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Guala MM, Bikic A, Bul K, Clinton D, Mejdal A, Nielsen HN, Stenager E, Søgaard Nielsen A. "Maze Out": a study protocol for a randomised controlled trial using a mix methods approach exploring the potential and examining the effectiveness of a serious game in the treatment of eating disorders. J Eat Disord 2024; 12:35. [PMID: 38429839 PMCID: PMC10908122 DOI: 10.1186/s40337-024-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Eating Disorders (ED) are severe and costly mental health disorders. The effects of existing treatment approaches are limited and there is a need to develop novel interventions, including digital strategies that can increase engagement and effectiveness. Maze Out is a new serious game coproduced by patients and ED therapists, which allows patients to "play" with the reality of an ED and reflect on associated challenges. OBJECTIVES The present study has two main objectives: (1) to evaluate the effectiveness of adding Maze Out to treatment as usual (TAU) in a randomised controlled trial (RCT); and (2) to examine in depth the potential of Maze Out by examining how it is perceived and used in the context of an RCT. METHODS Participants will be recruited from mental health care services, endocrinology departments or Community Centres offering treatment for ED. Patients suffering from ED (N = 94) will be randomised to either TAU or TAU plus Maze Out. Primary outcome will be measured in terms of changes in self-efficacy, measured by a 5-item self-efficacy questionnaire (5-item SE_ED). Secondary outcome measures will include feelings of ineffectiveness and self-image, as measured by Eating Disorder Inventory, version 3 (EDI-3), Brief INSPIRE-O and Structural Analysis of Social Behaviour Intrex Questionnaire (SAS-B). Data will be collected at baseline (enrolment in the study), and subsequently 8 and 15 weeks after inclusion. Experiences of playing Maze Out will be examined in a sub-sample of participants, utilising both quantitative user analytics and qualitative interview data of patients, interview data of significant others, and healthcare professionals to explore the possible impact of Maze Out on disorder insight, communication patterns between patients and therapists and understanding of their disorder. DISCUSSION To our knowledge Maze Out is the first serious game coproduced by patients and therapists. It is a novel and theoretically grounded intervention that may significantly contribute to the healing process of ED. If found effective, the potential for wide-spread impact and scalability is considerable. Trial registration ClinicalTrials.gov NCT05621018.
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Affiliation(s)
- Maria Mercedes Guala
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark.
| | - Aida Bikic
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatric Services Southern Jutland, Region of Southern Denmark, Aabenraa, Denmark
| | - Kim Bul
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
| | - David Clinton
- Department of Medical Epidemiology and Biostatistics (MEB), Centre for Eating Disorders Innovation (CEDI), Karolinska Institute, Stockholm, Sweden
| | - Anna Mejdal
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Helene Nygaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, Faculty of Health, University of Southern Denmark, Odense, Denmark
| | - Anette Søgaard Nielsen
- Psychiatric Research Unit, Institute of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, 5000, Odense, Denmark
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Iida N, Ono J, Mizuhara Y, Narumoto J. The subjective assessment of work and social adjustment impairments and associated psychopathologies in Japanese adult female patients with anorexia nervosa. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e151. [PMID: 38868735 PMCID: PMC11114435 DOI: 10.1002/pcn5.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 06/14/2024]
Abstract
Aim Patients with anorexia nervosa (AN) sometimes undergo a chronic course, and they hardly maintain social participation. Work and social adjustment impairments are generally significantly associated with the clinical symptoms of eating disorders. Psychopathologies associated with the subjective social difficulties of patients with AN have been unclear. This study examined the association between AN psychopathologies and work and social adjustment impairments in adult female patients with AN. Methods This study included 36 Japanese adult female patients with AN who completed the Work and Social Adjustment Scale (WSAS) and the Eating Disorder Inventory-2 (EDI-2). Spearman's rank correlation coefficient was used to assess correlations between WSAS and EDI-2 or demographic variables. Results The mean age was 31.8 years, the mean current body mass index was 13.4 kg/m2, and the median illness duration was 5 years. Patients demonstrated social difficulties, especially in social leisure activities. The total WSAS scores were significantly correlated with EDI-2 "impulse regulation" and "asceticism." WSAS "social leisure" was significantly correlated with EDI-2 "bulimia," "interoceptive awareness," "impulse regulation," and "asceticism." Conclusion Psychopathologies, such as impulse regulation, asceticism, and interoceptive awareness, may be related factors to social difficulties. Emotion regulation, such as impulse regulation and emotional awareness, could be an important realm of treatment not only for psychopathology but also for social functioning in patients with AN.
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Affiliation(s)
- Naoko Iida
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
| | - Junko Ono
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
- Kyoto Prefectural Comprehensive Mental Health and Welfare CenterKyotoJapan
| | - Yuki Mizuhara
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
- Department of Child PsychiatryKyoto Prefectural Child Development Support CenterKyotoJapan
| | - Jin Narumoto
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
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Harper JA, Palka JM, McAdams CJ. Interpersonal attribution bias and social evaluation in adolescent eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:258-270. [PMID: 36349493 PMCID: PMC9898092 DOI: 10.1002/erv.2954] [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: 05/08/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Improved understanding of adolescent eating disorders (EDs), including identification and refinement of treatment and recovery targets, may help improve clinical outcomes. Interpersonal function is a proposed risk and maintenance factor that may be particularly relevant given the significance of adolescence for both psychosocial development and ED onset. This study examined self-referential thinking in adolescents with EDs compared to healthy adolescents. METHOD Twenty-nine adolescents with EDs and 31 healthy controls completed a self-report measure of interpersonal attributions as well as a verbal appraisal task that required conducting direct and indirect evaluations about oneself and direct evaluations about others. RESULTS The ED group had a more negative self-attribution bias than the control group (p = 0.006) even when controlling for depression severity. Additionally, the ED group exhibited less positive direct self (p < 0.001), direct social (p = 0.015), and social reflected self-appraisals (p = 0.011) than the healthy cohort. After including depression as a covariate in the verbal appraisal model, the model was no longer significant, suggesting group differences related to social appraisals may be mediated by depression. CONCLUSIONS Adolescents with EDs have more negative interpersonal beliefs than comparison adolescents. Future studies are needed to determine how the constructs identified here relate to clinical course.
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Affiliation(s)
- Jessica A. Harper
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
| | - Jayme M. Palka
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Carrie J. McAdams
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
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Jhe GB, Lin J, Freizinger M, Richmond T. Adolescents with anorexia nervosa or atypical anorexia nervosa with premorbid overweight/obesity: What should we do about their weight loss? JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2023; 36:55-58. [PMID: 36121167 DOI: 10.1111/jcap.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/25/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
Traditionally, anorexia nervosa (AN) was understood to exist exclusively among underweight individuals and weight was used to assess level of severity and course of treatment. Recent trends have found a growing number of individuals presenting with AN or atypical AN (AAN) (i.e., those who remain with weight in a "normal" or "healthy" range despite significant weight loss) have a premorbid history of overweight/obesity. Individuals with AN/AAN and premorbid overweight/obesity represent an especially metabolically vulnerable population as with either AN or AAN, there is marked weight loss. Patients with AAN present a specific challenge as healthcare professionals must identify a clinically significant eating disorder in adolescents of potentially "normal" weights and then must balance their knowledge and training of traditional treatment of AN with obesity treatment and prevention. Currently, there are no evidence-based treatments to guide medical and mental health professionals regarding weight restoration, medical stabilization, and psychological treatment in patients with AN/AAN with a history of overweight/obesity while also addressing risk prevention for obesity.
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Affiliation(s)
- Grace B Jhe
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Melissa Freizinger
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Filipponi C, Visentini C, Filippini T, Cutino A, Ferri P, Rovesti S, Latella E, Di Lorenzo R. The Follow-Up of Eating Disorders from Adolescence to Early Adulthood: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16237. [PMID: 36498309 PMCID: PMC9736479 DOI: 10.3390/ijerph192316237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
Eating disorders (EDs) are common among children and adolescents and are characterized by excessive concerns for physical appearance, distorted body image, and fear of gaining weight. The purpose of this review is to evaluate the follow-up of EDs from adolescence to adulthood, analyzing persistence, relapses, and associated comorbidities. We searched scientific articles in PubMed, PsycInfo, Scopus, and Embase through two research strings, one for quantitative outcomes (recovery/persistence, relapse, and remission) and one for the other outcomes (psychiatric and medical comorbidities, substance use, and social-relational complications). From a total of 8043 retrieved articles, we selected 503 papers after exclusion of duplicates and title/abstract screening. After a full-text evaluation, we included 16 studies eligible for this review. We performed a meta-analysis describing the quantitative results, and we created a narrative synthesis for the qualitative outcomes. Results: Our results confirm that EDs can persist in early adulthood in 40.7% of cases with a relapse percentage of 24.5%. Individuals with an ED more frequently present with an empathy deficit and comorbid anxiety and depressive disorders. EDs are chronic and complex disorders, more frequent in females. In most cases, EDs reduce the autonomy of individuals who present many difficulties in affirming their independence from parental family.
