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Fekih-Romdhane F, Pardini S, Hallit S, Novara C, Brytek-Matera A. A multi-country examination of the relationship between perfectionism and disordered eating: the indirect effect of obsessive beliefs and obsessive-compulsive symptoms. J Eat Disord 2024; 12:69. [PMID: 38822447 PMCID: PMC11143671 DOI: 10.1186/s40337-024-01030-y] [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: 03/17/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Despite the extensive literature on the association between perfectionism and disordered eating (DE), only scant attention has been given to the underlying processes that may mediate this relationship. The present study aimed to contribute to existing literature by investigating the direct and indirect relations between perfectionism and DE through obsessive-compulsive disorder (OCD) symptoms and obsessive beliefs, among community adults from three different countries and cultural backgrounds (i.e. Poland, Italy and Lebanon). METHODS This is a cross-sectional study that was carried-out among 977 community adults (77.1% females, mean age: 21.94 ± 3.14 years) using the snowball sampling technique. RESULTS Obsessive-compulsive disorders (OCD) symptoms and obsessive beliefs had a partial indirect effect in the relationship between multidimensional perfectionism and disordered eating. Higher multidimensional perfectionism/obsessive beliefs were significantly associated with greater OCD symptoms and directly associated with higher DE scores. Finally, higher OCD symptoms were significantly linked to higher DE scores. CONCLUSION The preliminary results suggest that it would be helpful for clinicians to routinely include measures of perfectionism, OCD and obsessive beliefs when dealing with individuals who present DE problems. In addition, results hold promise for the combined use of perfectionism and OCD interventions as a potentially beneficial treatment option for DE concerns.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, Manouba, 2010, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Susanna Pardini
- Department of General Psychology, University of Padova, Padova, 35131, Italy
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Caterina Novara
- Department of General Psychology, University of Padova, Padova, 35131, Italy
| | - Anna Brytek-Matera
- Eating Behavior Laboratory (EAT Lab), Institute of Psychology, University of Wrocław, Wrocław, 50-527, Poland.
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Fischer S, Wonderlich J, Miller LA, Breithaupt L, Frietchen R, Cao L, Nelson JD, Izquierdo A. The association of alcohol use and positive and negative urgency to same day objective binge eating in emerging adults. Front Psychol 2023; 14:1152691. [PMID: 37680241 PMCID: PMC10480840 DOI: 10.3389/fpsyg.2023.1152691] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/30/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Objective binge eating and problematic alcohol use often co-occur and are common behaviors in emerging adults. Both behaviors are thought to be driven by affect regulation processes. Objective binge eating often occurs in the context of increasing or acute negative affect, and often occurs in solitude. Alcohol use in emerging adults can also be associated with negative affect regulation. However, in contrast to objective binge eating, a large body of research indicates that there are positively valenced pathways to alcohol use in this age group. Emerging adults often drink socially, to enhance enjoyment, and in the context of positive mood. We propose that one pathway to objective binge eating in this developmental period is through alcohol use itself, such that emerging adults who consume alcohol and who are more likely to act impulsively in the context of positive emotion (i.e., have high levels of positive urgency) may be more likely to binge eat following drinking. Methods We collected data using ecological momentary assessment in 106 undergraduates on positive and negative affect, motives for drinking and eating, and alcohol use and objective binge eating, in addition to baseline questionnaires of impulsivity. Results There were no significant changes in affect prior to drinking in this sample. Alcohol use at one time point significantly increased odds of objective binge eating at a later time point in the same day. Individual differences in positive urgency, the tendency to act rashly while experiencing positive affect, were also associated with increased odds of objective binge eating that occurred after alcohol use. Individual differences in negative urgency, the tendency to act rashly after experiencing negative affect, did not have a main effect on objective binge episodes, but did interact with alcohol use to increase the odds of objective binge eating following drinking. The vast majority of drinking episodes prior to objective binge eating were social drinking episodes, and participants most commonly endorsed "to have fun" as a reason for drinking. Discussion Results suggest that alcohol consumption may increase risk for objective binge eating in emerging adults.
