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Delaquis CP, Godart N, Barry C, Ringuenet D, Maria AS, Nicolas I, Berthoz S. Perfectionism, self-esteem, and affective symptoms in anorexia nervosa subtypes: A network analysis of French inpatients. J Clin Psychol 2024; 80:1852-1875. [PMID: 38646977 DOI: 10.1002/jclp.23698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Previous studies have highlighted the relevance of perfectionism, self-esteem, and anxio-depressive symptoms in anorexia nervosa (AN). However, the relationships between these factors and cardinal eating disorders (ED) symptoms remain unclear, particularly in AN subtypes. This study aimed to examine their interconnections using network analysis. METHOD The sample included n = 338 inpatients with AN who completed the Eating Disorder Examination Questionnaire, Frost Multidimensional Perfectionism Scale, Rosenberg Self-Esteem Scale, and Hospital Anxiety and Depression Scale. Using network analysis, we estimated three networks: full sample, AN-restrictive (AN-R) and AN-binge/purging (AN-BP) subtypes. We estimated central and bridge symptoms using expected influence and conducted an exploratory network comparison test to compare AN subtypes. RESULTS Overvaluation of Weight and Shape, Concern over Mistakes, and Personal Standards were consistently central in all networks. The most central bridge symptoms across all networks were Concern over Mistakes and Self-Esteem. Concern over Mistakes bridged perfectionism and ED symptoms, while Self-Esteem was highly connected to all symptom clusters. Anxiety was significantly more central in the AN-R network compared to the AN-BP network. CONCLUSIONS The present study contributes to a growing body of network studies suggesting that nodes related to perfectionism are just as central as cardinal ED symptoms, indicating the relevance of perfectionism in ED pathology. The high bridge centrality of self-esteem suggests that it may be an important link between perfectionism, mood, and ED symptoms. Future research should investigate the efficacy of targeting multiple psychological factors in the treatment of AN, as well as their potential transdiagnostic relevance.
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Affiliation(s)
| | - Nathalie Godart
- Fondation Santé des Etudiants de France, Paris, France
- CESP, Inserm, Université Paris Saclay, Villejuif, France
- UFR Simone Veil-Santé, Université Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Caroline Barry
- CESP, Inserm, Université Paris Saclay, Villejuif, France
| | - Damien Ringuenet
- CESP, Inserm, Université Paris Saclay, Villejuif, France
- Unité de Traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Paul Brousse, Villejuif, France
| | | | - Isabelle Nicolas
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Sylvie Berthoz
- INCIA CNRS UMR 5287, Univ. Bordeaux, Bordeaux, France
- Department of Psychiatry, Institut Mutualiste Montsouris, Paris, France
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2
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Dosal A, Denhardt B, Diaz R, Obleada K, Feldman M, Reese J, Sobalvarro S. Cross-sectional and longitudinal changes in body composition, anxiety, and depression in a clinical sample of adolescents with anorexia nervosa. J Pediatr Psychol 2024; 49:340-347. [PMID: 38452291 DOI: 10.1093/jpepsy/jsae012] [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: 10/11/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE Eating disorders among children and adolescents have increased in prevalence, and mortality rates for anorexia nervosa are among the highest for any psychiatric disorder. Our current study aimed to (a) examine the cross-sectional relationship between body composition and anxiety/depressive symptoms among 97 adolescents and young adults who have been diagnosed with anorexia nervosa, (b) examine the longitudinal changes in body composition and anxiety/depressive symptoms over three months (from baseline to follow-up visit), and (c) examine the longitudinal relationship between change in body composition and change in anxiety/depression over three months. METHOD A retrospective chart review was conducted within an interdisciplinary eating disorder clinic between August 2019 and December 2021. In total, 97 adolescents aged 11-20 years old with diagnoses of anorexia nervosa were included in the analyses. Body composition data were collected at each visit along with parent- and youth-report measures of symptoms of anxiety/depression symptoms. RESULTS Findings indicated adolescents demonstrated some improvement in body composition, as well as parent-reported reductions in anxiety/depression symptoms. Based on parent reports, increased BMI percentile was associated with improvements in anxiety/depression symptoms. On the other hand, youth did not report significant changes in anxiety/depressive symptoms. Additionally, there were no associated improvements with body composition measures, which may be associated with continued body dissatisfaction or symptoms of anxiety and depression predating the eating disorder. CONCLUSIONS These results suggest the importance of including interventions addressing depression, anxiety, and body image as part of treatment.
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Affiliation(s)
- Alexis Dosal
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Brenna Denhardt
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Rebekah Diaz
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Katrina Obleada
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Marissa Feldman
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Jasmine Reese
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
| | - Sarah Sobalvarro
- Center for Behavioral Health, Johns Hopkins All Children's Hospital, 880 6th Street South, St. Petersburg, FL, 33701, United States
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3
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Karth M, Kinzig KP. Adolescent activity-based anorexia has a substantial and prolonged impact on social behavior in young adult female rats. Physiol Behav 2024; 279:114528. [PMID: 38531425 DOI: 10.1016/j.physbeh.2024.114528] [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: 09/28/2023] [Revised: 03/01/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
Activity-based anorexia (ABA) is a rodent model of anorexia nervosa (AN) that induces several key components of AN, including voluntary reduction in food intake, reduced body weight, hyperactivity, and alterations to the hypothalamic-pituitary-adrenal (HPA) axis. Previous research has demonstrated persistently increased anxiety-like behavior in the elevated plus maze (EPM), a test measuring avoidance of novel and open areas in adult female rats that experienced ABA during adolescence and are weight-restored in adulthood. Whether the same behavioral effects of two bouts of adolescent ABA emerge in response to different anxiety-provoking stimuli, however, has not been explored. We used the social partition (SP), novelty suppressed feeding (NSF), marble burying, and EPM tests to explore whether two bouts of adolescent ABA have persistent effects on anxiety-like behavior in weight restored young adult female rats. One-way ANOVA analyses revealed that female rats that experienced two bouts of ABA during adolescence had increased anxiety-like behavior in the EPM and SP tests in young adulthood following weight restoration compared with controls. These data demonstrate that the enduring behavioral effects of two bouts of adolescent ABA are specific to particular anxiety-provoking stimuli and suggest that adolescent ABA has enduring effects on social relationships.
