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Arend AK, Blechert J, Yanagida T, Voderholzer U, Reichenberger J. Emotional food craving across the eating disorder spectrum: an ecological momentary assessment study. Eat Weight Disord 2024; 29:58. [PMID: 39264507 PMCID: PMC11393200 DOI: 10.1007/s40519-024-01690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
PURPOSE Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking. METHODS Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal. RESULTS Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred. CONCLUSION The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.
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Affiliation(s)
- Ann-Kathrin Arend
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron University of Salzburg, Salzburg, Austria.
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron University of Salzburg, Salzburg, Austria
| | - Takuya Yanagida
- School of Applied Health and Social Sciences, University of Applied Sciences Upper Austria, Linz, Austria
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of the LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
| | - Julia Reichenberger
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron University of Salzburg, Salzburg, Austria
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Barnhart WR, Kalantzis M, Gaggiano C, Braden AL. The relation between questionnaire-measured self-reported emotional eating and disordered eating behaviors: A meta-analysis of nearly three decades of research. Appetite 2024; 198:107343. [PMID: 38604382 DOI: 10.1016/j.appet.2024.107343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/15/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
Extensive research exists on the association between self-reported emotional eating (EE) and disordered eating (DE) behaviors. Heterogeneity exists by type (e.g., unidimensional vs. multidimensional) and valence (e.g., negative vs. positive) of self-reported EE, and no previous meta-analyses have examined the association between self-reported EE and DE behaviors. A total of 67 studies (N = 26,289; 43 reporting relations in one model, and 24 reporting relations in more than one model) met inclusion criteria; ranges for age and publication date were 18.0-61.8 years old and 1995 to 2022. Five models quantified relations between DE behaviors and 1) broad negative EE, 2) EE in response to depression, 3) EE in response to anger and anxiety, 4) EE in response to boredom, and 5) EE in response to positive emotions. Using random-effects models, pooled Cohen's d effect sizes suggested small, positive relations between DE behaviors and self-reported broad negative EE (d = 0.40, p < 0.001), EE-depression (d = 0.41, p < 0.001), EE-anger/anxiety (d = 0.35, p < 0.001), and EE-boredom (d = 0.38, p < 0.001). A significant, but very small, positive relation was observed between DE behaviors and self-reported EE-positive (d = 0.08, p = 0.01). Subgroup analyses suggested a medium, positive relation between self-reported broad negative EE and binge eating (d = 0.53, p < 0.001) and a small, positive relation between self-reported broad negative EE and dietary restraint (d = 0.20, p < 0.001). Significant heterogeneity was identified across all models except for the EE-boredom and DE behaviors model. Higher BMI, but not age, clinical status, or type of DE behavior strengthened the positive relation between self-reported broad negative EE and DE behaviors. Findings support previous research suggesting that negative and positive EE are distinct constructs, with negatively valenced EE being more closely associated with DE behaviors, especially binge eating.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA.
| | - Maria Kalantzis
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Christina Gaggiano
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Abby L Braden
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
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Martinelli MK, Schreyer CC, Vanzhula IA, Guarda AS. Impulsivity and reward and punishment sensitivity among patients admitted to a specialized inpatient eating disorder treatment program. Front Psychiatry 2024; 15:1325252. [PMID: 38832324 PMCID: PMC11145411 DOI: 10.3389/fpsyt.2024.1325252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/23/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Eating disorders (EDs) are conceptualized as disorders of under- and over-control, with impulsivity reflecting under-control. Extant research indicates that impulsivity and related factors such as reward sensitivity and punishment sensitivity may serve as trait-level transdiagnostic risk and/or maintenance factors in EDs. Findings on impulsivity and reward and punishment sensitivity by diagnosis are mixed and research on the relationship between these factors and ED symptoms, hospital course, and treatment outcomes is limited. Methods Participants (N = 228) were patients admitted to a specialized inpatient behavioral treatment program for EDs who agreed to participate in a longitudinal study and completed self-report measures of impulsivity, reward sensitivity, and punishment sensitivity at admission. Weight and ED symptomatology were measured at admission and discharge. Hospital course variables included length of stay and premature treatment dropout. Results Impulsivity was lower in individuals with anorexia nervosa (AN) restricting type compared to those with AN binge/purge type or bulimia nervosa; no other group differences were observed. Higher impulsivity was associated with greater bulimic symptoms on the Eating Disorder Inventory 2 (EDI-2) at admission. Impulsivity was not related to ED symptoms, weight outcomes, length of hospital stay, or treatment dropout at program discharge. Conclusion Impulsivity may help distinguish restrictive versus binge/purge EDs, but does not necessarily relate to discharge outcomes in an intensive inpatient ED program. Findings from this study provide novel contributions to the literature on personality traits in EDs and have important clinical implications. Results suggest that patients with higher levels of impulsivity or reward and punishment sensitivity can be expected to respond to inpatient treatment. Suggestions for future research are discussed.