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Affiliation(s)
- Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, United States
| | - Joseph Wonderlich
- Eating Disorders and Weight Management Center, Sanford Health, Fargo, ND, United States
| | - Leo A. Miller
- Department of Psychology, George Mason University, Fairfax, VA, United States
| | - Lauren Breithaupt
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Rachel Frietchen
- Butler Hospital, Brown University, Providence, RI, United States
| | - Li Cao
- Eating Disorders and Weight Management Center, Sanford Health, Fargo, ND, United States
| | - Jillian D. Nelson
- Department of Psychology, George Mason University, Fairfax, VA, United States
| | - Alyssa Izquierdo
- Department of Psychology, George Mason University, Fairfax, VA, United States
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Heriseanu AI, Spirou D, Moraes CEF, Hay P, Sichieri R, Appolinario JC. Grazing Is Associated with ADHD Symptoms, Substance Use, and Impulsivity in a Representative Sample of a Large Metropolitan Area in Brazil. Nutrients 2023; 15:2987. [PMID: 37447311 DOI: 10.3390/nu15132987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa.
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Affiliation(s)
- Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Dean Spirou
- School of Medicine, Western Sydney University, Sydney, NSW 2214, Australia
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Carlos E F Moraes
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, NSW 2214, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia
- Mental Health Service, South West Sydney Local Health District, Campbelltown, NSW 2560, Australia
| | - Rosely Sichieri
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Jose C Appolinario
- Obesity and Eating Disorders Group, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
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Abstract
BACKGROUND Binge eating disorder (BED) is the most common eating disorder, and is associated with significant comorbidity, with university students being particularly vulnerable. We aimed to assess associations of BED with a wide range of comorbidities and measures of impulsivity and compulsivity in university students, to gain better understanding of its prevalence, correlates and pathophysiology. METHODS We carried out an internet-based survey, assessing presence of BED using a validated structured self-report diagnostic tool, demographics, substance use, impulsive behaviors, psychiatric history, and measures of impulsivity and compulsivity. Approximately 10 000 students were invited to take part. Group differences between students with current BED and students without BED were investigated. RESULTS A total of 3415 students completed the survey, with 83 (2.4%) screening positive for BED. BED was associated with female gender, hazardous/harmful alcohol use, depression and anxiety symptoms, low self-esteem, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, treatment for psychological/emotional problems (including prescribed medication) and trait impulsivity and compulsivity. However, the largest effect sizes were evident for associations with trait impulsivity and compulsivity. CONCLUSIONS The associations of BED with trait impulsivity and compulsivity implicate these latent phenotypes in its pathophysiology. The identified links between BED and a wide range of mental disorders highlight the need to screen for disordered eating in student populations, including when students present with other mental health conditions.
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5
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Wilkinson ML, Boyajian LE, Juarascio AS. Characterizing alcohol-related disordered eating behaviors in adults with binge eating. Eat Weight Disord 2022; 27:3773-3779. [PMID: 36121559 DOI: 10.1007/s40519-022-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/09/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Alcohol-related disordered eating behaviors (ADEBs; i.e., engagement in dietary restriction or excessive exercise before or after drinking alcohol to avoid weight gain) are associated with negative psychosocial and medical consequences. Previous research has primarily studied ADEBs among community samples. Individuals with clinically significant binge eating may also engage in ADEBs given high rates of alcohol use and inappropriate weight-control behaviors. The current study aimed to characterize the prevalence and psychological correlates (i.e., weight and shape concerns, alcohol consumption, binge eating frequency) of ADEBs among individuals with clinically significant binge eating. METHODS Participants were 166 treatment-seeking individuals who engaged in once weekly binge eating over the past three months. Participants completed a clinical interview to assess eating disorder symptoms and self-report measures of alcohol consumption patterns and ADEBs engagement. RESULTS Over one-fourth of participants endorsed at least one ADEBs in the past three months. Participants who endorsed ADEBs reported greater alcohol consumption than participants who drank alcohol but did not endorse ADEBs, after controlling for eating disorder diagnosis. Greater frequency of ADEBs was related to higher weight and shape concerns among individuals who endorsed ADEBs in the past three months. Presence of ADEBs and ADEBs frequency were not related to binge eating frequency. CONCLUSION Results suggest that clinicians treating individuals with binge eating who drink alcohol should screen for ADEBs and assess how ADEBs may contribute to an individual's eating pathology. Future research should assess the temporal relationship between alcohol use and ADEBs engagement, and study ADEBs in BN-spectrum samples. LEVEL OF EVIDENCE Level V, descriptive studies.
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Affiliation(s)
- Megan L Wilkinson
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA.