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Affiliation(s)
- Caterina Filipponi
- School of Nursing, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Chiara Visentini
- Service of Psychiatric Diagnosis and Care (SPDC), Department of Mental Health and Drug Abuse, AUSL, 41126 Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
- School of Public Health, University of California Berkeley, Berkeley, CA 94704, USA
| | - Anna Cutino
- School of Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Paola Ferri
- School of Nursing, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Emanuela Latella
- School of Psychiatry, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Rosaria Di Lorenzo
- Service of Psychiatric Diagnosis and Care (SPDC), Department of Mental Health and Drug Abuse, AUSL, 41126 Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
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Luo Y, Mendoza C, Pelfrey S, Lohrenz T, Gu X, Montague PR, McAdams CJ. Elevated Neurobehavioral Responses to Negative Social Interactions in Women With Bulimia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:696-705. [PMID: 33561543 PMCID: PMC8342632 DOI: 10.1016/j.bpsc.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bulimia nervosa (BN) is a complex psychiatric illness that includes binge-purge behaviors and a belief that one's value as a person depends on body shape and weight. Social pressure strongly influences the development and maintenance of BN, but how this manifests neurobiologically within an individual remains unknown. We used a computational psychiatry approach to evaluate neural mechanisms underlying social interactions in BN. METHODS Behavioral and functional magnetic resonance imaging data were collected from 24 women with BN and 26 healthy comparison women using an iterated social exchange game. Data were sorted round by round based on whether the mathematically computed social signals indicated an improving (positive reciprocity) or deteriorating (negative reciprocity) relationship for each participant. RESULTS Social interactions with negative reciprocity resulted in more negative behavioral responses and stronger neural activations in both cortical and subcortical regions in women with BN than healthy comparison women. No behavioral or neural differences were observed for interactions demonstrating positive reciprocity, suggesting a very specific form of psychopathology in BN: amplification of negative self-relevant social interactions. Cortical activations (e.g., temporoparietal junction and dorsolateral prefrontal cortex) did not covary with mood symptoms, while subcortical activations (e.g., amygdala and dorsal striatum) were associated with acute psychopathology. CONCLUSIONS These data provide a first step toward a mechanistic neuropsychological model of aberrant social processing in BN, demonstrating how a computational psychiatric approach can elucidate neural mechanisms for complex psychiatric illnesses. Future treatments for BN may include targeting neural regions that support these negative biases in social perceptions.
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Affiliation(s)
- Yi Luo
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | | | - Sarah Pelfrey
- Department of Psychiatry, UT Southwestern Medical School, Dallas, Texas
| | - Terry Lohrenz
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - P Read Montague
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia; Department of Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Virginia Tech-Wake Forest University School of Biomedical Engineering and Mechanics, Blacksburg, Virginia; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Carrie J McAdams
- Department of Psychiatry, UT Southwestern Medical School, Dallas, Texas.
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Brewerton TD, Wang JB, Lafrance A, Pamplin C, Mithoefer M, Yazar-Klosinki B, Emerson A, Doblin R. MDMA-assisted therapy significantly reduces eating disorder symptoms in a randomized placebo-controlled trial of adults with severe PTSD. J Psychiatr Res 2022; 149:128-135. [PMID: 35272210 DOI: 10.1016/j.jpsychires.2022.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Eating disorders (EDs) and posttraumatic stress disorder (PTSD) are highly comorbid, yet there are no proven integrative treatment modalities for ED-PTSD. In clinical trials, MDMA-assisted therapy (MDMA-AT) has shown marked success in the treatment of PTSD and may be promising for ED-PTSD. METHODS Ninety individuals with severe PTSD received treatment in a double-blind, placebo-controlled pivotal trial of MDMA-AT. In addition to the primary (Clinician-Administered PTSD Scale) and secondary (Sheehan Disability Scale) outcome measures, the Eating Attitudes Test 26 (EAT-26) was administered for pre-specified exploratory purposes at baseline and at study termination. RESULTS The study sample consisted of 58 females (placebo = 31, MDMA = 27) and 31 males (placebo = 12, MDMA = 19) (n = 89). Seven participants discontinued prior to study termination. At baseline, 13 (15%) of the 89 individuals with PTSD had total EAT-26 scores in the clinical range (≥20), and 28 (31.5%) had total EAT-26 scores in the high-risk range (≥11) despite the absence of active purging or low weight. In completers (n = 82), there was a significant reduction in total EAT-26 scores in the total group of PTSD participants following MDMA-AT versus placebo (p = .03). There were also significant reductions in total EAT-26 scores in women with high EAT-26 scores ≥11 and ≥ 20 following MDMA-AT versus placebo (p = .0012 and p = .0478, respectively). CONCLUSIONS ED psychopathology is common in individuals with PTSD even in the absence of EDs with active purging and low weight. MDMA-AT significantly reduced ED symptoms compared to therapy with placebo among participants with severe PTSD. MDMA-AT for ED-PTSD appears promising and requires further study.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425-0742, USA.
| | - Julie B Wang
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Adele Lafrance
- Department of Psychology, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, P3E 2C6, Canada
| | - Chelsea Pamplin
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Michael Mithoefer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425-0742, USA; MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Berra Yazar-Klosinki
- Multidisciplinary Association for Psychedelic Studies, 3141 Stevens Creek Blvd #40563, San Jose, CA, 95117, USA
| | - Amy Emerson
- MAPS Public Benefit Corporations, 3141 Stevens Creek Blvd #40547, San Jose, CA, 95117, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, 3141 Stevens Creek Blvd #40563, San Jose, CA, 95117, USA
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Mason TB, Lesser EL, Dolgon-Krutolow AR, Wonderlich SA, Smith KE. An updated transdiagnostic review of social cognition and eating disorder psychopathology. J Psychiatr Res 2021; 143:602-627. [PMID: 33190838 DOI: 10.1016/j.jpsychires.2020.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023]
Abstract
Existing data suggest that deficits in social cognitive functioning are transdiagnostic phenomena that are observed across various forms of psychopathology. The goal of the present review was to provide an updated systematic review of the literature on social cognitive functioning across eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Studies that assessed six areas of social cognition were included: theory of mind, social perception, social knowledge, attributional bias, emotion perception, and emotion processing. A systematic search identified 71 studies, the majority of which examined adult women with AN. Research typically focused on alexithymia, theory of mind, empathy, social processing, emotion recognition, or emotion processing. Results suggested some deficits in social cognition in EDs. AN had the most studies with some evidence for deficiencies in social cognition but a fair amount of variability. Research on BN and BED was limited and inconsistent, though there appear to be some deficits in social cognition. Together, the limited coverage across EDs and heterogeneous methodology preclude firm conclusions regarding general or ED-specific deficits, as well as understanding the role of social cognition in ED etiology and maintenance. Therefore, several key questions and future directions are outlined for research moving forward.
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Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Anna R Dolgon-Krutolow
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen A Wonderlich
- Sanford Center for Bio-behavioral Research, Sanford Health, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
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Blomberg M, Schlegel K, Stoll L, Febry H, Wünsch-Leiteritz W, Leiteritz A, Brockmeyer T. Reduced emotion recognition from nonverbal cues in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:868-878. [PMID: 34431168 DOI: 10.1002/erv.2860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/23/2021] [Accepted: 08/09/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recent models of anorexia nervosa (AN) emphasise the role of reduced emotion recognition ability (ERA) in the development and maintenance of the disorder. However, methodological limitations impede conclusions from prior research. The current study tries to overcome these limitations by examining ERA with an audio-visual measure that focuses strictly on multimodal nonverbal cues and allows to differentiate between ERA for different emotion categories. METHOD Forty women with AN and 40 healthy women completed the Geneva Emotion Recognition Test. This test includes 83 video clips in which 10 actors express 14 different emotions while saying a pseudo-linguistic sentence without semantic meaning. All clips contain multimodal nonverbal cues (i.e., prosody, facial expression, gestures, and posture). RESULTS Patients with AN showed poorer ERA than the healthy control group (d = 0.71), particularly regarding emotions of negative valence (d = 0.26). Furthermore, a lower body weight (r = 0.41) and longer illness duration (ρ = -0.32) were associated with poorer ERA in the AN group. CONCLUSIONS Using an ecologically valid instrument, the findings of the study support illness models emphasising poor ERA in AN. Directly addressing ERA in the treatment of AN with targeted interventions may be promising.
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Affiliation(s)
- Maximilian Blomberg
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Katja Schlegel
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Linda Stoll
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Hagen Febry
- Klinik Lueneburger Heide, Bad Bevensen, Germany
| | | | | | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
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10
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Dann KM, Hay P, Touyz S. Are poor set-shifting and central coherence associated with everyday function in anorexia nervosa? A systematic review. J Eat Disord 2021; 9:40. [PMID: 33781337 PMCID: PMC8008586 DOI: 10.1186/s40337-021-00392-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), however, the relationship with everyday function is unclear. The current review synthesizes existing data regarding associations between scores on tests of set-shifting and central coherence and functional outcome measures for individuals with AN. METHOD A systematic electronic database search yielded 13 studies which included participants with current or lifetime AN where scores on a neuropsychological test of set-shifting or central coherence were directly or indirectly compared to a functional outcome measure. RESULTS Associations between set-shifting and central coherence performance measures and functional outcomes were limited in number and noted only in adult or mixed-age cohorts. Associations were noted at subscale level, suggesting they are specific in nature. In younger cohorts, assessments of executive functioning in everyday life appear sensitive to cognitive-behavioral flexibility issues. CONCLUSIONS Associations between cognitive performance and functional outcome have not been as systematically assessed in AN as in other psychiatric disorders. Key factors to address in future research include: (a) the use of function measures which are sensitive to both the level of impairment, and specific rather than general impairments (b) the ecological validity of measures, (c) the task impurity problem, especially in regard to cognitive flexibility assessment, and (d) the need to measure both cognitive deficits and strengths, because tests of specific cognitive processes may underestimate the ability to function in daily life due to compensatory strategies.
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Affiliation(s)
- Kelly M Dann
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute and School of Psychology, University of Sydney, Sydney, Australia
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11
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Harrison A. Experimental Investigation of Non-Verbal Communication in Eating Disorders. Psychiatry Res 2021; 297:113732. [PMID: 33535088 DOI: 10.1016/j.psychres.2021.113732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
This study aimed to be the first to measure non-verbal communication in 25 eating disorder (ED) and 25 non-ED control participants during a naturalistic social interaction incorporating positive, negative and neutrally-valenced topics. The first hypothesis, that ED participants would show significantly reduced facial emotional expression than controls, was not supported. Supporting the second hypothesis of between-group differences in non-verbal behaviour, ED participants were less likely to lean in towards their interlocutor (d=.81) discussing negatively-valanced topics and were more likely to be positioned upright when discussing positively-valenced topics (d=.1.09) than controls. Irrespective of emotional valence, ED participants positioned their gaze on their interlocutor significantly less (d=.29) and spent more time looking down (d=.54), or away than controls (d=.63). ED participants moved their hands along with speech significantly less (d=.63) and gestured fewer real/hypothetical/imagined images/actions/objects) than controls (d=.57), irrespective of emotional valence. Instead, ED participants indicated discomfort in the social interaction, touching their nose (d=.89) or playing with their nails (d=.95) more often than controls. ED participants, regardless of emotional valence, showed significantly lowered electro-dermal activity (d=.60) than controls, supporting the exploratory hypothesis. People with EDs appear to make less efficient use of non-verbal communication than controls.