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Affiliation(s)
- Mary K. Martinelli
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Rösch SA, Schmidt R, Hilbert A. Predictors of neurofeedback treatment outcome in binge-eating disorder: An exploratory study. Int J Eat Disord 2023; 56:2283-2294. [PMID: 37737523 DOI: 10.1002/eat.24062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Knowledge on predictors for treatment response to psychotherapy in binge-eating disorder (BED) is mixed and not yet available for increasingly popular neurofeedback (NF) treatment targeting self-regulation of aberrant brain activity. This study examined eating disorder- and psychopathology-related predictors for NF treatment success in BED. METHOD Patients with BED (N = 78) were randomized to 12 sessions of real-time functional near-infrared spectroscopy (rtfNIRS)-NF, targeting individual prefrontal cortex signal up-regulation, electroencephalography (EEG)-NF, targeting down-regulation of fronto-central beta activity, or waitlist (WL). The few studies assessing predictors for clinical outcomes after NF and evidenced predictors for psychotherapy guided the selection of baseline eating disorder-related predictors, including objective binge-eating (OBE) frequency, eating disorder psychopathology (EDP), food cravings, and body mass index (BMI), and general psychopathology-related predictors, including depressive and anxiety symptoms, impulsivity, emotion dysregulation, and self-efficacy. These questionnaire-based or objectively assessed (BMI) predictors were regressed on outcomes OBE frequency and EDP as key features of BED at post-treatment (t1) and 6-month follow-up (t2) in preregistered generalized mixed models (https://osf.io/4aktp). RESULTS Higher EDP, food cravings, and BMI predicted worse outcomes across all groups at t1 and t2. General psychopathology-related predictors did not predict outcomes at t1 and t2. Explorative analyses indicated that lower OBE frequency and higher self-efficacy predicted lower OBE frequency, and lower EDP predicted lower EDP after the waiting period in WL. DISCUSSION Consistent with findings for psychotherapy, higher eating disorder-related predictors were associated with higher EDP and OBE frequency. The specificity of psychopathological predictors for NF treatment success warrants further examination. PUBLIC SIGNIFICANCE This exploratory study firstly assessed eating disorder- and psychopathology-related predictors for neurofeedback treatment outcome in binge-eating disorder and overweight. Findings showed an association between higher eating disorder symptoms and worse neurofeedback outcomes, indicating special needs to be considered in neurofeedback treatment for patients with a higher binge-eating disorder symptom burden. In general, outcomes and assignment to neurofeedback treatment may be improved upon consideration of baseline psychological variables.
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Affiliation(s)
- Sarah A Rösch
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
- International Max Planck Research School NeuroCom, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Leipzig University Medical Center, Leipzig, Germany
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Miskovic-Wheatley J, Bryant E, Ong SH, Vatter S, Le A, Touyz S, Maguire S. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disord 2023; 11:85. [PMID: 37254202 PMCID: PMC10228434 DOI: 10.1186/s40337-023-00801-3] [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: 02/28/2023] [Accepted: 05/05/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality. METHODS This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review. RESULTS Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates. CONCLUSION Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.
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Affiliation(s)
- Jane Miskovic-Wheatley
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Emma Bryant
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Shu Hwa Ong
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sabina Vatter
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Stephen Touyz
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- Faculty of Medicine and Health, InsideOut Institute for Eating Disorders, University of Sydney, Level 2, Charles Perkins Centre (D17), Sydney, NSW, 2006, Australia
- Sydney Local Health District, Sydney, Australia
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6
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Boswell RG, Gueorguieva R, Grilo CM. Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder. Psychol Med 2023; 53:2789-2797. [PMID: 34812713 PMCID: PMC9124732 DOI: 10.1017/s003329172100475x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. METHODS In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. RESULTS Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. CONCLUSIONS Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.