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Affiliation(s)
- Melinda Karth
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA
| | - Kimberly P Kinzig
- Department of Psychological Sciences, Purdue University, West Lafayette, IN, USA; Purdue University Ingestive Behavior Research Center, Purdue University, West Lafayette, IN, USA.
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4
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Bédard A, Bernard C, Meilleur D, Taddeo D, Pesant C, Di Meglio G, Gingras N, Thibault I, Agostino H, Bélanger R, Nadeau PO, Frappier JY, Stheneur C, Dufresne L, Bégin C. Recovery Trajectories in Adolescent Girls with Anorexia Nervosa. J Clin Med 2024; 13:778. [PMID: 38337472 PMCID: PMC10856320 DOI: 10.3390/jcm13030778] [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: 12/22/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Background: This study aimed to document recovery trajectories among adolescents with anorexia nervosa (AN) based on three markers of remission, namely changes in body weight, food restriction, and excessive exercise, and to identify predictors of these trajectories. Methods: One hundred twenty-six adolescent girls (14.7 ± 1.3 years) were recruited during initial assessment visits at specialized eating disorder (ED) programs in five University Health Centers across the province of Quebec, Canada. z-BMI and AN symptom severity (food restriction and excessive exercise) were assessed at initial assessment visits and subsequently reassessed at each quarterly follow-up over a 12-month period to identify recovery trajectories. Results: Considering the three markers of remission, three distinct trajectories emerged: Group 1, rapid responders; Group 2, gradual responders; and Group 3, unstable responders. At initial visits, a difference between groups was found regarding the type of treatment (p = 0.01) and weight suppression (p = 0.02). Group 1 had a higher number of youths hospitalized than Group 2 and Group 3, and a greater weight suppression than Group 3. Furthermore, individuals with atypical AN were more likely to belong to Group 2 than to Group 1 and Group 3 (p < 0.0001). Conclusions: This study contributes to a better understanding of the heterogeneity of recovery trajectories in adolescent girls with AN.
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Affiliation(s)
- Alexandra Bédard
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
| | - Catherine Bernard
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Dominique Meilleur
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada;
| | - Danielle Taddeo
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Caroline Pesant
- Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5H3, Canada;
| | - Giuseppina Di Meglio
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Nathalie Gingras
- Centre de Pédopsychiatrie, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Québec, QC G1N 2W1, Canada;
- Département de Psychiatrie et de Neurosciences, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada
| | - Isabelle Thibault
- Département de Psychoéducation, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada;
| | - Holly Agostino
- Hôpital de Montréal pour Enfants/Montreal Children’s Hospital, Centre Universitaire de Santé McGill, Montréal, QC H4A 3J1, Canada; (G.D.M.); (H.A.)
| | - Richard Bélanger
- Département de Pédiatrie, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre Hospitalier Universitaire de Québec, Québec, QC G1V 4G2, Canada
| | - Pierre-Olivier Nadeau
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
| | - Jean-Yves Frappier
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Chantal Stheneur
- Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC H3T 1C5, Canada; (D.T.); (P.-O.N.); (J.-Y.F.); (C.S.)
- Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Laurie Dufresne
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
| | - Catherine Bégin
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec, QC G1V 0A6, Canada;
- École de Psychologie, Université Laval, Québec, QC G1V 0A6, Canada; (C.B.); (L.D.)
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Bazo Perez M, Hayes TB, Frazier LD. Beyond generalized anxiety: the association of anxiety sensitivity with disordered eating. J Eat Disord 2023; 11:173. [PMID: 37784155 PMCID: PMC10544544 DOI: 10.1186/s40337-023-00890-0] [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: 04/29/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Anxiety and eating disorders (EDs) are rising at alarming rates. These mental health disorders are often comorbid, yet the factors associated with their comorbidity are not well understood. The present study examined a theoretical model of the pathways and relative associations of anxiety sensitivity (AS) with different dimensions of ED risk, controlling for generalized anxiety. METHODS Participants (N = 795) were undergraduate students with an average age of 21 (SD = 4.02), predominantly female (71%), and Hispanic (71.8%). Participants completed an online survey with established measures of AS (i.e., Anxiety Sensitivity Index-3; ASI-3), general anxiety (i.e., Beck Anxiety Inventory; BAI), and eating behaviors (i.e., Eating Attitudes Test-26; EAT-26). RESULTS The results of our structural equation models indicated that AS subscales were significantly associated with dimensions of the EAT-26, even when controlling for generalized anxiety. Specifically, the ASI-3 factors reflecting cognitive and social concerns provided the most consistent significant associations with EDs. Whereas reporting higher cognitive concerns was associated with higher ED symptoms (e.g., reporting the urge to vomit after a meal), reporting higher social concerns was associated with fewer ED symptoms. These differential results may suggest risk and resilience pathways and potential protective or buffering effects of social concerns on ED risk. DISCUSSION Findings advance understanding of the role of AS in the comorbidity of anxiety and EDs, demonstrating the strong association of AS with ED pathology. These findings provide cognitive indicators for transdiagnostic therapeutic intervention in order to reduce the risk of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Timothy B Hayes
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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6
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Zsigo C, Sfärlea A, Lingl C, Piechaczek C, Schulte-Körne G, Feldmann L, Greimel E. Emotion Regulation Deficits in Adolescent Girls with Major Depression, Anorexia Nervosa and Comorbid Major Depression and Anorexia Nervosa. Child Psychiatry Hum Dev 2023; 54:1476-1488. [PMID: 35412201 PMCID: PMC10435395 DOI: 10.1007/s10578-022-01353-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 11/03/2022]
Abstract
In adolescence, both major depression (MD) and anorexia nervosa (AN) are associated with deficits in emotion regulation (ER). However, studies have yet to compare ER profiles within the disorders and the effect of comorbid MD+AN is unclear. This study examined the habitual use of ER in 229 girls, aged 12-18 years, with MD (n = 84), AN (n = 37), comorbid MD+AN (n = 25), and healthy girls (n = 83). Girls with MD, AN and MD+AN reported more maladaptive and less adaptive ER strategies than healthy girls. MD and MD+AN groups showed more frequent use of maladaptive ER compared to only AN, with no differences between only MD and MD+AN. This suggests that MD+AN is not necessarily associated with higher ER deficits, rather, an additional diagnosis of MD exacerbates impairments in AN. Identifying specific ER profiles can provide important targets in prevention and treatment for AN, MD and AN+MD.