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Affiliation(s)
- A Harrison
- Associate Professor in Psychology, University College London, Institute of Education, Department of Psychology and Human Development.
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12
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Harrison A, Stavri P, Tchanturia K. Individual and group format adjunct therapy on social emotional skills for adolescent inpatients with severe and complex eating disorders (CREST-A). NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:163-176. [PMID: 33252714 DOI: 10.1007/s40211-020-00375-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Relatively little is known about which psychological treatment adjuncts might be helpful for supporting people with the most severe and complex forms of anorexia nervosa (AN) with very low weight and malnutrition requiring inpatient admissions, but targeting key perpetuating factors such as social emotional difficulties may be one way to advance knowledge. This pilot feasibility project reports on the development of an adolescent adaptation of Cognitive Remediation and Emotion Skills Training (CREST-A) and explores its acceptability, feasibility and possible benefits. METHODS An uncontrolled, repeated measures design was employed with data collected at the start and end of treatment. CREST‑A was investigated in two formats: a 10-session individual format delivered to a case series of 12 patients and a 5-session group format delivered to 3 groups of 9 patients. RESULTS Acceptability, measured using a Patient Satisfaction Scale was 7/10 for the individual and 6/10 for the group format. Individual take-up was 100% and group take-up was 34.62%. Drop-out was 8.33% and 29.63% in the individual and group formats respectively. Homework was completed 66.67% and 75% of the time in the individual and group formats respectively. Patients reported medium-sized improvements in components of social emotional functioning measured using the Work and Social Adjustment Scale, the Toronto Alexithymia Scale and the Revised Social Anhedonia Scale in the individual and group formats. CONCLUSION Future studies employing randomized controlled designs may now be warranted to advance this evidence base of this low intensity treatment adjunct.
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Affiliation(s)
- Amy Harrison
- Department of Psychology and Human Development, University College London, 25 Woburn Square, WC1H 0AA, London, UK.
| | - Pamela Stavri
- Ellern Mede Service for Eating Disorders, Holcombe Hill, The Ridgeway, NW7 4HX, Mill Hill, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
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13
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Miles S, Gnatt I, Phillipou A, Nedeljkovic M. Cognitive flexibility in acute anorexia nervosa and after recovery: A systematic review. Clin Psychol Rev 2020; 81:101905. [PMID: 32891022 DOI: 10.1016/j.cpr.2020.101905] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
Difficulties in cognitive flexibility-the ability to adapt effectively to changes in the environment and/or changing task demands-have been reported in anorexia nervosa (AN). However, findings are inconsistent across studies and it remains unclear which specific aspects of cognitive flexibility patients with AN may struggle with. This systematic review aimed to synthesise existing research on cognitive flexibility in AN and clarify differences between patients with acute AN, patients who are weight-restored and patients who are fully recovered from AN. Electronic databases were searched through to January 2020. 3,310 papers were screened and 70 papers were included in the final review. Although adults with acute AN performed worse in perceptual flexibility tasks and self-report measures compared to HCs, they did not exhibit deficits across all domains of cognitive flexibility. Adolescents with acute AN did not differ to HCs in performance on neurocognitive tasks despite self-reporting poorer cognitive flexibility. Overall, significant differences in cognitive flexibility between acute and recovered participants was not evident, though, the findings are limited by a modest number of studies. Recovered participants performed poorer than HCs in some neurocognitive measures, however, results were inconsistent across studies. These results have implications for the assessment of cognitive flexibility in AN and targeted treatment approaches.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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14
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Saure E, Laasonen M, Lepistö-Paisley T, Mikkola K, Ålgars M, Raevuori A. Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:1056-1079. [PMID: 32181530 DOI: 10.1002/eat.23259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Laasonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Katri Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Monica Ålgars
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Åbo Akademi University, Department of Psychology, Åbo Akademi Fakulteten för humaniora psykologi och teologi, Turku, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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15
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Preis MA, Schlegel K, Stoll L, Blomberg M, Schmidt H, Wünsch-Leiteritz W, Leiteritz A, Brockmeyer T. Improving emotion recognition in anorexia nervosa: An experimental proof-of-concept study. Int J Eat Disord 2020; 53:945-953. [PMID: 32277519 DOI: 10.1002/eat.23276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms. METHOD Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training. RESULTS After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms. DISCUSSION ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings.
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Affiliation(s)
- Mira A Preis
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
| | - Katja Schlegel
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - Linda Stoll
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
| | - Maximilian Blomberg
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
| | | | | | | | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, University of Goettingen, Goettingen, Germany
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16
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Giles S, Hughes EK, Fuller‐Tyszkiewicz M, Krug I. The cognitive‐interpersonal model of disordered eating: A test of the mediating role of alexithymia. EUROPEAN EATING DISORDERS REVIEW 2020; 28:296-308. [DOI: 10.1002/erv.2720] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sarah Giles
- Melbourne School of Psychological SciencesThe University of Melbourne Melbourne Australia
| | - Elizabeth K. Hughes
- Melbourne School of Psychological SciencesThe University of Melbourne Melbourne Australia
- Department of PaediatricsThe University of Melbourne Melbourne Australia
- Centre for Adolescent HealthMurdoch Children's Research Institute Melbourne Australia
| | - Matthew Fuller‐Tyszkiewicz
- Centre for Social and Early Emotional Development, School of PsychologyDeakin University Melbourne Australia
- School of PsychologyDeakin University Geelong Australia
| | - Isabel Krug
- Melbourne School of Psychological SciencesThe University of Melbourne Melbourne Australia
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17
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Tapajóz F, Soneira S, Catoira N, Aulicino A, Allegri RF. Impaired theory of mind in unaffected first‐degree relatives of patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:692-699. [DOI: 10.1002/erv.2701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/08/2019] [Accepted: 08/25/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Fernanda Tapajóz
- CONICET‐Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
- Service of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni Buenos Aires Argentina
| | - Sebastian Soneira
- Section of Eating Disorders and Nutritional Psychiatry, Psychiatry Service, Fleni Buenos Aires Argentina
| | - Natalia Catoira
- Casa Hospital San Juan de Dios (Ramos Mejía) Buenos Aires Argentina
| | - Alfredo Aulicino
- Section of Eating Disorders, Hospital General Cosme Argerich Buenos Aires Argentina
| | - Ricardo F. Allegri
- CONICET‐Consejo Nacional de Investigaciones Científicas y Técnicas Buenos Aires Argentina
- Service of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni Buenos Aires Argentina
- Universidad de la Costa (CUC) Barranquilla Colombia
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18
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Karjalainen L, Råstam M, Paulson-Karlsson G, Wentz E. Do autism spectrum disorder and anorexia nervosa have some eating disturbances in common? Eur Child Adolesc Psychiatry 2019; 28:69-78. [PMID: 29974245 PMCID: PMC6349794 DOI: 10.1007/s00787-018-1188-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
A possible overlap between autism spectrum disorder (ASD) and anorexia nervosa (AN), in terms of both behavioural and cognitive features, has led to new areas of research. The aim of the present study was to examine the occurrence of eating behaviours frequently seen in ASD among adolescents and young adults with AN. The participants were females within the age range 15-25 years: 36 with current AN (32 were followed up after 1 year), 19 with ASD, and 30 healthy females. The participants completed the SWedish Eating Assessment for Autism spectrum disorders (SWEAA) and the Autism Spectrum Quotient tool (AQ). AN groups had significantly higher SWEAA scores than the healthy comparison group, also when patients had gained weight. Typical autistic eating behaviours, such as selective eating, were more common in the AN groups than in the ASD group. This is the first time that SWEAA has been implemented in an AN population. Eating behaviours frequently seen in ASD seem to be frequent in AN and some remain also after weight gain.
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Affiliation(s)
- Louise Karjalainen
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-41119, Göteborg, Sweden.
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-41119 Göteborg, Sweden ,Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gunilla Paulson-Karlsson
- Anorexia-Bulimia Unit, The Queen Silvia Children’s University Hospital, Göteborg, Sweden ,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
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19
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Fuglset TS. Set-shifting, central coherence and decision-making in individuals recovered from anorexia nervosa: a systematic review. J Eat Disord 2019; 7:22. [PMID: 31249687 PMCID: PMC6585061 DOI: 10.1186/s40337-019-0251-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 05/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aim of this study was to review the existing literature and evaluate whether deficits in set-shifting, central coherence and decision-making persist in individuals recovered from anorexia nervosa (AN-REC). METHOD A systematic review approach was used. Literature was identified via searches in PubMed, PsychInfo and Embase database. The main search resulted in 158 articles. After exclusion of 135 articles, 23 articles were included in the review. RESULTS The majority of studies on set-shifting showed that set-shifting difficulties persist after recovery. Central coherence might also be trait related, however findings are inconsistent. Few studies have investigated decision-making in AN-REC, however those studies that do exist suggest that decision-making is not impaired in AN-REC. CONCLUSIONS Novel treatment strategies based on neuroscience research are emerging, focusing on targeting the underlying mechanisms of the illness, including neuropsychological functioning. Whether these functions are trait or state related could have implications for how they are targeted in treatment.
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Affiliation(s)
- Tone Seim Fuglset
- Division of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Parkvegen 84, 6412 Molde, Norway
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20
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Oldershaw A, Lavender T, Schmidt U. Are socio-emotional and neurocognitive functioning predictors of therapeutic outcomes for adults with anorexia nervosa? EUROPEAN EATING DISORDERS REVIEW 2018; 26:346-359. [PMID: 29744972 DOI: 10.1002/erv.2602] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/08/2018] [Accepted: 04/10/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Emotional, social, and neurocognitive factors are theorised to maintain anorexia nervosa (AN). Yet whether they predict outcomes or relate to clinical change remains unclear. METHODS Seventy-one consecutive adult outpatient eating disorder service referrals presenting with AN, who participated in a randomised controlled trial comparing 2 psychotherapies, were assessed for emotional processing, social cognition, and neurocognition pretherapy and posttherapy. Intention-to-treat analysis employed maximum-likelihood methods to model missing data. Baseline self-reported emotional processing, social cognitive, or neurocognitive task performance was entered into forward stepwise regression models with posttreatment clinical outcomes (weight, eating disorder psychopathology, psychosocial functioning) as dependent variables. Correlation analyses examined relationships between clinical and self-report/task score change. RESULTS Self-reported emotional avoidance (behavioural/cognitive avoidance, low acceptance) and submissive behaviour predicted clinical outcomes. Social cognitive (emotion recognition, emotional theory of mind) and neurocognitive performance (set-shifting, detail focus) had limited predictive ability. CONCLUSIONS Emotional avoidance and submissiveness may represent maintenance factors for AN.