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Affiliation(s)
- Rebecca G Boswell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Princeton Center for Eating Disorders, Penn Medicine, Princeton, NJ, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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7
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Ahn J, Lee D, Lee JE, Jung YC. Orbitofrontal cortex functional connectivity changes in patients with binge eating disorder and bulimia nervosa. PLoS One 2022; 17:e0279577. [PMID: 36576922 PMCID: PMC9797068 DOI: 10.1371/journal.pone.0279577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
We aimed to define the shared and unshared functional neurobiological underpinnings of binge eating disorder (BED) and bulimia nervosa (BN). These disorders both involve loss of control over binge eating, but differ based on purging behavior and body image distortion. BED and BN have also been found to show differences in brain activation patterns in reward sensitivity. We enrolled 13 and 12 drug-naive and medication-free women with BED and BN, respectively, and 22 age- and sex-matched healthy controls. We performed an orbitofrontal cortex (OFC)-seeded resting-state whole brain functional connectivity (FC) analysis among the groups. In this study, BED patients exhibited significantly higher impulsivity than controls, whereas the difference in impulsivity between BN and controls was not significant. Participants with BED and BN showed weaker FC between the left lateral OFC and the right precuneus than controls. In the BED only group, the FC strength between these regions was negatively correlated with self-reported impulsivity. In both BED and BN, FC between the left lateral OFC and the right dorsolateral prefrontal cortex was weaker than that in controls. In BED, FC between the left medial OFC and the right cerebellar lobule IV was stronger than that of other groups. Our current results suggest similarities and differences between BED and BN in OFC-seeded FC with respect to reward processing. In particular, FC of the OFC in BED patients showed a significant correlation with their high impulsivity, which may reflect a decline in executive control over binge eating.
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Affiliation(s)
- Jaeun Ahn
- Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - DeokJong Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Jung Eun Lee
- Yonsei Empathy Psychiatric Clinic, Seoul, South Korea
| | - Young-Chul Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
- * E-mail:
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Barakat S, Maguire S. Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010119. [PMID: 36612445 PMCID: PMC9819826 DOI: 10.3390/ijerph20010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/30/2023]
Abstract
Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
- School of Psychology, University of Sydney, Camperdown 2050, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
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Castellini G, Cassioli E, Rossi E, Mancini M, Ricca V, Stanghellini G. Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders. Eat Weight Disord 2022; 27:2273-2289. [PMID: 35179727 PMCID: PMC9556383 DOI: 10.1007/s40519-022-01379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/17/2021] [Indexed: 10/29/2022] Open
Abstract
Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for "objective" (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons' lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive-behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since "being anorexic" becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Milena Mancini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Giovanni Stanghellini
- Department of Psychological Sciences, Health, Territory, G. d'Annunzio University of Chieti and Pescara, Chieti, Italy.,Centro de Estudios de Fenomenología y Psiquiatría, Diego Portales' University, Santiago, Chile
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Presseller EK, Wilkinson ML, Trainor C, Lampe EW, Juarascio AS. Self-regulation deficits moderate treatment outcomes in a clinical trial evaluating just-in-time adaptive interventions as an augmentation to cognitive-behavioral therapy for bulimia-spectrum eating disorders. Int J Eat Disord 2022; 55:709-716. [PMID: 35212017 PMCID: PMC9106913 DOI: 10.1002/eat.23695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022]
Abstract
Objective: Just-in-time adaptive interventions (JITAIs), momentary interventions delivered at identified times of risk, may improve skill utilization during cognitive-behavioral therapy (CBT-E) for bulimia-spectrum eating disorders (BN-EDs). JITAIs may be especially helpful for individuals with self-regulation deficits, including emotion regulation deficits and elevated impulsivity. Method: Participants (N = 55 with BN-EDs) received 16 sessions of CBT-E with electronic self-monitoring and were randomized to receive JITAIs (JITAIs-On) or not receive JITAIs (JITAIs-Off). Baseline Difficulties in Emotion Regulation Scale (DERS) and UPPS-P Impulsive Behavior Scale (UPPS-P) total scores were examined as moderators of baseline to post-treatment change in binge episodes, compensatory behaviors, and Eating Disorder Examination (EDE) global score using repeated measures ANOVAs. Results: Emotion regulation difficulties significantly moderated compensatory behavior change (F [1, 51] = 4.31, p = .04, ηp2 = 0.08) such that individuals with emotion regulation deficits demonstrated greater improvements in the JITAIs-On condition. Impulsivity moderated change in binge episodes (F [1, 51] = 8.94, p = .004, ηp2 = 0.15) and compensatory behaviors (F [1, 51] = 7.83, p = .007, ηp2 = 0.13), such that individuals with high impulsivity showed greater improvement in the JITAIs-On condition. Neither DERS nor UPPS-P scores moderated EDE global score change. Discussion: JITAIs appear particularly beneficial for facilitating skill use during treatment for BN-EDs for individuals with self-regulation deficits, yielding improved treatment outcomes. Public Significance Statement: Reminders to use therapy skills that are delivered via smartphone as an individual goes about their daily life may improve treatment response among individuals with bulimia nervosa who have difficulty coping with emotions or who tend to act impulsively. Results from this study indicate that individuals with these difficulties benefitted more from cognitive-behavioral therapy when it was accompanied by in-the-moment reminders to use therapeutic skills, which may facilitate long-term recovery. Clinical Trials.gov Registration Number: NCT03673540 .