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Affiliation(s)
- Carolin Zsigo
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Carolin Lingl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Charlotte Piechaczek
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Lisa Feldmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Ellen Greimel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
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7
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Melles H, Jansen A. Transdiagnostic fears and avoidance behaviors in self-reported eating disorders. J Eat Disord 2023; 11:19. [PMID: 36782316 PMCID: PMC9926724 DOI: 10.1186/s40337-023-00745-8] [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: 07/06/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Fears and avoidance behaviors are common symptoms of eating disorders. It was investigated whether different eating disorder diagnoses are equally characterized by similar fears and avoidance behaviors. METHODS Individuals with self-reported eating disorders (n = 250) and healthy controls (n = 95) completed online questionnaires assessing general fears, eating related fears, and avoidance behaviors. RESULTS All self-reported eating disorder diagnoses showed more eating related fears, general fears, and avoidance behaviors than healthy controls. Individuals with binge eating disorder showed less specific and general fears on some but by no means all scales, yet they showed less food avoidance behaviors than all other eating disorders and less eating restraint than anorexia nervosa and bulimia nervosa. CONCLUSIONS Eating related fears, general fears, and food avoidance behaviors were found to be transdiagnostic symptoms in self-reported eating disorders. Individuals with binge eating disorder also exhibit more fears and avoidance behaviors than healthy controls, but to a lesser extent than the other eating disorders. Specialized interventions targeting fears and avoidance may be promising add-on interventions not only in the treatment of anorexia nervosa, but in the treatment of all eating disorders.
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Affiliation(s)
- Hanna Melles
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Anita Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Ghrelin and Obestatin in Adolescent Patients with Anorexia Nervosa: Is There an Association with Disordered Eating, Depression, and Obsessive-Compulsive Symptoms? PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by restrictive eating and significant weight loss. In the course of AN, changes are observed in appetite regulation, including orexigenic ghrelin and potentially anorexigenic obestatin. The study aimed to determine if any changes in serum ghrelin and obestatin levels during treatment of AN are observed, while investigating the correlations between these peptides and the severity of disturbed eating attitudes, depression, and anxiety. Thirty adolescent inpatients with AN (examined twice: before hospitalization treatment AN-BT and after treatment AN-AT) and thirty healthy age- and height-matched girls (CG) participated in the study. Anthropometric, serum ghrelin and obestatin concentrations and psychometric evaluations (Eating Attitudes Test 26 Item-EAT-26, Beck Depression Inventory-BDI, Hamilton Depression Rating Scale-HDRS, and Yale Brown Obsessive-Compulsive Scale-Y-BOCS) were performed. The study revealed significantly higher ghrelin and obestatin levels in AN-BT than in AN-AT. A trend toward lower levels during treatment provided partial normalizations. Analyzing correlations in the AN-BT vs. CG group, correlations of peptides with EAT-26, BDI, and HDRS scores were detected. These results suggest a potential role for ghrelin and obestatin in the context of defense mechanisms regulating appetite and body weight in the course of AN and in terms of psychopathological changes co-occurring with this eating disorder.
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10
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Eck KM, Byrd-Bredbenner C. Disordered eating concerns, behaviors, and severity in young adults clustered by anxiety and depression. Brain Behav 2021; 11:e2367. [PMID: 34825780 PMCID: PMC8671770 DOI: 10.1002/brb3.2367] [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: 05/28/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Little is known about how anxiety and depression in combination relate to eating disorder concerns (eating, shape, and weight concern) and behaviors (restraint eating, binge eating, and purging) indicative of eating disorder symptom severity. This study examined links among disordered eating concerns, behaviors, and severity clustered by depression and anxiety. METHODS College students (n = 1792) completed a survey comprised of the Generalized Anxiety Disorder Scale (GAD-7), 2-item Patient Health Questionnaire (PHQ-2) assessing Major Depressive Disorder (MDD), and Eating Disorder Exam Questionnaire (EDE-Q) assessing concerns and behaviors indicative of disordered eating. RESULTS Cluster analysis yielded four groups: not depressed or anxious to subclinical, moderate, and high depression and anxiety. Analysis of variance (ANOVA) indicated overall eating disorder severity scores increased significantly as GAD and MDD increased, suggesting that as anxiety and depression rise in tandem, disturbed eating severity rises. Results revealed that even at subclinical levels, disordered eating concerns, behaviors, and overall severity scores increase. DISCUSSION Future interventions aiming to reduce disordered eating in young adults may be strengthened by incorporating depression and anxiety management strategies. A screening for subclinical anxiety and depression (Mixed Anxiety and Depression Disorder [MADD]) may be helpful in providing early intervention to resolve disordered eating behaviors before they become entrenched.
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Affiliation(s)
- Kaitlyn M Eck
- Research Program Coordinator, Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Carol Byrd-Bredbenner
- Department of Nutritional Sciences, Distinguished Professor Rutgers University, New Brunswick, New Jersey, USA
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11
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Homan KJ, Crowley SL, Rienecke RD. Predictors of improvement in a family-based partial hospitalization/intensive outpatient program for eating disorders. Eat Disord 2021; 29:644-660. [PMID: 32174240 DOI: 10.1080/10640266.2020.1734410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.
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Affiliation(s)
- Kendra J Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L Crowley
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
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Sfärlea A, Lukas L, Schulte-Körne G, Platt B. The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls. J Eat Disord 2021; 9:139. [PMID: 34715933 PMCID: PMC8555351 DOI: 10.1186/s40337-021-00494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). METHODS The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. DISCUSSION This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.
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Affiliation(s)
- Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
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13
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Knejzlíková T, Světlák M, Malatincová T, Roman R, Chládek J, Najmanová J, Theiner P, Linhartová P, Kašpárek T. Electrodermal Response to Mirror Exposure in Relation to Subjective Emotional Responses, Emotional Competences and Affectivity in Adolescent Girls With Restrictive Anorexia and Healthy Controls. Front Psychol 2021; 12:673597. [PMID: 34566754 PMCID: PMC8461306 DOI: 10.3389/fpsyg.2021.673597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing. Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology. Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients. Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.