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Affiliation(s)
- Anna Oldershaw
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tony Lavender
- Salomons Centre for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
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21
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Franta C, Philipp J, Waldherr K, Truttmann S, Merl E, Schöfbeck G, Koubek D, Laczkovics C, Imgart H, Zanko A, Zeiler M, Treasure J, Karwautz A, Wagner G. Supporting Carers of Children and Adolescents with Eating Disorders in Austria (SUCCEAT): Study protocol for a randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 26:447-461. [PMID: 29732651 PMCID: PMC6175075 DOI: 10.1002/erv.2600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/20/2018] [Accepted: 03/30/2018] [Indexed: 12/12/2022]
Abstract
Supporting Carers of Children and Adolescents with Eating Disorders in Austria (SUCCEAT) is an intervention for carers of children and adolescents with anorexia nervosa and atypical anorexia nervosa. This paper describes the study protocol for a randomised controlled trial including the process and economic evaluation. Carers are randomly allocated to one of the 2 SUCCEAT intervention formats, either 8 weekly 2‐hr workshop sessions (n = 48) or web‐based modules (n = 48), and compared with a nonrandomised control group (n = 48). SUCCEAT includes the cognitive‐interpersonal model, cognitive behavioural elements, and motivational interviewing. The goal is to provide support for carers to improve their own well‐being and to support their children. Outcome measures include carers' distress, anxiety, depression, expressed emotions, needs, motivation to change, experiences of caregiving, and skills. Further outcome measures are the patients' eating disorder symptoms, emotional problems, behavioural problems, quality of life, motivation to change, and perceived expressed emotions. These are measured before and after the intervention, and 1‐year follow‐up.
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Affiliation(s)
- Claudia Franta
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Julia Philipp
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Karin Waldherr
- Ferdinand Porsche Distance Learning University for Applied Sciences, Vienna, Austria
| | - Stefanie Truttmann
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Merl
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gabriele Schöfbeck
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Doris Koubek
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Clarissa Laczkovics
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Hartmut Imgart
- Parkland-Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen-Reinhardshausen, Germany
| | - Annika Zanko
- Parkland-Clinic, Clinic for Psychosomatic Medicine and Psychotherapy, Bad Wildungen-Reinhardshausen, Germany
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Gudrun Wagner
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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22
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Harrison A, Stavri P, Ormond L, McEnemy F, Akyol D, Qureshi A, Al-Khairulla H. Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: A treatment trial. EUROPEAN EATING DISORDERS REVIEW 2018. [PMID: 29542258 DOI: 10.1002/erv.2584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whether individual and group CRT was a feasible, acceptable, and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age = 15.22, SD = 1.44) received 10 sessions of individual CRT, and 55 patients (mean age = 14.89, SD = 1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out, and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills, and large-sized improvements in motivation to recover. Group CRT had higher dropout (9.09%; n = 5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest that a randomised controlled trial for adolescents with AN is warranted.
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Affiliation(s)
- Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK.,Ellern Mede Service for Eating Disorders, London, UK
| | - Pamela Stavri
- Ellern Mede Service for Eating Disorders, London, UK
| | - Lynn Ormond
- Ellern Mede Service for Eating Disorders, London, UK
| | | | - Dilan Akyol
- Ellern Mede Service for Eating Disorders, London, UK
| | - Annum Qureshi
- Ellern Mede Service for Eating Disorders, London, UK
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23
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McAdams CJ, Harper JA, Van Enkevort E. Mentalization and the left inferior frontal gyrus and insula. EUROPEAN EATING DISORDERS REVIEW 2018; 26:265-271. [PMID: 29464819 DOI: 10.1002/erv.2580] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/05/2017] [Accepted: 01/15/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine if an interpersonal attribution bias associated with self-perception, the externalizing bias, was related to neural activations during mentalization. METHODS A functional magnetic resonance imaging task involving verbal appraisals measured neural activations when thinking about oneself and others in 59 adults, including healthy women as well as women with and recovered from anorexia nervosa. Whole-brain regressions correlated brain function during mentalization with the externalizing bias measured using the Internal, Personal, and Situational Attributions Questionnaire. RESULTS Women with anorexia nervosa had a lower externalizing bias, demonstrating a tendency to self-attribute more negative than positive social interactions, unlike the other groups. The externalizing bias was correlated with activation of the left inferior frontal gyrus and posterior insula, when comparing thinking about others evaluating oneself with direct self-evaluation. DISCUSSION Externalizing biases may provide an office-based assay reflecting neurocognitive disturbances in social self-perception that are common during anorexia nervosa.
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Affiliation(s)
- Carrie J McAdams
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Psychiatry, Children's Medical Center, Dallas, TX, USA.,Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - Jessica A Harper
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Erin Van Enkevort
- Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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24
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Tamiya H, Ouchi A, Chen R, Miyazawa S, Akimoto Y, Kaneda Y, Sora I. Neurocognitive Impairments Are More Severe in the Binge-Eating/Purging Anorexia Nervosa Subtype Than in the Restricting Subtype. Front Psychiatry 2018; 9:138. [PMID: 29713293 PMCID: PMC5911723 DOI: 10.3389/fpsyt.2018.00138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Objective: To evaluate cognitive function impairment in patients with anorexia nervosa (AN) of either the restricting (ANR) or binge-eating/purging (ANBP) subtype. Method: We administered the Japanese version of the MATRICS Consensus Cognitive Battery to 22 patients with ANR, 18 patients with ANBP, and 69 healthy control subjects. Our participants were selected from among the patients at the Kobe University Hospital and community residents. Results: Compared to the healthy controls, the ANR group had significantly lower visual learning and social cognition scores, and the ANBP group had significantly lower processing speed, attention/vigilance, visual learning, reasoning/problem-solving, and social cognition scores. Compared to the ANR group, the ANBP group had significantly lower attention/vigilance scores. Discussion: The AN subtypes differed in cognitive function impairments. Participants with ANBP, which is associated with higher mortality rates than ANR, exhibited greater impairment severities, especially in the attention/vigilance domain, confirming the presence of impairments in continuous concentration. This may relate to the impulsivity, an ANBP characteristic reported in the personality research. Future studies can further clarify the cognitive impairments of each subtype by addressing the subtype cognitive functions and personality characteristics.
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Affiliation(s)
- Hiroko Tamiya
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atushi Ouchi
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Runshu Chen
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shiho Miyazawa
- Department of Biological Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoritaka Akimoto
- Department of Information & Management Systems Engineering, Nagaoka University of Technology, Nagaoka, Japan
| | | | - Ichiro Sora
- Department of Psychiatry, Kobe University Graduate School of Medicine, Kobe, Japan
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25
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Harper JA, Brodrick B, Van Enkevort E, McAdams CJ. Neuropsychological and Cognitive Correlates of Recovery in Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:491-500. [PMID: 28799287 DOI: 10.1002/erv.2539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight recovery in adult women with anorexia nervosa. METHODS Participants were recruited from prior studies of women with anorexia nervosa (AN-C) and in weight-recovery following anorexia nervosa (AN-WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow-up. Groups based on clinical outcome (continued eating disorder, AN-CC; newly in recovery, AN-CR; sustained weight-recovery, AN-WR) were compared by using one-way ANOVAs with Bonferroni-corrected post hoc comparisons. RESULTS Women with continued eating disorder had poorer neuropsychological function and self-competence at baseline than AN-CR. AN-CR showed changes in depression and externalizing bias, a measure of self-related attributions. AN-WR differed from both AN-CC and AN-CR at baseline in externalizing bias, but only from AN-CC at outcome. DISCUSSION Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Jessica A Harper
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA
| | - Brooks Brodrick
- Department of Internal Medicine, University of Texas Southwestern Medical Center, TX, USA
| | - Erin Van Enkevort
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA.,Department of Psychiatry, Children's Medical Center, TX, USA.,Department of Psychiatry, Texas Health Presbyterian Hospital of Dallas, TX, USA
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Burns BD, Zhang Y, Wieth M, Touyz S. An exploratory study of creativity and eating disorders. J Eat Disord 2017; 5:45. [PMID: 29075495 PMCID: PMC5649089 DOI: 10.1186/s40337-017-0176-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We examined whether cognitive rigidity associated with having an eating disorder generalized to creativity. METHOD One hundred twelve participants from the participant pool of an Australian university were given a measure of disordered eating (EDE-Q), asked if they had ever had a diagnosis of an eating disorder (16 reported yes), and given 3 min to generate alternative uses for a paper-clip. The alternative uses task yielded measures of creative fluency, originality, elaboration and flexibility. RESULTS A logistic regression found that only lower flexibility predicted a self-reported ED diagnosis. Across the spectrum of disordered eating behaviour there was no association between creativity measures and EDE-Q global scores. CONCLUSION Our results were consistent with previous findings of an association between cognitive inflexibility and having an ED. However we found no evidence that cognitive inflexibility generalized to creativity more broadly. Our results may lend support to Cognitive Remediation Therapy, but further study is required.