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Affiliation(s)
- Emily K. Presseller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Megan L. Wilkinson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Claire Trainor
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth W. Lampe
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S. Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
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Comparing the effectiveness and predictors of cognitive behavioural therapy-enhanced between patients with various eating disorder diagnoses: a naturalistic study. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Cognitive behaviour therapy-enhanced (CBT-E) is an effective treatment for non-underweight patients with eating disorders. Its efficacy and effectiveness is investigated mostly among transdiagnostic samples and remains unknown for binge eating disorder. The aim of the present study was to assess several treatment outcome predictors and to compare effectiveness of CBT-E among adult out-patients with bulimia nervosa (n=370), binge eating disorder (n=113), and those with a restrictive food pattern diagnosed with other specified feeding and eating disorders (n=139). Effectiveness of CBT-E was assessed in routine clinical practice in a specialised eating disorders centre. Eating disorder pathology was measured with the EDEQ pre- and post-treatment, and at 20 weeks follow-up. Linear mixed model analyses with fixed effect were performed to compare treatment outcome among the eating disorder groups. Several predictors of treatment completion and outcome were examined with a regression analysis. No predictors for drop-out were found, except the diagnosis of bulimia nervosa. Eating disorder pathology decreased among all groups with effect sizes between 1.43 and 1.70 on the EDE-Q total score. There were no differences in remission rates between the three groups at end of treatment or at follow-up. Eating disorder severity at baseline affected treatment response. The results can be generalised to other specialised treatment centres. No subgroup of patients differentially benefited from CBT-E supporting the transdiagnostic perspective for the treatment of eating disorders. Longer-term follow-up data are necessary to measure persistence of treatment benefits.
Key learning aims
(1)
What is the effectiveness of CBT-E among patients suffering from binge eating disorder?
(2)
Does any subgroup of patients suffering from an eating disorder differentially benefit from CBT-E?
(3)
What factors predict treatment response?
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12
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Hartmann S, Pruessner L, Rubel JA, Lalk C, Barnow S, Timm C. Applying a web-based self-help intervention for bulimia nervosa in routine care: Study protocol for a randomized controlled trial. Internet Interv 2022; 28:100512. [PMID: 35251938 PMCID: PMC8894237 DOI: 10.1016/j.invent.2022.100512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Individuals with bulimia nervosa (BN) experience persistent episodes of binge eating and inappropriate compensatory behavior associated with impaired physical and mental health. Despite the existence of effective treatments, many individuals with BN remain untreated, leading to a high burden and an increased risk of chronicity. Web-based interventions may help facilitate access to evidence-based treatments for BN by reducing barriers to the health care system. METHODS The present study will investigate the effectiveness of a web-based self-help intervention for BN in a two-armed randomized controlled trial. Individuals diagnosed with BN (N = 152) will be randomly assigned to either (1) an intervention group receiving a 12-week web-based intervention or (2) a waitlist control group with delayed access to the intervention. Further assessments will be scheduled 6 (mid-treatment) and 12 (post-treatment) weeks after baseline. Changes in the number of binge eating episodes and compensatory behaviors will be examined as primary outcomes. Secondary outcomes include global eating pathology, functional impairments, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. DISCUSSION Adding web-based interventions into routine care is a promising approach to overcome the existing treatment gap for patients with BN. Therefore, the current study will test the effectiveness of a web-based intervention for BN under standard clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT04876196 (registered on May 6th, 2021).
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Affiliation(s)
- Steffen Hartmann
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Luise Pruessner
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Julian A. Rubel
- Psychotherapy Research Unit, University of Giessen, Otto-Behaghel-Straße 10, 35394 Giessen, Germany
| | - Christopher Lalk
- Psychotherapy Research Unit, University of Giessen, Otto-Behaghel-Straße 10, 35394 Giessen, Germany
| | - Sven Barnow
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Christina Timm
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
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13
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Wu YK, Brownley KA, Bardone-Cone AM, Bulik CM, Baker JH. Associations of Stress and Appetite Hormones with Binge Eating in Females with Anorexia Nervosa after Weight Restoration: A Longitudinal Study. J Pers Med 2021; 11:jpm11101020. [PMID: 34683161 PMCID: PMC8538976 DOI: 10.3390/jpm11101020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/29/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023] Open
Abstract
Binge eating is a transdiagnostic eating disorder symptom that can occur in patients with anorexia nervosa (AN), persisting after weight restoration, and impeding their recovery. However, little is known about the biological predictors of binge eating after AN weight restoration. The goals of this exploratory study of 73 females with AN were: (1) to examine changes in cortisol, the adrenocorticotropic hormone, norepinephrine, ghrelin (total and active), and leptin levels across the admission, discharge, and 3 months post-discharge from the inpatient AN weight restoration; and (2) to determine whether the target hormones were associated with objective or subjective binge eating (OBE or SBE). The participants completed the self-reported Eating Disorder Examination Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory-II, and provided fasting whole blood samples for hormone assays. The results showed significant changes in body mass index (BMI), cortisol, total ghrelin, and leptin levels over the three time points. The cortisol levels at admission and discharge were significantly associated with the number of SBE episodes at 3 months post-discharge. Findings suggest the need to replicate and confirm the role of cortisol in predicting the emergence of SBE and uncover the mechanisms underlying SBE and cortisol to prevent SBE and its negative consequences.