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA.
| | - Laura E Boyajian
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
| | - Adrienne S Juarascio
- Weight, Eating, and Lifestyle Sciences Center, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
- Department of Psychological and Brain Sciences, Drexel University, 3201 Chestnut Street, Stratton 238, Philadelphia, PA, 19104, USA
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6
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Ganson KT, Lisi NE, O'Connor J, Nagata JM. Association between binge eating and physical violence perpetration among U.S. college students. J Eat Disord 2022; 10:171. [PMID: 36397125 PMCID: PMC9673326 DOI: 10.1186/s40337-022-00700-z] [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: 09/02/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To date, no known research has explored the link between binge eating and physical violence perpetration despite overlapping psychological constructs that underpin these behaviors (i.e., emotion regulation difficulties, impulsivity). Therefore, this study aimed to determine the association between binge eating and self-reported physical violence perpetration. METHODS Cross-sectional data from four survey years (2016-2020) of the national (U.S.) Healthy Minds Study (N = 6210) were analyzed. Unadjusted (Independent samples t test) and adjusted (logistic regression) analyses were conducted to determine the associations between binge eating in the past four weeks and violence perpetration in the past 12 months, while adjusting for potential confounders. RESULTS The unadjusted mean number of days of binge eating was significantly higher among participants who reported physical violence perpetration (M = 2.6, SD = 5.2) compared to those who did not (M = 1.8, SD = 3.7). Logistic regression analysis demonstrated that each additional day of binge eating was associated with 5% higher odds (95% confidence interval 1.02-1.09) of self-reported physical violence perpetration, while adjusting for potential confounders. CONCLUSIONS Results from this study are the first known to identify an association between binge eating and physical violence perpetration among U.S. college students. Findings are supported by the potential mechanistic overlap of emotion regulation and impulsivity associated with both binge eating and violence perpetration, underscoring the need for more research.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Nicole E Lisi
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Julia O'Connor
- School of Social Work, University of Central Florida, Orlando, FL, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16Th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
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7
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Coakley KE, Lardier DT. Self-reported Alcohol Misuse Is Associated with Disordered Eating and Binge Eating Disorder in Adults. ALCOHOLISM TREATMENT QUARTERLY 2022. [DOI: 10.1080/07347324.2022.2101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kathryn E Coakley
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, New Mexico, USA
| | - David T Lardier
- Department of Psychiatry & Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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8
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Miranda-Olivos R, Agüera Z, Granero R, Vergeer RR, Dieguez C, Jiménez-Murcia S, Gearhardt AN, Fernández-Aranda F. Food addiction and lifetime alcohol and illicit drugs use in specific eating disorders. J Behav Addict 2022; 11:102-115. [PMID: 35029544 PMCID: PMC9109624 DOI: 10.1556/2006.2021.00087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/21/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Food addiction (FA) and substance use (SU) have frequently been reported in patients with eating disorders (EDs). Our study aimed to assess the prevalence rates of FA and/or lifetime problematic alcohol and illicit drug use among patients with specific ED, such as: bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorder (OSFED). We sought to identify clinical, psychopathological, and personality profiles involved in these addictive behavior-based phenotypes. METHODS The total sample was 527 patients (176 BN, 115 BED, and 236 OSFED). FA was assessed through the Yale Food Addiction Scale 2.0. To determine lifetime SU, a semi-structured clinical interview was carried out. RESULTS Patients with BN had the highest rates of FA both with and without SU. No gender differences were obtained for the prevalence of current FA and/or lifetime SU. Patients reporting at least one addictive-related behavior exhibited increased clinical severity compared to those who reported none. Increased impulsivity (such as high lack of premeditation, sensation seeking, and positive urgency) and low self-directedness were differentiating factors for presenting one or two addictive behaviors. DISCUSSION AND CONCLUSIONS Overall, patients presenting with at least one addictive-like behavior reported a poorer clinical status than those without. Also, patients with FA and SU exhibited a more dysfunctional profile characterized by high impulsivity and low self-directedness. These findings would support the need for targeted treatments to reduce impulsivity and increase self-directedness, especially in patients with any addictive-related behavior, as a step towards improving their treatment outcome.