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Affiliation(s)
- Bruce D Burns
- University of Sydney, Sydney, New South Wales Australia
| | | | | | - Stephen Touyz
- University of Sydney, Sydney, New South Wales Australia
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Lang K, Roberts M, Harrison A, Lopez C, Goddard E, Khondoker M, Treasure J, Tchanturia K. Central Coherence in Eating Disorders: A Synthesis of Studies Using the Rey Osterrieth Complex Figure Test. PLoS One 2016; 11:e0165467. [PMID: 27806073 PMCID: PMC5091879 DOI: 10.1371/journal.pone.0165467] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/12/2016] [Indexed: 11/19/2022] Open
Abstract
Background Large variability in tests and differences in scoring systems used to study central coherence in eating disorders may lead to different interpretations, inconsistent findings and between study discrepancies. This study aimed to address inconsistencies by collating data from several studies from the same research group that used the Rey Osterrieth Complex Figure Test (Rey Figure) in order to produce norms to provide benchmark data for future studies. Method Data was collated from 984 participants in total. Anorexia Nervosa, Bulimia Nervosa, recovered Anorexia Nervosa, unaffected family members and healthy controls were compared using the Rey Figure. Results Poor global processing was observed across all current eating disorder sub-groups and in unaffected relatives. There was no difference in performance between recovered AN and HC groups. Conclusions This is the largest dataset reported in the literature and supports previous studies implicating poor global processing across eating disorders using the Rey Figure. It provides robust normative data useful for future studies.
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Affiliation(s)
- Katie Lang
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Marion Roberts
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Amy Harrison
- Regents School of Psychotherapy & Psychology, Faculty of Humanities, Arts & Social Sciences, Regent’s University, London, United Kingdom
| | - Carolina Lopez
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Department of Pediatrics and Child Surgery East, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Elizabeth Goddard
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Mizan Khondoker
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Janet Treasure
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Kate Tchanturia
- King’s College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- Illia State University, Department of Psychology, Tbilisi, Georgia
- * E-mail:
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Maria AS, Bourdier L, Duclos J, Ringuenet D, Berthoz S. Psychometric properties of the French version of a scale measuring perceived emotional intelligence : the Trait Meta-Mood Scale (TMMS). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:652-62. [PMID: 27310229 PMCID: PMC5348089 DOI: 10.1177/0706743716639936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Trait Meta-Mood Scale (TMMS), a 30-item self-assessment questionnaire, has been developed to measure perceived emotional intelligence (EI) level in 3 dimensions: Attention, Clarity and Repair. This study aimed to explore the psychometric properties of the French version of this instrument. METHOD The instrument factor structure, normality, internal consistency, stability and concurrent validity were assessed in a sample of 824 young adults (456 female). Besides TMMS, participants completed self-assessment questionnaires for affectivity (Shortened Beck Depression Inventory, State and Trait Anxiety Inventory, Positive and Negative emotion scale), alexithymia (Bermond-Vorst Alexithymia Questionnaire-B) and interpersonal functioning (Empathy Quotient). Discriminant validity was tested in 64 female patients with anorexia nervosa, identified in literature as having difficulties with introspection, expression and emotional regulation. RESULTS Confirmatory factor analysis results replicate the 3-factor structure. Internal consistency and reliability indices are adequate. Direction and degree of correlation coefficients between TMMS dimensions and other questionnaires support the instrument concurrent validity. TMMS allows to highlight differences in perceived EI levels between men and women (Attention: p < 0.001 ; Clarity: p < 0.05) as well as between patients with anorexia nervosa and control subjects (p < 0.001 for all 3 dimensions). CONCLUSION This first validation study shows satisfying psychometric properties for TMMS French version.
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Affiliation(s)
- Anne-Solène Maria
- Unité de traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Universitaire Paul Brousse, Villejuif, France Centre de recherche en épidémiologie et santé des populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France Institut Mutualiste Montsouris, Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Paris, France
| | - Léna Bourdier
- Université Paris Ouest Nanterre La Défense, Nanterre, France
| | - Jeanne Duclos
- Centre de recherche en épidémiologie et santé des populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France Institut Mutualiste Montsouris, Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Paris, France Université de Reims Champagne-Ardenne, Laboratoire Cognition, Santé, Socialisation, Reims, France
| | - Damien Ringuenet
- Unité de traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Universitaire Paul Brousse, Villejuif, France Centre de recherche en épidémiologie et santé des populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France
| | - Sylvie Berthoz
- Centre de recherche en épidémiologie et santé des populations (CESP), Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France Institut Mutualiste Montsouris, Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Paris, France
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Brockmeyer T, Pellegrino J, Münch H, Herzog W, Dziobek I, Friederich HC. Social cognition in anorexia nervosa: Specific difficulties in decoding emotional but not nonemotional mental states. Int J Eat Disord 2016; 49:883-90. [PMID: 27315544 DOI: 10.1002/eat.22574] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Building on recent models of anorexia nervosa (AN) that emphasize the importance of impaired social cognition in the development and maintenance of the disorder, the present study aimed at examining whether women with AN have more difficulties with inferring other people's emotional and nonemotional mental states than healthy women. METHOD Social cognition was assessed in 25 adult women with AN and 25 age-matched healthy women. To overcome limitations of previous research on social cognition in AN, the processing of social information was examined in a more complex and ecologically valid manner. The Movie for the Assessment of Social Cognition (MASC) reflects complex real-life social interaction and allows for disentangling emotional and non-emotional mental state inference as well as different types of errors in mentalizing. RESULTS Women with AN showed poorer emotional mental state inference, whereas non-emotional mental state inference was largely intact. Groups did not differ in undermentalizing (overly simplistic theory of mind) and overmentalizing (overly complex or over-interpretative mental state reasoning). Performance in the MASC was independent of levels of eating disorder psychopathology and symptoms of depression and anxiety. DISCUSSION The findings suggest that AN is associated with specific difficulties in emotional mental state inference despite largely intact nonemotional mental state inference. Upon replication in larger samples, these findings advocate a stronger emphasis on socio-emotional processing in AN treatment. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:883-890).
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany. .,Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Judith Pellegrino
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Hannah Münch
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany
| | - Isabell Dziobek
- Berlin School of Mind and Brain and Institute of Psychology, Humboldt-University, Berlin, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Center for Psychosocial Medicine, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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30
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Westwood H, Stahl D, Mandy W, Tchanturia K. The set-shifting profiles of anorexia nervosa and autism spectrum disorder using the Wisconsin Card Sorting Test: a systematic review and meta-analysis. Psychol Med 2016; 46:1809-1827. [PMID: 27109830 DOI: 10.1017/s0033291716000581] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Difficulties in set-shifting are commonly reported in both autism spectrum disorder (ASD) and anorexia nervosa (AN) populations. Despite this, it is not known whether this cognitive profile persists across different ages, or whether the profiles seen in ASD and AN are comparable. This systematic review and meta-analyses aimed to compare the set-shifting profiles, as measured by the Wisconsin Card Sorting Test (WCST) in adults and younger people with either ASD or AN, relative to healthy controls (HCs) and to statistically compare performance on the WCST between ASD and AN. In all, 24 studies on ASD and 22 studies on AN were identified. In ASD, there were significant differences between the clinical group and HCs, with the ASD group making significantly more perseverative errors, indicating greater difficulty in set-shifting [pooled effect size of d = 0.67, 95% confidence interval (CI) 0.53-0.81, p ⩽ 0.001]. This effect was consistent across the age span. For AN studies, there was a significant difference between adults with AN and HCs (d = 0.52, 95% CI 0.36-0.68, p ⩽ 0.001) but a non-significant effect in child studies (d = 0.25, 95% CI -0.05 to 0.55, z = 1.66, p = 0.096). Meta-regression indicated no effect of diagnosis (AN or ASD) on performance in adult studies but there was a non-significant trend (p = 0.053) towards children with ASD performing worse than children with AN. While difficulties with set-shifting appear to be stable in ASD, there may be differences between children and adults with AN, which warrant further investigation.
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Affiliation(s)
- H Westwood
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - D Stahl
- Department of Biostatistics,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
| | - W Mandy
- University College London,Research Department of Clinical, Educational and Health Psychology,London,UK
| | - K Tchanturia
- Psychological Medicine,King's College London,Institute of Psychiatry, Psychology & Neuroscience,London,UK
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31
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Mason TB, Lavender JM, Wonderlich SA, Crosby RD, Joiner TE, Mitchell JE, Crow SJ, Klein MH, Le Grange D, Bardone-Cone AM, Peterson CB. The role of interpersonal personality traits and reassurance seeking in eating disorder symptoms and depressive symptoms among women with bulimia nervosa. Compr Psychiatry 2016; 68:165-71. [PMID: 27234198 PMCID: PMC5293149 DOI: 10.1016/j.comppsych.2016.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The role of interpersonal factors has been proposed in various models of eating disorder (ED) psychopathology and treatment. We examined the independent and interactive contributions of two interpersonal-focused personality traits (i.e., social avoidance and insecure attachment) and reassurance seeking in relation to global ED psychopathology and depressive symptoms among women with bulimia nervosa (BN). METHOD Participants were 204 adult women with full or subclinical BN who completed a battery of self-report questionnaires. Hierarchical multiple OLS regressions including main effects and interaction terms were used to analyze the data. RESULTS Main effects were found for social avoidance and insecure attachment in association with global ED psychopathology and depressive symptoms. In addition, two-way interactions between social avoidance and reassurance seeking were observed for both global ED psychopathology and depressive symptoms. In general, reassurance seeking strengthened the association between social avoidance and global ED psychopathology and depressive symptoms. CONCLUSION These results demonstrate the importance of reassurance seeking in psychopathology among women with BN who display personality features characterized by social avoidance.
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Affiliation(s)
- Tyler B Mason
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND.
| | - Jason M Lavender
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Stephen A Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Ross D Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL
| | - James E Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN; The Emily Program, St. Paul, MN
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA
| | - Anna M Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina - Chapel Hill, Chapel Hill, NC
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN; The Emily Program, St. Paul, MN
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Family Functioning and Dysfunctional Eating Among Italian Adolescents: The Moderating Role of Gender. Child Psychiatry Hum Dev 2016; 47:43-52. [PMID: 25776344 DOI: 10.1007/s10578-015-0543-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The first aim of this study was to examine the association between different dimensions of family functioning and dysfunctional eating in a sample of Italian adolescent boys and girls. The second aim was to investigate whether gender moderates the relationship between family functioning and dysfunctional eating. Seven hundred and twenty seven adolescents (500 boys and 227 girls) with ages ranging from 15 to 18 years completed a survey of self-report measures. Findings from hierarchical multiple regression analysis suggested that aspects of family functioning such as flexibility, cohesion, disengagement, enmeshment, rigidity and chaotic were related to dysfunctional eating in adolescents. Additionally the results indicated differences between boys and girls, in particular dysfunctional eating in adolescent boys seemed to be more affected by dimensions of enmeshment and disengagement than dysfunctional eating in girls. This research highlights the important role of various aspects of family functioning in relation to dysfunctional eating in adolescents.