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Affiliation(s)
- Ya-Ke Wu
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
| | - Kimberly A. Brownley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Solna, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (K.A.B.); (C.M.B.)
- Correspondence: ; Tel.: +1-984-974-3834
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14
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Fumagalli G, Margola D. Is personality the key in cognitive-behavioural therapy for eating disorders? A review. Clin Psychol Psychother 2021; 29:164-177. [PMID: 34110647 DOI: 10.1002/cpp.2627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022]
Abstract
The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator). Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator. Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.
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Affiliation(s)
| | - Davide Margola
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
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15
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Reichenberger J, Schnepper R, Arend A, Richard A, Voderholzer U, Naab S, Blechert J. Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating. Int J Eat Disord 2021; 54:773-784. [PMID: 33656204 PMCID: PMC8252459 DOI: 10.1002/eat.23477] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison. METHOD Interview-diagnosed female ED patients (n = 204) with restrictive (AN-R) or binge-purge anorexia nervosa (AN-BP), bulimia nervosa (BN), or binge-eating disorder (BED) completed a questionnaire assessing "negative emotional eating" (sadness, anger, anxiety) and "happiness eating." ED groups were compared to BMI-matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound. RESULTS Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN-R reported the lowest degree of negative emotional eating relative to other EDs and BMI-matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI-matched HCs. Patients with AN-BP occupied an intermediate position between AN-R and BN/BED and reported less happiness eating compared to BMI-matched HCs. DISCUSSION Negative emotional and happiness eating patterns differ across EDs. BMI-independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN-BP and AN-R would need specific treatment modules.
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Affiliation(s)
- Julia Reichenberger
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | - Rebekka Schnepper
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | - Ann‐Kathrin Arend
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
| | | | - Ulrich Voderholzer
- Schoen Clinic RoseneckPrien am ChiemseeGermany
- Department of Psychiatry and PsychotherapyUniversity Hospital of the LMU MunichMunichGermany
- Department of Psychiatry and PsychotherapyUniversity Hospital FreiburgFreiburgGermany
| | - Silke Naab
- Schoen Clinic RoseneckPrien am ChiemseeGermany
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive NeuroscienceParis‐Lodron‐University of SalzburgSalzburgAustria
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16
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Fichter MM, Quadflieg N. How precisely can psychotherapists predict the long-term outcome of anorexia nervosa and bulimia nervosa at the end of inpatient treatment? Int J Eat Disord 2021; 54:535-544. [PMID: 33320351 DOI: 10.1002/eat.23443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the ability of psychotherapists to predict the future outcome for inpatients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD Psychotherapists rated the prognosis of the patient's eating disorder on a five point Likert scale on several dimensions at the end of inpatient treatment. Actual outcome was assessed about 10 years after treatment. The sample comprised 1,065 patients treated for AN, and 1,192 patients treated for BN. RESULTS Psychotherapists' rating of their patient's prognosis was not better than chance for good outcome in AN and BN and for poor outcome in BN. Prediction of poor outcome in AN was somewhat better with approximately two thirds of correct predictions. In logistic regression analysis, psychotherapists' rating of the patients' prognosis for AN contributed to the explained variance of long-term outcome, increasing the variance explained from 7% (by conventional predictors) to 8% after including psychotherapists' prognosis. In BN, there was no significant contribution of psychotherapists' prognosis to overall prediction. DISCUSSION Our current knowledge of risk and protective factors for the course of eating disorders is unsatisfying. More specialized research is urgently needed.
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Affiliation(s)
- Manfred M Fichter
- Ludwig-Maximilians-University (LMU), Munich, Department of Psychiatry and Psychotherapy, Munich, Germany.,Schoen Klinik Roseneck affiliated with the Medical Faculty of the University of Munich (LMU), Prien, Germany
| | - Norbert Quadflieg
- Ludwig-Maximilians-University (LMU), Munich, Department of Psychiatry and Psychotherapy, Munich, Germany
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17
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From the patients' perspective: what it is like to suffer from eating disorders. Eat Weight Disord 2021; 26:751-755. [PMID: 32440995 DOI: 10.1007/s40519-020-00913-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023] Open
Abstract
The available treatments of Eating Disorders (EDs) mirror an excessive focus on symptoms to be eliminated rather than on the acknowledgment of what is relevant from the patient's perspective. This Editorial offers a critical review of the limitations of the DSM-5-oriented approaches, as well as of their extreme consequences, namely ocularcentrism, nosographism, and paternalistic moralism. To overcome these limitations, it is suggested to get back to Psychopathology as the basic science of psychiatric practice whose aim is to grasp the distinctly personal dimension of the patient's experience and to connect understanding with care. With the help of Psychopathology, clinicians engaged in the treatment of ED patients will better make sense of what it is like to suffer from these disorders and be encouraged to suspend their judgment and take patient's perspective in the light of their troubled existence which is rich in meanings and not merely in abnormal beliefs and trivial anomalous behavior. According to these principles, treatment is a journey shared with the patient, which allows her/him to feel recognized and accepted in terms of her/his individuality.