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Affiliation(s)
- Terézia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Miroslav Světlák
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tatiana Malatincová
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Robert Roman
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Institute of Scientific Instruments of the CAS, Brno, Czechia
| | - Jana Najmanová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavel Theiner
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
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14
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Timko CA, Bhattacharya A, Fitzpatrick KK, Howe H, Rodriguez D, Mears C, Heckert K, Ubel PA, Ehrenreich-May J, Peebles R. The shifting perspectives study protocol: Cognitive remediation therapy as an adjunctive treatment to family based treatment for adolescents with anorexia nervosa. Contemp Clin Trials 2021; 103:106313. [PMID: 33539993 PMCID: PMC8489286 DOI: 10.1016/j.cct.2021.106313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied. METHODS/DESIGN This is a randomized controlled trial designed to determine if CRT is effective in increasing flexibility in adolescents with anorexia and/or their parents. Participants are adolescents 12-18 years old with anorexia and their parents. 54 family groups will be randomized into one of three groups: FBT only, FBT plus Parent-focused CRT, or FBT plus Adolescent-focused CRT. Psychosocial, neurocognitive, and behavioral measures will be collected throughout the study. DISCUSSION This is the first study of its kind to apply CRT to parents. All forms of CRT in the context of anorexia have targeted the individual with anorexia's thinking style. We propose that it may be impactful to target the parent of the adolescent with anorexia as parents carry the burden of treatment and re-nourishment of their child during FBT and may have similar thinking styles. CONCLUSION This study takes an experimental therapeutics approach to further our understanding of the mechanisms of treatment for adolescents with anorexia. It focuses on increasing cognitive flexibility in patients or their parents and determining the appropriate dose of CRT needed to achieve positive change. TRIAL REGISTRATION ClinicalTrails.gov Identifier NCT03928028.
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Affiliation(s)
- C Alix Timko
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Anushua Bhattacharya
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Holly Howe
- The Fuqua School of Business, Duke University, Durham, NC, United States of America
| | - Daniel Rodriguez
- School of Nursing and Health Sciences and Public Health, La Salle University, Philadelphia, PA, United States of America
| | - Connor Mears
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Kerri Heckert
- Deptartment of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Peter A Ubel
- The Fuqua School of Business, Duke University, Durham, NC, United States of America; Sanford School of Policy, Duke University, Durham, NC, United States of America; School of Medicine, Duke University, Durham, NC, United States of America
| | - Jill Ehrenreich-May
- Psychology Department, University of Miami, Miami, FL, United States of America
| | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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15
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Is Serum BDNF Altered in Acute, Short- and Long-Term Recovered Restrictive Type Anorexia Nervosa? Nutrients 2021; 13:nu13020432. [PMID: 33572701 PMCID: PMC7910942 DOI: 10.3390/nu13020432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 12/19/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF), a neurotrophin involved in the regulation of food intake and body weight, has been implicated in the development and maintenance of Anorexia nervosa (AN). The majority of previous studies reported lower BDNF levels in acutely underweight AN patients (acAN) and increasing levels after weight rehabilitation. Here, we investigated serum BDNF concentrations in the largest known AN sample to date, both before and after weight restoration therapy. Serum BDNF was measured in 259 female volunteers: 77 in-patient acAN participants of the restrictive type (47 reassessed after short-term weight rehabilitation), 62 individuals long-term recovered from AN, and 120 healthy controls. We validated our findings in a post-hoc mega-analysis in which we reanalyzed combined data from the current sample and those from our previous study on BDNF in AN (combined sample: 389 participants). All analyses carefully accounted for known determinants of BDNF (age, sex, storage time of blood samples). We further assessed relationships with relevant clinical variables (body-mass-index, physical activity, symptoms). Contrary to our hypotheses, we found zero significant differences in either cross-sectional or longitudinal comparisons and no significant relationships with clinical variables. Together, our study suggests that BDNF may not be a reliable state- or trait-marker in AN after all.
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16
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Garcia SC, Mikhail ME, Keel PK, Burt SA, Neale MC, Boker S, Klump KL. Increased rates of eating disorders and their symptoms in women with major depressive disorder and anxiety disorders. Int J Eat Disord 2020; 53:1844-1854. [PMID: 32844425 PMCID: PMC7669595 DOI: 10.1002/eat.23366] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Individuals with eating disorders (EDs) have increased rates of major depressive disorder (MDD) and anxiety disorders. Yet, few studies have investigated rates of EDs and their symptoms in individuals presenting with MDD/anxiety disorders. Identifying potential disordered eating in people with MDD/anxiety disorders is important because even subclinical disordered eating is associated with reduced quality of life, and undiagnosed eating pathology may hinder treatment progress for both MDD/anxiety disorders and comorbid EDs. METHOD We compared rates of EDs (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding and eating disorders) and their symptoms in 130 women with, and 405 women without, lifetime MDD or an anxiety disorder (generalized anxiety disorder, obsessive-compulsive disorder, social phobia, specific phobia, panic disorder, agoraphobia, or post-traumatic stress disorder) recruited from the population-based Michigan State University Twin Registry. Lifetime ED and MDD/anxiety diagnoses, and lifetime clinically significant disordered eating behaviors (e.g., binge eating, excessive exercise) were assessed using the Structured Clinical Interview for DSM-IV (SCID). RESULTS Among participants with lifetime MDD or any anxiety disorder, 13% met criteria for a lifetime ED and 39% reported engaging in at least one lifetime clinically significant disordered eating behavior (e.g., binge eating) on the SCID. In contrast, only 3% of participants without a history of MDD/an anxiety disorder met criteria for a lifetime ED, and only 11% reported lifetime clinically significant disordered eating behavior. DISCUSSION Our findings suggest that women with MDD and anxiety disorders have elevated rates of EDs, and it is therefore imperative to screen for disordered eating in these populations.