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Whalen DJ, Belden AC, Barch D, Luby J. Emotion Awareness Predicts Body Mass Index Percentile Trajectories in Youth. J Pediatr 2015; 167:821-828.e4. [PMID: 26227437 PMCID: PMC4586388 DOI: 10.1016/j.jpeds.2015.06.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/02/2015] [Accepted: 06/25/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine the rate of change in body mass index (BMI) percentile across 3 years in relation to emotion identification ability and brain-based reactivity in emotional processing regions. STUDY DESIGN A longitudinal sample of 202 youths completed 3 functional magnetic resonance imaging-based facial processing tasks and behavioral emotion differentiation tasks. We examined the rate of change in the youth's BMI percentile as a function of reactivity in emotional processing brain regions and behavioral emotion identification tasks using multilevel modeling. RESULTS Lower correct identification of both happiness and sadness measured behaviorally predicted increases in BMI percentile across development, whereas higher correct identification of both happiness and sadness predicted decreases in BMI percentile, while controlling for children's pubertal status, sex, ethnicity, IQ score, exposure to antipsychotic medication, family income-to-needs ratio, and externalizing, internalizing, and depressive symptoms. Greater neural activation in emotional reactivity regions to sad faces also predicted increases in BMI percentile during development, also controlling for the aforementioned covariates. CONCLUSION Our findings provide longitudinal developmental data demonstrating links between both emotion identification ability and greater neural reactivity in emotional processing regions with trajectories of BMI percentiles across childhood.
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Affiliation(s)
- Diana J. Whalen
- Washington University School of Medicine, Department of Psychiatry
| | - Andrew C. Belden
- Washington University School of Medicine, Department of Psychiatry
| | - Deanna Barch
- Washington University School of Medicine, Department of Psychiatry,Washington University, Department of Psychology
| | - Joan Luby
- Washington University School of Medicine, Department of Psychiatry
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Acevedo SF, Valencia C, Lutter M, McAdams CJ. Severity of eating disorder symptoms related to oxytocin receptor polymorphisms in anorexia nervosa. Psychiatry Res 2015; 228:641-8. [PMID: 26106053 PMCID: PMC4532594 DOI: 10.1016/j.psychres.2015.05.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/21/2015] [Accepted: 05/05/2015] [Indexed: 12/11/2022]
Abstract
Oxytocin is a peptide hormone important for social behavior and differences in psychological traits have been associated with variants of the oxytocin receptor gene in healthy people. We examined whether single nucleotide polymorphisms (SNPs) of the oxytocin receptor gene (OXTR) correlated with clinical symptoms in women with anorexia nervosa, bulimia nervosa, and healthy comparison (HC) women. Subjects completed clinical assessments and provided DNA for analysis. Subjects were divided into four groups: HC, subjects currently with anorexia nervosa (AN-C), subjects with a history of anorexia nervosa but in long-term weight recovery (AN-WR), and subjects with bulimia nervosa (BN). Five SNPs of the oxytocin receptor were examined. Minor allele carriers showed greater severity in most of the psychiatric symptoms. Importantly, the combination of having had anorexia and carrying either of the A alleles for two SNPS in the OXTR gene (rs53576, rs2254298) was associated with increased severity specifically for ED symptoms including cognitions and behaviors associated both with eating and appearance. A review of psychosocial data related to the OXTR polymorphisms examined is included in the discussion. OXTR polymorphisms may be a useful intermediate endophenotype to consider in the treatment of patients with anorexia nervosa.
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Affiliation(s)
- Summer F. Acevedo
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas TX 75390-8828
| | - Celeste Valencia
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas TX 75390-8828
| | - Michael Lutter
- Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA, USA. 52242
| | - Carrie J. McAdams
- University of Texas at Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas TX 75390-8828
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Via E, Soriano-Mas C, Sánchez I, Forcano L, Harrison BJ, Davey CG, Pujol J, Martínez-Zalacaín I, Menchón JM, Fernández-Aranda F, Cardoner N. Abnormal Social Reward Responses in Anorexia Nervosa: An fMRI Study. PLoS One 2015; 10:e0133539. [PMID: 26197051 PMCID: PMC4510264 DOI: 10.1371/journal.pone.0133539] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/29/2015] [Indexed: 11/19/2022] Open
Abstract
Patients with anorexia nervosa (AN) display impaired social interactions, implicated in the development and prognosis of the disorder. Importantly, social behavior is modulated by reward-based processes, and dysfunctional at-brain-level reward responses have been involved in AN neurobiological models. However, no prior evidence exists of whether these neural alterations would be equally present in social contexts. In this study, we conducted a cross-sectional social-judgment functional magnetic resonance imaging (fMRI) study of 20 restrictive-subtype AN patients and 20 matched healthy controls. Brain activity during acceptance and rejection was investigated and correlated with severity measures (Eating Disorder Inventory -EDI-2) and with personality traits of interest known to modulate social behavior (The Sensitivity to Punishment and Sensitivity to Reward Questionnaire). Patients showed hypoactivation of the dorsomedial prefrontal cortex (DMPFC) during social acceptance and hyperactivation of visual areas during social rejection. Ventral striatum activation during rejection was positively correlated in patients with clinical severity scores. During acceptance, activation of the frontal opercula-anterior insula and dorsomedial/dorsolateral prefrontal cortices was differentially associated with reward sensitivity between groups. These results suggest an abnormal motivational drive for social stimuli, and involve overlapping social cognition and reward systems leading to a disruption of adaptive responses in the processing of social reward. The specific association of reward-related regions with clinical and psychometric measures suggests the putative involvement of reward structures in the maintenance of pathological behaviors in AN.
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Affiliation(s)
- Esther Via
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- Melbourne Neuropsychiatry Centre, The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Carles Soriano-Mas
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain
| | - Isabel Sánchez
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Laura Forcano
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- IMIM Research Institute at the Hospital de Mar, clinical research group in human pharmacology and neuroscience, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Ben J. Harrison
- Melbourne Neuropsychiatry Centre, The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Christopher G. Davey
- Melbourne Neuropsychiatry Centre, The Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Jesús Pujol
- MRI Research Unit, Hospital del Mar, CIBERSAM G21, Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - José M. Menchón
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Narcís Cardoner
- Bellvitge University Hospital - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
- CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
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Treasure J, Stein D, Maguire S. Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidence. Early Interv Psychiatry 2015; 9:173-84. [PMID: 25263388 DOI: 10.1111/eip.12170] [Citation(s) in RCA: 186] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/22/2014] [Indexed: 12/13/2022]
Abstract
AIM To examine the evidence to support using a staging heuristic for eating disorders, suggesting that the diagnosis of an eating disorder follows a trajectory across the life course. Specifically, to examine whether high-risk markers and prodromal features presenting in childhood and adolescence can later transition to the full manifestation of the illness in early adulthood, and whether over time, the illness can be described as becoming severe and enduring, often resistant to treatment. METHODS We conducted a comprehensive literature search on the MEDLINE, PubMed, PsycINFO, EMBASE and Cochrane databases from using the following terms: staging, duration of illness, early intervention, developmental epidemiology, neurobiological marker, phenotype, partial syndrome, severe enduring, chronic, prospective, longitudinal, cohort, epidemiology, adolescent, adult with anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder. The evidence was organized according to the staging heuristic defined by McGorry. RESULTS Evidence from epidemiological studies, neuropsychological findings, treatment responsivity and prognosis, support a specific staging trajectory for anorexia nervosa in that there is a longitudinal trajectory with evidence of neurobiological progression and evidence that interventions matched to stage of illness may optimize the benefit. There is less data at the moment to support such a model for bulimia nervosa and binge eating disorder. CONCLUSION The staging heuristic is a useful model for anorexia nervosa in terms of providing prognostic information and stage matched interventions. Although the evidence is encouraging, further research is needed before a similar model could be applied for bulimia nervosa and binge eating disorder.
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Affiliation(s)
- Janet Treasure
- PO59 Eating Disorder Unit, Kings College London, Institute of Psychiatry, London, UK
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Renwick B, Musiat P, Lose A, DeJong H, Broadbent H, Kenyon M, Loomes R, Watson C, Ghelani S, Serpell L, Richards L, Johnson-Sabine E, Boughton N, Treasure J, Schmidt U. Neuro- and social-cognitive clustering highlights distinct profiles in adults with anorexia nervosa. Int J Eat Disord 2015; 48:26-34. [PMID: 25363476 DOI: 10.1002/eat.22366] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to explore the neuro- and social-cognitive profile of a consecutive series of adult outpatients with anorexia nervosa (AN) when compared with widely available age and gender matched historical control data. The relationship between performance profiles, clinical characteristics, service utilization, and treatment adherence was also investigated. METHOD Consecutively recruited outpatients with a broad diagnosis of AN (restricting subtype AN-R: n = 44, binge-purge subtype AN-BP: n = 33 or Eating Disorder Not Otherwise Specified-AN subtype EDNOS-AN: n = 23) completed a comprehensive set of neurocognitive (set-shifting, central coherence) and social-cognitive measures (Emotional Theory of Mind). Data were subjected to hierarchical cluster analysis and a discriminant function analysis. RESULTS Three separate, meaningful clusters emerged. Cluster 1 (n = 45) showed overall average to high average neuro- and social- cognitive performance, Cluster 2 (n = 38) showed mixed performance characterized by distinct strengths and weaknesses, and Cluster 3 (n = 17) showed poor overall performance (Autism Spectrum disorder (ASD) like cluster). The three clusters did not differ in terms of eating disorder symptoms, comorbid features or service utilization and treatment adherence. A discriminant function analysis confirmed that the clusters were best characterized by performance in perseveration and set-shifting measures. DISCUSSION The findings suggest that considerable neuro- and social-cognitive heterogeneity exists in patients with AN, with a subset showing ASD-like features. The value of this method of profiling in predicting longer term patient outcomes and in guiding development of etiologically targeted treatments remains to be seen.