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18
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Dingemans AE, van Son GE, Vanhaelen CB, van Furth EF. Depressive symptoms rather than executive functioning predict group cognitive behavioural therapy outcome in binge eating disorder. EUROPEAN EATING DISORDERS REVIEW 2020; 28:620-632. [PMID: 32692421 PMCID: PMC7689843 DOI: 10.1002/erv.2768] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 12/15/2022]
Abstract
Executive functions play an important role in mediating self-control and self-regulation. It has been suggested that the inability to control eating in Binge Eating Disorder (BED) may indicate inefficiencies in executive functioning. This study investigated whether executive functioning predicted cognitive behavioural therapy outcome in BED while accounting for other possible predictors: depressive symptoms, interpersonal factors, eating disorder psychopathology, and self-esteem. Executive functioning and other predictors were assessed in 91 patients with BED by means of neuropsychological tests and questionnaires at baseline. Eating disorder (ED) symptoms were assessed during treatment at variable time points. Potential predictor variables were investigated using multivariate Cox regression models. Recovery was defined by means of two different indicators based on the Eating Disorder Examination-Questionnaire: (a) showing a 50% reduction in baseline symptom ED severity and/or reaching the clinical significance cut-off; and (b) achieving abstinence of objective binge eating. Severity of depressive symptoms was a significant predictor for outcome on both indicators. Patients with no or mild depressive symptoms recovered faster (i.e., 50% reduction in ED symptoms and abstinence of objective binge eating) than those with severe depressive symptoms, which is in line with previous studies. Executive functioning was not related to treatment outcome in this study.
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Affiliation(s)
- Alexandra E. Dingemans
- Rivierduinen Eating Disorders UrsulaLeidenThe Netherlands
- Institute of PsychologyLeiden UniversityLeidenThe Netherlands
| | | | | | - Eric F. van Furth
- Rivierduinen Eating Disorders UrsulaLeidenThe Netherlands
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
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19
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Schulte EM, Wadden TA, Allison KC. An evaluation of food addiction as a distinct psychiatric disorder. Int J Eat Disord 2020; 53:1610-1622. [PMID: 32725769 DOI: 10.1002/eat.23350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the state of the literature for whether food addiction may warrant consideration as a distinct psychiatric disorder in the Diagnostic and Statistical Manual (DSM) using Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) five criteria. This framework was utilized because it has recently been applied to examine the diagnostic utility of several eating disorder phenotypes. The criteria are: (a) at least 50 journal articles published on the proposed syndrome in the past 10 years; (b) proposal of diagnostic criteria and assessment measures; (c) clinician reliability in diagnosis; (d) cohesiveness of the proposed diagnostic criteria; and (e) differentiation from similar, existing diagnostic categories. METHOD For each criterion, a literature review was conducted to examine if the minimum qualification had been met, and key findings were discussed. RESULTS Two of the criteria (literature and differentiation) have been empirically supported to extent specified. Two criteria (diagnostic criteria and syndrome) have been partially fulfilled, due to only having self-report assessment measures and no examination of the odds ratios for meeting more than one symptom, respectively. Clinician reliability has not yet been evaluated. DISCUSSION The existing literature suggests that food addiction may warrant consideration as a proposed diagnostic category in the DSM, though future research is needed to fulfill Blashfield et al.'s (1990; Comprehensive Psychiatry, 31(1), 15-19) criteria. The development of a semi-structured interview would be an impactful contribution for addressing these gaps.