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Affiliation(s)
- Susana C. Garcia
- Department of Psychology, John Jay College of Criminal Justice, New York, New York
| | - Megan E. Mikhail
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Pamela K. Keel
- Department of Psychology, Florida State University, Tallahassee, Florida
| | - S. Alexandra Burt
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Michael C. Neale
- Departments of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Steven Boker
- Department of Psychology, University of Virginia, Charlottesville, Virginia
| | - Kelly L. Klump
- Department of Psychology, Michigan State University, East Lansing, Michigan
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17
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Kahn M, Brunstein-Klomek A, Hadas A, Snir A, Fennig S. Early changes in depression predict outcomes of inpatient adolescent anorexia nervosa. Eat Weight Disord 2020; 25:777-785. [PMID: 30963421 DOI: 10.1007/s40519-019-00686-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/02/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the predictive value of early changes in depression levels during inpatient treatment of adolescent anorexia nervosa (AN). METHODS Fifty-six adolescents (88% girls) aged 10-18 years (M = 15.35, SD = 2.23) diagnosed with AN were assessed at admission and 1 month following admission to an inpatient setting. Depression levels and eating disorder symptoms were reported at both assessments. Re-hospitalization within 12 months of discharge was documented using official national records. RESULTS Whereas depression levels at baseline were found equivalent between subsequently re-hospitalized and non-re-hospitalized patients, at 1 month after admission patients who were later re-hospitalized had higher levels of depression compared to those who were not re-hospitalized. These differences remained significant after controlling for weight gain and anti-depressant medication intake. We additionally found that the proportion of boys in the non-re-hospitalized group was substantially larger than their proportion in the re-hospitalized group. CONCLUSIONS Our results suggest that depression at the point of hospital admission may not be a reliable predictor of treatment outcomes, and highlight the risk of relapse in AN patients whose depression levels do not alleviate after a month of inpatient treatment. Clinicians should consider providing more adjusted and intensive attention to such patients in their efforts to facilitate remission. LEVEL OF EVIDENCE III Well-designed cohort study.
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Affiliation(s)
- Michal Kahn
- Schneider Children's Medical Center, Petah Tikva, Israel. .,The School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel.
| | - Anat Brunstein-Klomek
- Schneider Children's Medical Center, Petah Tikva, Israel.,The School of Psychology, Interdisciplinary Center, Herzlyia, Israel
| | - Arie Hadas
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Avigal Snir
- Schneider Children's Medical Center, Petah Tikva, Israel
| | - Silvana Fennig
- Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Medical School, Tel-Aviv University, Tel-Aviv, Israel
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18
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Reid M, Wilson-Walsh R, Cartwright L, Hammersley R. Stuffing down feelings: Bereavement, anxiety and emotional detachment in the life stories of people with eating disorders. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:979-987. [PMID: 31840343 DOI: 10.1111/hsc.12930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to explore the life stories of people with eating disorders (EDs) in order to better understand possible contributing factors to their development. It used a qualitative Life Story method, in order to reduce the tendency to focus on the negative in the lives of people with EDs. Sixteen people in contact with an EDs charity participated. Data were analysed using a thematic analysis. Despite the attempt to elicit both positive and negative information, most themes from the life stories were negative. Here, the focus is on the three most common themes reported, which are less often reported in previous research: (a) substantial bereavement and loss; (b) major issues with anxiety and (c) difficulties coping with emotions. A model is proposed whereby major losses and the resultant anxiety can lead to emotional deadening and 'stuffing down feelings' with food, leading on to an ED. This model implies that interventions need to consider psychological factors in an ED, especially the use of it as a dysfunctional coping strategy, as well as the behavioural and physiological aspects of an ED.
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Affiliation(s)
- Marie Reid
- Department of Psychology, University of Hull, Hull, UK
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19
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Trainor C, Gorrell S, Hughes EK, Sawyer SM, Burton C, Le Grange D. Family-based treatment for adolescent anorexia nervosa: What happens to rates of comorbid diagnoses? EUROPEAN EATING DISORDERS REVIEW 2020; 28:351-357. [PMID: 31995262 DOI: 10.1002/erv.2725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/26/2019] [Accepted: 01/11/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family-based treatment (FBT). METHODS Adolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association. RESULTS Rates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p < .05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = -1.63, p = .04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT. CONCLUSIONS Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co-occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment.
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Affiliation(s)
- Claire Trainor
- Department of Psychiatry, University of California, San Francisco, CA
| | - Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, CA
| | - Elizabeth K Hughes
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Claire Burton
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, CA.,Department of Paediatrics, The University of Chicago, Chicago, IL
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20
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Murray SB, Strober M, Craske MG, Griffiths S, Levinson CA, Strigo IA. Fear as a translational mechanism in the psychopathology of anorexia nervosa. Neurosci Biobehav Rev 2018; 95:383-395. [DOI: 10.1016/j.neubiorev.2018.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022]
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21
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Berona J, Richmond R, Rienecke RD. Heterogeneous weight restoration trajectories during partial hospitalization treatment for anorexia nervosa. Int J Eat Disord 2018; 51:914-920. [PMID: 30058155 DOI: 10.1002/eat.22922] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
Abstract
UNLABELLED Early response to treatment has been shown to predict good outcome in family-based treatment, but little is known about who responds quickly. OBJECTIVE The purpose of the current study was to examine the short-term weight gain trajectories among youth receiving partial hospitalization program services for anorexia nervosa (AN), and to identify predictors of these trajectories. METHOD Adolescent and young adults (n = 102) with AN or subthreshold AN completed semi-structured interviews and self-report measures on admission to a family-based partial hospitalization program. Patients participated in programming 5 days a week. RESULTS Three weight gain trajectories were found to indicate slow, moderate, and rapid weight gain trajectories. All rapid responders gained at least four lbs. in the first 4 weeks of treatment, compared to 86.1% of moderate responders and 51.2% of slow responders. Patients were less likely to have a moderate or rapid response trajectory if they had a mood disorder diagnosis and higher parental expressed emotion. Additionally, the presence of compensatory behavior increased the likelihood of having a rapid response. DISCUSSION Despite the sometimes chronic nature of AN, most patients fell into one of the two favorable response trajectories. The identification of these trajectories underscores the importance of considering the core disordered eating behaviors (i.e., restricting, binge eating, and purging), comorbid psychopathology, and parental expressed emotion.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
| | - Rebekah Richmond
- MUSC Friedman Center for Eating Disorders, Medical University of South Carolina, Charleston, South Carolina
| | - Renee D Rienecke
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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22
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Hicks White AA, Snyder A. Examining youth and caregiver reports of depression and anxiety in families seeking eating disorder treatment. Eat Disord 2018; 26:326-342. [PMID: 29173058 DOI: 10.1080/10640266.2017.1405650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examines discrepancies between adolescent and caregiver reports of youth internalizing symptoms in families presenting for an initial eating disorder assessment. Initial diagnostic assessments of 49 adolescent-caregiver dyads seeking treatment at an urban pediatric hospital eating disorder clinic were utilized to examine differences between youth and caregiver reports of youth anxiety and depression symptoms. Caregivers reported significantly higher scores of major depression and generalized anxiety than adolescents (p=.000). Caregivers of youth with more severe ED symptoms exhibited more congruence with youth's own reports of their depression and anxiety. Our results suggest that agreement within families regarding comorbid psychological concerns may be beneficial in promoting treatment uptake for those who desire a reduction in depression and anxiety symptoms, regardless of motivation to change eating behaviors.