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Affiliation(s)
- Romina Miranda-Olivos
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain,Department of Public Health, Mental Health and Perinatal Nursing, School of Nursing, University of Barcelona, L’Hospitalet de Llobregat, Spain,Corresponding author. E-mail:
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rhianna R. Vergeer
- Laboratory on Human Psychopharmacology, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Carlos Dieguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Instituto de Investigaciones Sanitarias (IDIS), Department of Physiology (CIMUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | | | - Fernando Fernández-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain,Department of Psychiatry, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Corresponding author. E-mail:
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9
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Yan WS, Zheng DH, Liu MM. Trait Impulsivity and Choice Impulsivity in Young Adult Students With Probable Binge Eating Disorder. Front Psychiatry 2022; 13:838700. [PMID: 35479492 PMCID: PMC9037330 DOI: 10.3389/fpsyt.2022.838700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/22/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Binge eating disorder (BED) as a public health problem has been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Akin to addictive disorders, impulsivity-related neuropsychological constructs might be potentially involved in the onset and development of BED. However, it remains unclear which facets of impulsivity are connected to overeating and binge eating behaviors among non-clinical populations. The present study aimed to detect the relationship between impulsivity and binge eating both on the personality-trait and behavioral-choice levels in undiagnosed young adults. METHODS Fifty-eight individuals with probable BED and 59 healthy controls, matched on age, gender, and educational level, were assessed by using a series of self-report measurements, including the Barratt Impulsiveness Scale (BIS-11), UPPS-P Impulsive Behaviors Scale (UPPS-P), Delay Discounting Test (DDT), and Probability Discounting Test (PDT). RESULTS Multivariate analysis of variance models revealed that compared with healthy controls, the probable BED group showed elevated scores on the BIS-11 Attentional and Motor impulsiveness, and on the UPPS-P Negative Urgency, Positive Urgency, and Lack of Perseverance. However, the probable BED subjects had similar discounting rates on the DDT and PDT with healthy controls. Regression models found that Negative Urgency was the only positive predictor of binge eating behavior. CONCLUSIONS These findings suggested that typical facets of trait impulsivity, which have been recognized in addictive disorders, were associated with binge eating in young adults, whereas choice impulsivity was not aberrantly seen in the same probable BED sample. This study might promote a better understanding of the pathogenesis of BED.
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Affiliation(s)
- Wan-Sen Yan
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Dan-Hui Zheng
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
| | - Meng-Meng Liu
- Department of Psychology, School of Medical Humanitarians, Guizhou Medical University, Guiyang, China
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10
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Mellentin AI, Mejldal A, Guala MM, Støving RK, Eriksen LS, Stenager E, Skøt L. The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. Am J Psychiatry 2022; 179:46-57. [PMID: 34974750 DOI: 10.1176/appi.ajp.2021.21030274] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects. METHODS A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs). RESULTS For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs. CONCLUSIONS SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lene Stryhn Eriksen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
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Mellentin AI, Mejldal A, Guala MM, Støving RK, Eriksen LS, Stenager E, Skøt L. The Impact of Alcohol and Other Substance Use Disorders on Mortality in Patients With Eating Disorders: A Nationwide Register-Based Retrospective Cohort Study. Am J Psychiatry 2021:appiajp21030274. [PMID: 34698521 DOI: 10.1176/appi.ajp.21030274] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research is lacking on the contribution of different types of substance use disorders (SUDs) to excess mortality across the full spectrum of eating disorders. The authors assessed the association of alcohol use disorders and other SUDs with mortality in anorexia nervosa, bulimia nervosa, and unspecified eating disorder compared with matched control subjects. METHODS A retrospective cohort study was conducted using Danish nationwide registers. The study included 20,759 patients with eating disorders and 83,036 matched control subjects. Hazard ratios were calculated to compare all-cause mortality risk between eating disorder patients and control subjects both with and without a lifetime SUD diagnosis (abuse or dependence of alcohol, cannabis, or hard drugs). RESULTS For patients with each type of eating disorder, a higher risk of all-cause mortality was observed relative to control subjects without SUDs among those who abused alcohol and/or cannabis (adjusted hazard ratios for the anorexia nervosa, bulimia nervosa, and unspecified eating disorder patients, respectively, were 11.28 [95% CI=7.01, 18.16], 5.86 [95% CI=3.37, 10.1], and 10.86 [95% CI=6.74, 17.50]), or hard drugs alone or in combination with alcohol and/or cannabis (adjusted hazard ratios, respectively, were 22.34 [95% CI=15.13, 33.00], 11.43 [95% CI=7.14, 18.28], and 15.53 [95% CI=10.15, 23.78]), than in those without SUDs (adjusted hazard ratios, respectively, were 3.21 [95% CI=2.43, 4.23], 1.24 [95% CI=0.88, 1.77], and 4.75 [95% CI=3.57, 6.31]). Control subjects with SUDs also exhibited an elevated risk of all-cause mortality relative to control subjects without SUDs, although to a much lesser extent than eating disorder patients with SUDs. CONCLUSIONS SUDs have an additive effect on excess mortality in patients with eating disorders. The prevention and treatment of SUDs in this patient group is thus imperative to reduce mortality.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lene Stryhn Eriksen