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Affiliation(s)
- Beth Renwick
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, London, United Kingdom
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Øverås M, Kapstad H, Brunborg C, Landrø NI, Lask B. Are poor set-shifting abilities associated with a higher frequency of body checking in anorexia nervosa? J Eat Disord 2015; 3:17. [PMID: 25897402 PMCID: PMC4403677 DOI: 10.1186/s40337-015-0053-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 03/19/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The rigid and obsessional features of anorexia nervosa (AN) have led researchers to explore possible underlying neuropsychological difficulties. Numerous studies have demonstrated poorer set-shifting in patients with AN. However, due to a paucity of research on the connection between neuropsychological difficulties and the clinical features of AN, the link remains hypothetical. The main objective of this study was to explore the association between set-shifting and body checking. METHODS The sample consisted of 30 females diagnosed with AN and 45 healthy females. Set-shifting was assessed using the Wisconsin Card Sorting Test (WCST) and frequency of body checking was assessed using the Body Checking Questionnaire (BCQ). RESULTS The analysis showed no significant correlations between any of the WCST scores and the BCQ. CONCLUSION The results suggest that there is no association between set-shifting difficulties and frequency of body checking among patients with AN. An alternative explanation could be that the neuropsychological measure included in this study is not sensitive to the set-shifting difficulties observed in clinical settings. We recommend that future studies include more ecologically valid measures of set-shifting in addition to standard neuropsychological tests.
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Affiliation(s)
- Maria Øverås
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Hilde Kapstad
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Cathrine Brunborg
- Unit of Biostatistics and Epidemiology, Oslo University Hospital, Ullevål, Pb 4950 Nydalen, 0424 Oslo, Norway
| | - Nils Inge Landrø
- Department of Psychology, Clinical Neuroscience Research Group, Box 1094, , Blindern, 0317 Oslo, Norway
| | - Bryan Lask
- Regional Department for Eating Disorders (RASP), Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Pb 4950 Nydalen, 0424 Oslo, Norway ; Care UK, London, UK ; Great Ormond Street Hospital for Children, London, WC1 N 3JH UK
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Talbot A, Hay P, Buckett G, Touyz S. Cognitive deficits as an endophenotype for anorexia nervosa: an accepted fact or a need for re-examination? Int J Eat Disord 2015; 48:15-25. [PMID: 25046823 DOI: 10.1002/eat.22332] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate whether impaired set shifting and weak central coherence represent state or trait characteristics and, therefore, candidate endophenotypes of anorexia nervosa (AN). METHOD Forty-nine individuals with lifetime AN (24 acutely unwell, 10 weight recovered, and 15 fully recovered) and 43 healthy controls completed the Wisconsin Card Sorting Test (WCST), the Matching Familiar Figures Test, and the Rey Complex Figure Task measuring cognitive flexibility, local processing, and global processing, respectively. Participants also completed questionnaires assessing eating disorder, anxiety and depressive symptoms, obsessional traits, interpersonal functioning, and quality of life. Body mass index was calculated from height and weight measurements. RESULTS Participants with lifetime AN demonstrated poorer set shifting ability than healthy controls as evidenced by a greater number of perseverative errors on the WCST. When participants were grouped according to illness status, only those in the two recovered groups demonstrated poorer set shifting ability than healthy controls while patients with acute AN performed comparably to all other groups. There were no significant differences between groups on measures of local and global processing. No relationship was found between specific clinical features of AN and cognitive performance. DISCUSSION The results of this study are consistent with a global trend toward set shifting difficulties in patients with AN but do not support weak central coherence as a candidate endophenotype for AN. These findings have clinical implications in terms of treatment selection and planning, particularly in relation to the use of cognitive remediation therapy with patients with AN.
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Affiliation(s)
- Amy Talbot
- The Redleaf Practice, Wahroonga, New South Wales, Australia; Department of Psychology, University of Sydney, New South Wales, Australia
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40
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Tchanturia K, Lounes N, Holttum S. Cognitive remediation in anorexia nervosa and related conditions: a systematic review. EUROPEAN EATING DISORDERS REVIEW 2014; 22:454-62. [PMID: 25277720 DOI: 10.1002/erv.2326] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/07/2022]
Abstract
Research evidence for cognitive remediation therapy's (CRT) effectiveness for anorexia nervosa (AN) has been gathering. This approach is also increasingly being implemented in other disorders including major depressive disorder, obsessive-compulsive disorder and autistic spectrum disorder that share commonalities with AN in neuropsychological profiles and clinical presentations. This systematic literature review identified and appraised the current evidence base to see whether evidence from related conditions could be integrated into the theoretical understanding of CRT for AN as well as future AN treatment developments and research. Overall, CRT studies in AN report promising findings, and CRT appears to be associated with improvements in set-shifting and in central coherence. Cognitive remediation approaches in other conditions also show promising evidence in associated improvements in areas of executive functioning and information processing; links are made between AN treatment and what future treatment developments could consider.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK; South London and Maudsley NHS Trust Eating Disorders National Service, UK; Illia University Tbilisi, Georgia
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Goddard E, Carral-Fernández L, Denneny E, Campbell IC, Treasure J. Cognitive flexibility, central coherence and social emotional processing in males with an eating disorder. World J Biol Psychiatry 2014; 15:317-26. [PMID: 23336111 DOI: 10.3109/15622975.2012.750014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Females are more likely to develop an eating disorder (ED) than males. Studies of affected men may therefore inform models of risk and resilience to EDs. The aim of this study was to examine putative neurocognitive intermediate phenotypes of EDs in affected males. METHODS Cognitive flexibility, central coherence (global/detail processing), complex emotion recognition and social-threat sensitivity were investigated in men with EDs and healthy men. Measures of distress, perfectionism, and obsessive compulsivity were collected. RESULTS Men with EDs were more cognitively inflexible across tasks and had more difficulty integrating global information than healthy men. Unexpectedly, there were no group differences on a visuospatial task of detail processing or on social-emotional processing tasks. Men with EDs had higher scores on measures of distress, perfectionism and obsessive compulsivity than healthy men. CONCLUSIONS Men with EDs share some of the intermediate cognitive phenotype present in women with EDs. Like their female counterparts, males with EDs show an inflexible, fragmented cognitive style. However, relative to healthy men, men with EDs do not have superior detail processing abilities, poor emotion recognition or increased sensitivity to social-threat. It is possible that gender differences in social-threat processing contribute to the female preponderance of EDs.
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Affiliation(s)
- Elizabeth Goddard
- Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry , London, UK
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42
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Validity and reliability of the behavior rating inventory of executive function - adult version in a clinical sample with eating disorders. Eat Behav 2014; 15:175-81. [PMID: 24854800 DOI: 10.1016/j.eatbeh.2014.01.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/29/2013] [Accepted: 01/22/2014] [Indexed: 11/20/2022]
Abstract
This study is a preliminary investigation of the reliability and validity of the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) in a clinical sample of patients with eating disorders (ED). Participants were 252 adult females who were referred to a centre for the treatment of EDs, as well as 31 individuals who completed the informant version of the BRIEF-A. Patients completed the BRIEF-A and other psychological measures on one occasion during their initial clinic visit, and informants nominated by patients completed the informant version at home. Reliability analyses revealed high internal consistency (Cronbach's alpha) of the two indices (Metacognition Index and Behavioral Regulation Index), and for the Global Executive Composite (GEC) of the BRIEF-A (α = .96). Convergent validity was shown by a high positive relationship between the self-report and informant-report versions of the BRIEF-A, and between the GEC and the Anxiety and Depression scales. Construct validity was assessed by an exploratory and confirmatory factor analysis. The BRIEF-A may be a reliable and valid tool for measuring executive functioning (EF) in an ED population, and may serve as an initial screening tool of EF for clinicians and researchers.
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43
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Griffiths S, Angus D, Murray SB, Touyz S. Unique associations between young adult men's emotional functioning and their body dissatisfaction and disordered eating. Body Image 2014; 11:175-8. [PMID: 24418309 DOI: 10.1016/j.bodyim.2013.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 12/03/2013] [Accepted: 12/05/2013] [Indexed: 11/26/2022]
Abstract
Research on emotional functioning, body dissatisfaction, and disordered eating in males is predominated by studies of negative affect and emotion regulation. Other aspects of emotional functioning, namely emotion recognition and attentional biases toward emotional stimuli, have received little empirical attention. The present study investigated the unique associations between different aspects of men's emotional functioning and their disordered eating attitudes, muscularity dissatisfaction, and body fat dissatisfaction. Results from 132 male undergraduates showed that muscularity dissatisfaction was uniquely associated with both emotion regulation difficulties and an attentional bias toward rejecting faces. Body fat dissatisfaction was not uniquely associated with any aspect of emotional functioning. Disordered eating was uniquely associated with emotion regulation difficulties. Collectively, the results indicate differences in the patterns of associations between men's emotional functioning and their body dissatisfaction and disordered eating.
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Affiliation(s)
- Scott Griffiths
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
| | - Douglas Angus
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Stuart B Murray
- The Redleaf Practice, Wahroonga, Sydney, NSW 2076, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
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Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria. REVISTA LATINOAMERICANA DE PSICOLOGIA 2014. [DOI: 10.1016/s0120-0534(14)70022-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Tapajóz P de Sampaio F, Soneira S, Aulicino A, Martese G, Iturry M, Allegri RF. Theory of mind and central coherence in eating disorders: two sides of the same coin? Psychiatry Res 2013; 210:1116-22. [PMID: 24064463 DOI: 10.1016/j.psychres.2013.08.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate central coherence and theory of mind (ToM) and explore the relationships between these domains in patients with eating disorders (ED). ToM and central coherence were assessed in 72 women [24 with anorexia nervosa (AN), 24 with bulimia nervosa (BN) and 24 healthy controls (HC)]. The Reading the Mind in the Eyes (RME) and the Faux Pas Test (FPT) to measure ToM, and the copy strategy of the Rey-Osterrieth Complex Figure Test to assess central coherence were used. It was observed that patients with ED had a decrease in central coherence skills compared with the control group; that patients with anorexia had a poor performance on RME ToM task compared with BN patients and HCs, and also that these measures were related in both clinical groups. The statistically significant correlation between them suggests that the central coherence and ToM measures might involve common cognitive processes. These results provide a better understanding of the nature of the socio-cognitive deficits observed in patients with eating disorders.