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Affiliation(s)
- Ashley A Hicks White
- a Marriage and Family Therapy , Louisville Presbyterian Theological Seminary , Louisville , KY , USA
| | - Anastasia Snyder
- b Department of Human Sciences , The Ohio State University , Columbus , OH, USA
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23
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Curzio O, Maestro S, Rossi G, Calderoni S, Giombini L, Scardigli S, Ragione LD, Muratori F. Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study. Eur Psychiatry 2018; 49:81-93. [PMID: 29413810 DOI: 10.1016/j.eurpsy.2017.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. METHODS A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. RESULTS Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. CONCLUSION Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.
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Affiliation(s)
- O Curzio
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - S Maestro
- IRCCS Stella Maris Foundation, Pisa, Italy.
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy; G Monasterio Foundation, CNR-Tuscany Region, Pisa, Italy
| | - S Calderoni
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - L Giombini
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | | | - L Dalla Ragione
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | - F Muratori
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
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24
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Ranta K, Väänänen J, Fröjd S, Isomaa R, Kaltiala-Heino R, Marttunen M. Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking. Nord J Psychiatry 2017; 71:605-613. [PMID: 28868945 DOI: 10.1080/08039488.2017.1366548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. AIM We aimed to examine these associations in a large-scale follow-up study among middle adolescents. METHOD We surveyed 3278 Finnish adolescents with a mean age of 15 years for these disorders. Two years later, 2070 were reached and again surveyed for psychopathology and treatment seeking. Longitudinal associations between the self-reported disorders and treatment-seeking patterns for self-acknowledged ED symptoms were examined in multivariate analyses, controlling for SP/depression comorbidity and relevant socioeconomic covariates. RESULTS Self-reported anorexia nervosa (AN) at age 15 years predicted self-reported depression at age 17 years. Furthermore, self-reported SP at age 15 years predicted not seeking treatment for bulimia nervosa (BN) symptoms, while self-reported depression at age 15 years predicted not seeking treatment for AN symptoms during the follow-up period. CONCLUSIONS Adolescents with AN should be monitored for subsequent depression. Barriers caused by SP to help seeking for BN, and by depression for AN, should be acknowledged by healthcare professionals who encounter socially anxious and depressive adolescents, especially when they present with eating problems.
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Affiliation(s)
- Klaus Ranta
- a Department of Adolescent Psychiatry , Helsinki University Central Hospital , Helsinki , Finland
| | - Juha Väänänen
- b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere, Finland
| | - Sari Fröjd
- c School of Health Sciences , University of Tampere , Tampere, Finland
| | - Rasmus Isomaa
- d City of Jakobstad, Department of Social Services and Health Care , Jakobstad , Finland
| | - Riittakerttu Kaltiala-Heino
- b Department of Adolescent Psychiatry , Tampere University Hospital , Tampere, Finland.,e Medical School, University of Tampere , Tampere, Finland
| | - Mauri Marttunen
- a Department of Adolescent Psychiatry , Helsinki University Central Hospital , Helsinki , Finland.,f Department of Adolescent Psychiatry , University of Helsinki, Helsinki, Finland.,g Department of Mental Health and Substance Use Services , National Institute for Health and Welfare , Helsinki , Finland
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25
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Voltas N, Hernández-Martínez C, Arija V, Canals J. The natural course of anxiety symptoms in early adolescence: factors related to persistence. ANXIETY STRESS AND COPING 2017; 30:671-686. [PMID: 28678525 DOI: 10.1080/10615806.2017.1347642] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Anxiety disorders are the most common mental health problems during childhood and adolescence. This study examined the course of anxiety symptoms in early adolescents from the general population over three phases. DESIGN Prospective cohort study. METHODS Two hundred and forty-two participants (mean-age of 13.52) from a baseline sample of 1514 (mean-age of 10.23) were followed up three times. Of the 1514 children, those with emotional risk and controls without risk constituted the second-phase sample (n = 562; mean-age of 11.25). The Screen for Child Anxiety Related Emotional Disorders-SCARED was administered in all three phases. RESULTS Fifty-six percent and 32% of respondents showed total scores above the SCARED cutoff point at one and three years follow-up, respectively. Eight percent showed fluctuating symptoms. Fifty-five percent of respondents showed high scores for any subtype of anxiety over three years. Social phobia and generalized anxiety symptoms were the most prevalent and persistent. Participants with persistent separation anxiety showed the highest co-occurrence with symptoms of other psychopathological disorders. Participants with persistent anxiety showed lower academic performance. Being male was a protective factor against persistence. CONCLUSIONS The data support anxiety maintenance during early adolescence. Early adolescence is a critical period which may involve other serious academic, social, and family problems.
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Affiliation(s)
- Núria Voltas
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
| | - Carmen Hernández-Martínez
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
| | - Victoria Arija
- b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili.,c Nutrition and Public Health Unit , University Rovira i Virgili , Reus , Spain
| | - Josefa Canals
- a Department of Psychology, Research Center for Behavioral Assessment (CRAMC) , University Rovira i Virgili , Tarragona , Spain.,b Nutrition and Mental Health Research Group (NUTRISAM) , University Rovira i Virgili
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Hughes EK, Le Grange D, Court A, Sawyer SM. A case series of family-based treatment for adolescents with atypical anorexia nervosa. Int J Eat Disord 2017; 50:424-432. [PMID: 28093790 DOI: 10.1002/eat.22662] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/17/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022]
Abstract
The aim of this case series was to examine engagement in and outcomes of family-based treatment (FBT) for adolescents with DSM-5 atypical AN, that is, adolescents who were not underweight at presentation. Consecutive referrals for FBT of adolescents with atypical AN to a specialist child and adolescent eating disorder program were examined. Engagement in treatment (i.e., dose of treatment, completion rate), and changes in psychological symptomatology (i.e., eating disorder symptoms, depressive symptoms, self-esteem, obsessive compulsiveness), weight, and menstrual function were examined. The need for additional interventions (i.e., hospitalization and medication), and estimated remission rates were also examined. The sample comprised 42 adolescents aged 12-18 years (88% female). Engagement in FBT was high, with 83% completing at least half the treatment dose. There were significant decreases in eating disorder and depressive symptoms during FBT (p < .05) but no improvement in self-esteem. There was no significant change in percent of median BMI for age and gender for the sample as a whole (105 vs. 106%, p = .128). However, adolescents who were not admitted to hospital prior to FBT gained some weight (M = 3.4 kg) while those who were admitted did not gain weight during FBT (M = 0.2 kg, p < .01). The overall remission rate ranged from 38 to 52% depending on the criteria applied. FBT appears to be an effective treatment for adolescents with atypical AN. However, more research is needed into systematic adaptations of FBT and other treatments that could improve overall remission rates.
