psychopathological characteristics of amenorrheic patients with AN in predicting ROM.
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New therapeutic approaches to target gut-brain axis dysfunction during anorexia nervosa. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Treasure J, Monteleone P, Fernandez-Aranda F. Homeostasis disrupted: Eating disorders as a paradigm of psychosomatic disorders. Mol Cell Endocrinol 2019; 497:110609. [PMID: 31586651 DOI: 10.1016/j.mce.2019.110609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Janet Treasure
- King's College and Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Barcelona, Spain; Department of Psychiatry, Bellvitge University Hospital -IDIBELL, Barcelona, Spain.
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