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Affiliation(s)
- Fernanda Tapajóz P de Sampaio
- CONICET - Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina; Department of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Instituto de Investigaciones Neurológicas Raúl Carrea - FLENI, Buenos Aires, Argentina; Section of Eating Disorders, Hospital General Cosme Argerich, Buenos Aires, Argentina.
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46
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Fonville L, Giampietro V, Surguladze S, Williams S, Tchanturia K. Increased BOLD signal in the fusiform gyrus during implicit emotion processing in anorexia nervosa. NEUROIMAGE-CLINICAL 2013; 4:266-73. [PMID: 24501698 PMCID: PMC3913832 DOI: 10.1016/j.nicl.2013.12.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/30/2013] [Accepted: 12/02/2013] [Indexed: 12/02/2022]
Abstract
Background The behavioural literature in anorexia nervosa (AN) has suggested impairments in psychosocial functioning and studies using facial expression processing tasks (FEPT) have reported poorer recognition and slower identification of emotions. Methods Functional magnetic resonance imaging (fMRI) was used alongside a FEPT, depicting neutral, mildly happy and happy faces, to examine the neural correlates of implicit emotion processing in AN. Participants were instructed to specify the gender of the faces. Levels of depression, anxiety, obsessive–compulsive symptoms and eating disorder behaviour were obtained and principal component analysis (PCA) was performed to acquire uncorrelated variables. Results fMRI analysis revealed a greater blood-oxygenation level dependent (BOLD) response in AN in the right fusiform gyrus to all facial expressions. This response showed a linear increase with the happiness of the facial expression and was found to be stronger in those not taking medication. PCA analysis revealed a single component indicating a greater level of general clinical symptoms. Conclusion Neuroimaging findings would suggest that alterations in implicit emotion processing in AN occur during early perceptual processing of social signals and illustrate greater engagement on the FEPT. The lack of separate components using PCA suggests that the questionnaires used might not be suited as predictive measures. Greater BOLD response in AN in the right fusiform gyrus to all facial expressions. The BOLD response showed a linear increase with the happiness of the expression The BOLD response was stronger in those not taking psychotropic medication These alterations occur during early perceptual processing of social signals
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Affiliation(s)
- Leon Fonville
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Simon Surguladze
- King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom ; Cognitive & Affective Neuroscience Lab, Ilia University, Tblisi, Georgia
| | - Steven Williams
- King's College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom ; NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, United Kingdom
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
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47
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Tchanturia K, Smith E, Weineck F, Fidanboylu E, Kern N, Treasure J, Baron Cohen S. Exploring autistic traits in anorexia: a clinical study. Mol Autism 2013; 4:44. [PMID: 24220604 PMCID: PMC4176300 DOI: 10.1186/2040-2392-4-44] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 11/05/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The objectives of this study were to explore associations between autistic traits and self-reported clinical symptoms in a population with anorexia nervosa (AN). Experimental and self-report evidence reveals similarities between AN and autism spectrum condition (ASC) populations in socio-emotional and cognitive domains; this includes difficulties with empathy, set-shifting and global processing. Focusing on these similarities may lead to better tailored interventions for both conditions. METHODS A cross-sectional independent-groups design was employed. Participants with AN (n = 66) and typical controls (n = 66) completed self-report questionnaires including the Short (10-Item) Version Autism Spectrum Quotient (AQ-10) questionnaire (the first time this has been implemented in this population), the Eating Disorder Examination Questionnaire, the Hospital Anxiety and Depression Scale and the Work and Social Adjustment Scale. Group differences and the relationship between autistic traits and other questionnaire measures were investigated. RESULTS The AN group had a significantly higher AQ-10 total score and a greater proportion scored above the clinical cut-off than the control group. Seven out of ten AQ-10 items significantly discriminated between groups. In the AN group, levels of autistic traits correlated with a greater self-reported anxiety and depression and a lower ability to maintain close relationships; however, eating disorder symptoms were not associated with autistic traits. CONCLUSIONS Women with anorexia possess a greater number of autistic traits than typical women. AQ-10 items that discriminated between groups related to 'bigger picture' (global) thinking, inflexibility of thinking and problems with social interactions, suggesting that autistic traits may exacerbate factors that maintain the eating disorder rather than cause the eating disorder directly. Using screening instruments may improve understanding of patients' problems, leading to better tailoring of intervention. We conclude that further investigation of autistic traits in AN could inform new intervention approaches based on joint working between ASC and eating disorder services.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Emma Smith
- King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.,Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Felicitas Weineck
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Eliz Fidanboylu
- King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Nikola Kern
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK
| | - Janet Treasure
- Psychological Medicine Clinical Academic Group, South London and Maudsley NHS Trust, London, UK.,King's College London, Mental Health Studies Programme, Institute of Psychiatry, London, UK
| | - Simon Baron Cohen
- Autism Research Centre, Psychiatry Department, Cambridge University, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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48
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Fonville L, Lao-Kaim NP, Giampietro V, Van den Eynde F, Davies H, Lounes N, Andrew C, Dalton J, Simmons A, Williams SC, Baron-Cohen S, Tchanturia K. Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study. PLoS One 2013; 8:e63964. [PMID: 23691129 PMCID: PMC3653828 DOI: 10.1371/journal.pone.0063964] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 04/08/2013] [Indexed: 01/12/2023] Open
Abstract
The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.
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Affiliation(s)
- Leon Fonville
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Nick P. Lao-Kaim
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Vincent Giampietro
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Frederique Van den Eynde
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
- Eating Disorders Program, Douglas University Institute, Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Helen Davies
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Naima Lounes
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
| | - Christopher Andrew
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Jeffrey Dalton
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
| | - Andrew Simmons
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Steven C.R. Williams
- King’s College London, Institute of Psychiatry, Department of Neuroimaging, London, United Kingdom
- NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College, London, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Centre, University of Cambridge, Department of Psychiatry, Cambridge, United Kingdom
| | - Kate Tchanturia
- King’s College London, Institute of Psychiatry, Department of Psychological Medicine, London, United Kingdom
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49
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Treasure J, Schmidt U. The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 2013; 1:13. [PMID: 24999394 PMCID: PMC4081714 DOI: 10.1186/2050-2974-1-13] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/03/2013] [Indexed: 12/12/2022] Open
Abstract
AIM To describe the evidence base relating to the Cognitive-Interpersonal Maintenance Model for anorexia nervosa (AN). BACKGROUND A Cognitive-Interpersonal Maintenance Model maintenance model for anorexia nervosa was described in 2006. This model proposed that cognitive, socio-emotional and interpersonal elements acted together to both cause and maintain eating disorders. METHOD A review of the empirical literature relating to the key constructs of the model (cognitive, socio-emotional, interpersonal) risk and maintaining factors for anorexia nervosa was conducted. RESULTS Set shifting and weak central coherence (associated with obsessive compulsive traits) have been widely studied. There is some evidence to suggest that a strong eye for detail and weak set shifting are inherited vulnerabilities to AN. Set shifting and global integration are impaired in the ill state and contribute to weak central coherence. In addition, there are wide-ranging impairments in socio-emotional processing including: an automatic bias in attention towards critical and domineering faces and away from compassionate faces; impaired signalling of, interpretation and regulation of emotions. Difficulties in social cognition may in part be a consequence of starvation but inherited vulnerabilities may also contribute to these traits. The shared familial traits may accentuate family members' tendency to react to the frustrating and frightening symptoms of AN with high expressed emotion (criticism, hostility, overprotection), and inadvertently perpetuate the problem. CONCLUSION The cognitive interpersonal model is supported by accumulating evidence. The model is complex in that cognitive and socio-emotional factors both predispose to the illness and are exaggerated in the ill state. Furthermore, some of the traits are inherited vulnerabilities and are present in family members. The clinical formulations from the model are described as are new possibilities for targeted treatment.
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Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King’s College London, Institute of Psychiatry, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK
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McAdams CJ, Krawczyk DC. Neural Responses during Social and Self-Knowledge Tasks in Bulimia Nervosa. Front Psychiatry 2013; 4:103. [PMID: 24065928 PMCID: PMC3770922 DOI: 10.3389/fpsyt.2013.00103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/28/2013] [Indexed: 11/24/2022] Open
Abstract
Self-evaluation closely dependent upon body shape and weight is one of the defining criteria for bulimia nervosa (BN). We studied 53 adult women, 17 with BN, 18 with a recent history of anorexia nervosa (AN), and 18 healthy comparison women, using three different fMRI tasks that required thinking about self-knowledge and social interactions: the Social Identity task, the Physical Identity task, and the Social Attribution task. Previously, we identified regions of interest (ROI) in the same tasks using whole-brain voxel-wise comparisons of the healthy comparison women and women with a recent history of AN. Here, we report on the neural activations in those ROIs in subjects with BN. In the Social Attribution task, we examined activity in the right temporoparietal junction (RTPJ), an area frequently associated with mentalization. In the Social Identity task, we examined activity in the precuneus (PreC) and dorsal anterior cingulate (dACC). In the Physical Identity task, we examined activity in a ventral region of the dACC. Interestingly, in all tested regions, the average activation in subjects with bulimia was more than the average activation levels seen in the subjects with a history of anorexia but less than that seen in healthy subjects. In three regions, the RTPJ, the PreC, and the dACC, group responses in the subjects with bulimia were significantly different from healthy subjects but not subjects with anorexia. The neural activations of people with BN performing fMRI tasks engaging social processing are more similar to people with AN than healthy people. This suggests biological measures of social processes may be helpful in characterizing individuals with eating disorders.
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Affiliation(s)
- Carrie J McAdams
- Department of Psychiatry, The University of Texas Southwestern Medical Center , Dallas, TX , USA
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