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Affiliation(s)
- Erica M Schulte
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kelly C Allison
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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20
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Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int J Eat Disord 2020; 53:1353-1376. [PMID: 32583527 DOI: 10.1002/eat.23297] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes. METHOD Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling. RESULTS Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely. DISCUSSION This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Reinhard Pietrowsky
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Silja Vocks
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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21
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Atwood ME, Friedman A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. Int J Eat Disord 2020; 53:311-330. [PMID: 31840285 DOI: 10.1002/eat.23206] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To review the literature examining the efficacy and effectiveness of enhanced cognitive behavioral therapy (CBT-E) for adults and older adolescents with eating disorders. METHOD A systematic search of the literature (using PsycINFO and PubMed) was conducted in order to identify relevant publications (randomized controlled trials [RCTs] and uncontrolled trials) up to June 2019. Effect sizes were reported for outcomes including treatment attrition and remission rates, eating disorder behaviors, body mass index (BMI), and core eating disorder psychopathology. The Downs and Black checklist was used to assess the quality of included studies. RESULTS Twenty studies (10 RCTs and 10 uncontrolled trials) met criteria for inclusion. Support was found for the efficacy and effectiveness of CBT-E for the full spectrum of eating disorders, with respect to reducing eating disorder behaviors and core psychopathology. BMI also increased, with large effects, for individuals with AN. However, the majority of the randomized trials included in this review did not demonstrate superiority of CBT-E over comparison treatments, particularly in the longer-term. Furthermore, rates of attrition and remission for CBT-E among individuals without AN did not appear to differ from rates for CBT-BN. DISCUSSION There is evidence to support CBT-E as an efficacious and effective treatment for adults and older adolescents with a range of eating disorder diagnoses. Future research would benefit from directly comparing CBT-E to CBT-BN, expanding measured outcomes to include driven exercise and subjective binge eating, increasing consistency in the definition and measurement of outcomes, and exploring factors associated with treatment retention.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Aliza Friedman
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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22
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Serra R, Kiekens G, Tarsitani L, Vrieze E, Bruffaerts R, Loriedo C, An A, Vanderlinden J. The effect of trauma and dissociation on the outcome of cognitive behavioural therapy for binge eating disorder: A 6-month prospective study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:309-317. [PMID: 32080958 DOI: 10.1002/erv.2722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is commonly associated with a history of trauma. Yet, there is little insight into the potential effect that trauma, dissociation, and depressive symptoms may have on the outcome of treatment interventions. METHODS A total of 142 treatment-seeking patients admitted with a diagnosis of DSM-5 BED (88% female; mean age = 38.7; SD = 10.8) took part in a 6-month, protocolized, group cognitive behavioural therapy (CBT). Self-report questionnaires were administered to assess lifetime traumatic experiences, dissociation, and depression. Body mass index and the number of binges per week (BPW) were measured throughout treatment. The main outcomes were the percentage reduction in BPW and remission (i.e., less than one BPW; cf. DSM-5). RESULTS Most BED patients (91.5%) reported a history of trauma, with two in three patients reporting three or more traumatic experiences. Whereas the number of traumatic experiences was not significantly associated with a reduction in BPW or remission, a higher traumatic impact score significantly decreased the likelihood of obtaining remission at the end of treatment (OR = 0.96; 95% CI [0.92, 0.99]). Higher levels of dissociative symptoms partially mediated this prospective association. CONCLUSIONS The impact of traumatic experiences, as opposed to the number of traumatic experiences experienced, negatively predicts remission after 6 months of CBT. These findings highlight the importance of addressing trauma and dissociative features in the CBT treatment of BED.
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Affiliation(s)
- Riccardo Serra
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy.,Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium
| | - Glenn Kiekens
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Lorenzo Tarsitani
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | - Elske Vrieze
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Ronny Bruffaerts
- Research Group Psychiatry, Department of Neurosciences, KU Leuven University, Leuven, Belgium.,Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium
| | - Camillo Loriedo
- Department of Human Neurosciences and Mental Health, Sapienza University of Rome, Rome, Italy
| | | | - Johan Vanderlinden
- Universitair Psychiatrisch Centrum, KU Leuven University, Leuven, Belgium.,Faculty of Psychology and Educational Sciences, KU Leuven University, Leuven, Belgium
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23
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Quadflieg N, Fichter MM. Long-term outcome of inpatients with bulimia nervosa-Results from the Christina Barz Study. Int J Eat Disord 2019; 52:834-845. [PMID: 31002430 DOI: 10.1002/eat.23084] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the long-term outcome and identify outcome predictors in a very large sample of inpatients treated for bulimia nervosa (BN). METHOD Out of a total of 2,033 patients admitted consecutively to specialized treatment, 1,351 patients (mean age at treatment 25.94) were assessed for follow-up on average 11 (SD 6) years after admission. Also a very long-term (21 years) subsample (N = 147; mean age 25.92) was defined. Bivariate and logistic regression analyses identified predictors of poor outcome. RESULTS For more than 70% of the patients follow-up information could be gathered. Severity of eating disorder (ED) and other symptoms decreased over time but remained higher than in healthy controls, using published normative data. Remission rate was 38% after 11 years and 42% in the subsample after 21 years. Out of the total sample of N = 2,033 patients, 49 had died (2.4%). Persistent BN was found in 14.2% and the most frequent crossover was to ED not otherwise specified. Predictors of poor outcome were fewer follow-up years, higher drive for thinness, higher age at treatment, and less global functioning. DISCUSSION Based on clinical indicators, patients presented with a high level of ED and psychiatric symptomatology. With less than half of the patients remitted after 22 years, efforts are needed to improve treatment outcome.