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Affiliation(s)
- Elizabeth K Hughes
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daniel Le Grange
- Departments of Psychiatry and Pediatrics, University of California, San Francisco, California.,Psychiatry and Behavioral Neuroscience, The University of Chicago, Illinois
| | - Andrew Court
- Mental Health Service, Royal Children's Hospital, Melbourne, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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27
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Murray SB, Treanor M, Liao B, Loeb KL, Griffiths S, Le Grange D. Extinction theory & anorexia nervosa: Deepening therapeutic mechanisms. Behav Res Ther 2016; 87:1-10. [PMID: 27580026 DOI: 10.1016/j.brat.2016.08.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
By virtue of adopting the core symptomatic fear (i.e., a fear of weight gain) as a primary treatment target, the treatment of AN centrally involves exposure-driven processes. However, exposure trials targeting the fear of weight gain in AN have been sparse, yielding mixed results to date. In translating extinction theory to the treatment of AN, it is likely that the absence of a clear distinction between what constitutes the core feared cue and the core feared outcome has stymied the application of exposure treatments in AN. This review considers several configurations of the core fear association in AN, noting distinct therapeutic strategies which may allow for more precise efforts in violating fear-based expectancies. Specific guidance is offered in the clinical decision making process as to which strategies might best promote inhibitory learning, and a clinical case is discussed, in which treatment was adjusted to specifically violate the core underlying fear association.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Michael Treanor
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Betty Liao
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University, Teaneck, NJ, USA
| | - Scott Griffiths
- School of Psychology, University of Sydney, Sydney, NSW, Australia
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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28
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Laurent JS, Sibold J. Addictive-Like Eating, Body Mass Index, and Psychological Correlates in a Community Sample of Preadolescents. J Pediatr Health Care 2016; 30:216-23. [PMID: 26256236 DOI: 10.1016/j.pedhc.2015.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The two main objectives were to identify addictive-like eating in youth and determine the relationship between addictive-like eating, hedonic hunger, and psychological variables. METHOD A cross-sectional design was used. Each subject's objective heights and weights were measured. Subjects completed questionnaires about anxiety, depression, appetitive responsiveness, addictive-like eating, other forms of disordered eating, and exercise patterns. RESULTS Sixty-five children, ages 9 to 14 years, participated in the study. The mean body mass index percentile for age and gender was 69%. Thirty-eight percent of the children were either overweight or obese. Sixteen percent reported three or more addictive-like eating behaviors, and 4% met the criteria for "food addiction." Addictive-like eating was significantly correlated with appetitive responsiveness but not body mass index, anxiety, depression, or other measures of disordered eating. DISCUSSION Addictive-like eating occurs in children as young as 9 years and appears to be a different type of disordered eating. The hedonic value and proximity of food is a contributor to addictive-like eating behaviors.
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29
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Timko CA, Zucker NL, Herbert JD, Rodriguez D, Merwin RM. An open trial of Acceptance-based Separated Family Treatment (ASFT) for adolescents with anorexia nervosa. Behav Res Ther 2015; 69:63-74. [PMID: 25898341 PMCID: PMC4869854 DOI: 10.1016/j.brat.2015.03.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/19/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
Abstract
Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed.
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Affiliation(s)
- C Alix Timko
- Department of Behavioral and Social Sciences, University of the Sciences, 600 S. 43rd St, Philadelphia, PA 19063, USA; Department of Psychology, Towson University, 8000 York Rd., Towson, MD 21252, USA.
| | - Nancy L Zucker
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA 19104, USA
| | - Daniel Rodriguez
- Department of Urban Public Health and Nutrition, La Salle University, Philadelphia, PA 19141, USA
| | - Rhonda M Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Kezelman S, Touyz S, Hunt C, Rhodes P. Does anxiety improve during weight restoration in anorexia nervosa? A systematic review. J Eat Disord 2015; 3:7. [PMID: 25874111 PMCID: PMC4396079 DOI: 10.1186/s40337-015-0046-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
Weight restoration is considered a principal outcome for treatment of Anorexia Nervosa (AN) due to the significant physiological disturbances resultant from acute states of malnutrition. Treatment outcomes for populations with AN are relatively poor, with increasing evidence suggesting that weight restoration alone is insufficient for long-term recovery. Research aimed at understanding the psychological sequaele of AN, in particular during weight restoration, nevertheless remain scarce. This systematic review aimed to evaluate existing research regarding anxiety symptoms during treatment for AN, and the relationship of anxiety symptomology and weight restoration. Twelve articles were identified from a systematic search of three electronic databases (PsycINFO, MEDLINE, and Web of Science), and were eligible for inclusion. Study methodology, results and quality were reviewed. Results regarding change in anxiety symptomology were inconsistent, though evidence did not support a relationship between anxiety change and weight restoration. Reasons for these inconsistencies and limitations of included studies were reviewed. Further research is warranted to elucidate the role of anxiety in AN and its implications for treatment and longer-term outcome.
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Affiliation(s)
- Sarah Kezelman
- School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, Australia
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
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31
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Keating L, Tasca GA, Bissada H. Pre-treatment attachment anxiety predicts change in depressive symptoms in women who complete day hospital treatment for anorexia and bulimia nervosa. Psychol Psychother 2015; 88:54-70. [PMID: 24715589 DOI: 10.1111/papt.12028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 02/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. DESIGN Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. RESULTS Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. CONCLUSIONS These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. PRACTITIONER POINTS That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders.