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense (Mellentin, Mejldal, Guala, Støving, Eriksen, Skøt); Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense (Mellentin); Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense (Mellentin); Center for Eating Disorders, Odense University Hospital, Odense (Guala, Støving); Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, Odense (Støving);Unit for Psychiatric Research, Institute of Regional Health Services Research, University of Southern Denmark, Aabenraa (Stenager)
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Pairing Binge Drinking and a High-Fat Diet in Adolescence Modulates the Inflammatory Effects of Subsequent Alcohol Consumption in Mice. Int J Mol Sci 2021; 22:ijms22105279. [PMID: 34067897 PMCID: PMC8157004 DOI: 10.3390/ijms22105279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/08/2021] [Accepted: 05/15/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol binge drinking (BD) and poor nutritional habits are two frequent behaviors among many adolescents that alter gut microbiota in a pro-inflammatory direction. Dysbiotic changes in the gut microbiome are observed after alcohol and high-fat diet (HFD) consumption, even before obesity onset. In this study, we investigate the neuroinflammatory response of adolescent BD when combined with a continuous or intermittent HFD and its effects on adult ethanol consumption by using a self-administration (SA) paradigm in mice. The inflammatory biomarkers IL-6 and CX3CL1 were measured in the striatum 24 h after BD, 3 weeks later and after the ethanol (EtOH) SA. Adolescent BD increased alcohol consumption in the oral SA and caused a greater motivation to seek the substance. Likewise, mice with intermittent access to HFD exhibited higher EtOH consumption, while the opposite effect was found in mice with continuous HFD access. Biochemical analyses showed that after BD and three weeks later, striatal levels of IL-6 and CX3CL1 were increased. In addition, in saline-treated mice, CX3CL1 was increased after continuous access to HFD. After oral SA procedure, striatal IL-6 was increased only in animals exposed to BD and HFD. In addition, striatal CX3CL1 levels were increased in all BD- and HFD-exposed groups. Overall, our findings show that adolescent BD and intermittent HFD increase adult alcohol intake and point to neuroinflammation as an important mechanism modulating this interaction.
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Coker CR, Keller BN, Arnold AC, Silberman Y. Impact of High Fat Diet and Ethanol Consumption on Neurocircuitry Regulating Emotional Processing and Metabolic Function. Front Behav Neurosci 2021; 14:601111. [PMID: 33574742 PMCID: PMC7870708 DOI: 10.3389/fnbeh.2020.601111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/28/2020] [Indexed: 01/12/2023] Open
Abstract
The prevalence of psychiatry disorders such as anxiety and depression has steadily increased in recent years in the United States. This increased risk for anxiety and depression is associated with excess weight gain, which is often due to over-consumption of western diets that are typically high in fat, as well as with binge eating disorders, which often overlap with overweight and obesity outcomes. This finding suggests that diet, particularly diets high in fat, may have important consequences on the neurocircuitry regulating emotional processing as well as metabolic functions. Depression and anxiety disorders are also often comorbid with alcohol and substance use disorders. It is well-characterized that many of the neurocircuits that become dysregulated by overconsumption of high fat foods are also involved in drug and alcohol use disorders, suggesting overlapping central dysfunction may be involved. Emerging preclinical data suggest that high fat diets may be an important contributor to increased susceptibility of binge drug and ethanol intake in animal models, suggesting diet could be an important aspect in the etiology of substance use disorders. Neuroinflammation in pivotal brain regions modulating metabolic function, food intake, and binge-like behaviors, such as the hypothalamus, mesolimbic dopamine circuits, and amygdala, may be a critical link between diet, ethanol, metabolic dysfunction, and neuropsychiatric conditions. This brief review will provide an overview of behavioral and physiological changes elicited by both diets high in fat and ethanol consumption, as well as some of their potential effects on neurocircuitry regulating emotional processing and metabolic function.
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Affiliation(s)
- Caitlin R. Coker
- Biochemistry and Molecular & Cellular Biology, Georgetown University School of Medicine, Washington, DC, United States
| | - Bailey N. Keller
- Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Amy C. Arnold
- Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Yuval Silberman
- Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
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