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Affiliation(s)
- Leah Keating
- Department of Psychology, York University, Toronto, Canada
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32
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Nehmy TJ, Wade TD. Reduction in the prospective incidence of adolescent psychopathology: A review of school-based prevention approaches. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mhp.2014.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Le Grange D, O'Connor M, Hughes EK, Macdonald J, Little K, Olsson CA. Developmental antecedents of abnormal eating attitudes and behaviors in adolescence. Int J Eat Disord 2014; 47:813-24. [PMID: 25046731 DOI: 10.1002/eat.22331] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study capitalizes on developmental data from an Australian population-based birth cohort to identify developmental markers of abnormal eating attitudes and behaviors in adolescence. The aims were twofold: (1) to develop a comprehensive path model identifying infant and childhood developmental correlates of Abnormal Eating Attitudes and Behaviors in adolescence, and (2) to explore potential gender differences. METHOD Data were drawn from a 30-year longitudinal study that has followed the health and development of a population based cohort across 15 waves of data collection from infancy since 1983: The Australian Temperament Project. Participants in this analysis were the 1,300 youth who completed the 11th survey at 15-16 years (1998) and who completed the eating disorder inventory at this time point. RESULTS Developmental correlates of Abnormal Eating Attitudes and Behaviors in mid-adolescence were temperamental persistence, early gestational age, persistent high weight, teen depression, stronger peer relationships, maternal dieting behavior, and pubertal timing. Overall, these factors accounted for 28% of the variance in Abnormal Eating Attitudes and Behaviors at 15-16 years of age. Depressive symptoms, maternal dieting behavior, and early puberty were more important factors for girls. Late puberty was a more important factor for boys. DISCUSSION Findings address an important gap in our understanding of the etiology of Abnormal Eating Attitudes and Behaviors in adolescence and suggest multiple targets for preventive intervention.
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Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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34
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Exposure-Based Family Therapy (FBT-E): An Open Case Series of a New Treatment for Anorexia Nervosa. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Øverås M, Kapstad H, Brunborg C, Landrø NI, Lask B. Memory versus perception of body size in patients with anorexia nervosa and healthy controls. EUROPEAN EATING DISORDERS REVIEW 2014; 22:109-15. [PMID: 24590562 DOI: 10.1002/erv.2276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Abstract
The objective of this study was to compare body size estimation based on memory versus perception, in patients with anorexia nervosa (AN) and healthy controls, adjusting for possible confounders. Seventy-one women (AN: 37, controls: 35), aged 14-29 years, were assessed with a computerized body size estimation morphing program. Information was gathered on depression, anxiety, time since last meal, weight and height. Results showed that patients overestimated their body size significantly more than controls, both in the memory and perception condition. Further, patients overestimated their body size significantly more when estimation was based on perception than memory. When controlling for anxiety, the difference between patients and controls no longer reached significance. None of the other confounders contributed significantly to the model. The results suggest that anxiety plays a role in overestimation of body size in AN. This finding might inform treatment, suggesting that more focus should be aimed at the underlying anxiety.
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Affiliation(s)
- Maria Øverås
- Regional Unit for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, Norway
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37
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MacGregor MW, Lamborn P. Personality Assessment Inventory profiles of university students with eating disorders. J Eat Disord 2014; 2:20. [PMID: 25426291 PMCID: PMC4243782 DOI: 10.1186/s40337-014-0020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 07/08/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Eating disorders are complex disorders that involve medical and psychological symptoms. Understanding the psychological factors associated with different eating disorders is important for assessment, diagnosis, and treatment. METHODS This study sought to determine on which of the 22 Personality Assessment Inventory (PAI) scales patients with anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) differed, and whether the PAI can be used to classify eating disorder subtypes. Because we were interested in both whether the PAI could be used to differentiate eating disorder subtypes from each other, as well as from other disorders, we also included a group of patients with major depression. RESULTS The three eating disorder groups did differ significantly from each other, and from the patients with depression, on a number of the PAI scales. Only two PAI scales (Anxiety and Depression), however, exceeded a T-score of 70 for the patients with anorexia nervosa, no scales exceeded a T-score of 70 for the patients with bulimia nervosa or EDNOS, and only two exceeded a T-score of 70 for the patients with depression (Depression and Suicide). A discriminant function analysis revealed an overall correct classification between the groups of 81.6%. CONCLUSIONS The PAI helps to understand the psychological factors associated with eating disorders and can be used to assist with assessment. Continued investigation using the PAI in an eating disordered population is supported.
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Affiliation(s)
| | - Paige Lamborn
- University of Saskatchewan, Saskatoon, Saskatchewan Canada
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Conti E, Tremolizzo L, Bomba M, Uccellini O, Rossi MS, Raggi ME, Neri F, Ferrarese C, Nacinovich R. Reduced fasting plasma levels of diazepam-binding inhibitor in adolescents with anorexia nervosa. Int J Eat Disord 2013; 46:626-9. [PMID: 23625555 DOI: 10.1002/eat.22129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/07/2013] [Accepted: 01/27/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Altered expression and/or function, both peripherally and centrally, of various neuropeptides is involved in the neurophysiology of anorexia nervosa (AN). Diazepam-binding inhibitor (DBI) is an interesting peptide for understanding this crosstalk. The aim of this work was to assess fasting plasma levels of DBI and leptin in patients with AN. METHOD Twenty-four AN adolescents were recruited together with 10 age-comparable healthy controls. Neuropeptide determinations were performed on plasma samples by enzyme-linked immunosorbent assays. Patients with AN were further characterized for the presence of a depressive state or anxiety by using, respectively, the Children's Depression Inventory or the State-Trait Anxiety Inventory form Y. RESULTS Levels of both plasma DBI and leptin were reduced in patients with AN (∼40 and ∼70%, respectively). DBI levels displayed a tendency to increase in the presence of a depressive state, although not with anxiety, whereas leptin levels correlated exclusively with body mass index. DISCUSSION These data further extend our knowledge of neuropeptide dysfunction in AN, and plasma DBI may represent a marker for this disease, in particular considering its correlation with comorbid mood disorders.
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Affiliation(s)
- Elisa Conti
- Neurology and Laboratory of Neurobiology, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
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Hughes EK, Goldschmidt AB, Labuschagne Z, Loeb KL, Sawyer SM, Grange DL. Eating Disorders with and without Comorbid Depression and Anxiety: Similarities and Differences in a Clinical Sample of Children and Adolescents. EUROPEAN EATING DISORDERS REVIEW 2013; 21:386-94. [DOI: 10.1002/erv.2234] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/10/2013] [Accepted: 04/12/2013] [Indexed: 01/13/2023]
Affiliation(s)
| | - Andrea B. Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; IL; USA
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Neuroscience; The University of Chicago; IL; USA
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