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Affiliation(s)
- Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
| | - Manfred M Fichter
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany.,Schön Klinik Roseneck affiliated with the Medical Faculty of the University of Munich(LMU), Prien, Germany
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24
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Hayes NA, Welty LJ, Slesinger N, Washburn JJ. Moderators of treatment outcomes in a partial hospitalization and intensive outpatient program for eating disorders. Eat Disord 2019; 27:305-320. [PMID: 30204570 DOI: 10.1080/10640266.2018.1512302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eating disorders cause a number of severely impairing symptoms that may require more intensive intervention that is available through outpatient therapy services. The PHP/IOP level of care may be an effective mode of treatment in these cases, but few studies have examined overall outcomes or treatment moderators for this level of care. Using a large sample from a PHP/IOP specifically designed for the treatment of eating disorders, the current study examines a variety of symptoms (eating disorder severity, quality of life, depression, etc.) from admission to discharge, as well as potential moderators of treatment, including demographic and clinical factors. Overall, the PHP/IOP level of care was found to improve treatment outcomes. Age, race, gender, and depression were found to moderate the change in quality of life and functional impairment. Additionally, patients diagnosed with anorexia nervosa had significantly lowered quality of life and greater eating disorder symptomatology than all other diagnoses. The results of this study can help to inform clinical practice and help guide in treatment decisions at the partial hospitalization level of care.
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Affiliation(s)
- Nicole A Hayes
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Leah J Welty
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,b Department of Preventative Medicine, Division of Biostatistics , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Noel Slesinger
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA
| | - Jason J Washburn
- a Department of Psychiatry and Behavioral Sciences , Northwestern University, Feinberg School of Medicine , IL , Chicago , USA.,c Center for Evidence-Based Practice , AMITA Health Behavioral Medicine, Hoffman Estates , IL , USA
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25
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Li N, Mitchison D, Touyz S, Hay P. Cross-sectional comparison of health-related quality of life and other features in people with and without objective and subjective binge eating using a general population sample. BMJ Open 2019; 9:e024227. [PMID: 30787086 PMCID: PMC6398903 DOI: 10.1136/bmjopen-2018-024227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Evidence suggests that while objective binge eating (OBE) and subjective binge eating (SBE) differ in the amount of food consumed, both are associated with impairment in people with eating disorders. However, only OBE is accounted for in the diagnostic criteria of eating disorders. This study compared the sociodemographic profile and burden of OBE versus SBE at a population level. DESIGN Population-based survey. PARTICIPANTS A representative sample of 3028 men and women. Participants were categorised into four groups based on their reporting of binge eating in the past 3 months: non-binge eating group (no OBE or SBE), OBE group, SBE group and OSBE group (both OBE and SBE). OUTCOME MEASURES Demographics (age, genderand body mass index, BMI), binge eating, distress, weight/shape overvaluation and health-related quality of life. Groups were compared on sociodemographic information, overvaluation and health-related quality of life. The OBE and SBE groups were also compared on the distress related to binge eating. RESULTS No differences were found between the SBE group and OBE group in age, gender, BMI, mental health-related quality of life and overvaluation (all p>0.05). However, differences were found in the OSBE participants, namely that they were younger, had a higher mean BMI, lower mental health-related quality of life and higher overvaluation of weight/shape than the non-binge-eating participants (all p<0.001). Proportions of participants who reported distress related to binge eating in the OBE and SBE groups also did not differ (p=0.678). CONCLUSION There is little difference in the demographic profile or burden of people who engage in OBE versus SBE, supporting the proposed inclusion of SBE in the diagnostic criteria for eating disorders in International Classification of Diseases-11. People who experience both OBE and SBE may experience a relatively higher eating disorder severity and impairment.
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Affiliation(s)
- Natalie Li
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Deborah Mitchison
- Psychology Department, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Touyz
- Clinical Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillipa Hay
- Translational Health Research Institure, School of Medicine, Western Sydney, Penrith, New South Wales, Australia
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26
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Preuss H, Pinnow M, Schnicker K, Legenbauer T. Improving Inhibitory Control Abilities (ImpulsE)-A Promising Approach to Treat Impulsive Eating? EUROPEAN EATING DISORDERS REVIEW 2017; 25:533-543. [DOI: 10.1002/erv.2544] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 07/24/2017] [Accepted: 08/09/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Hanna Preuss
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center; Johannes Gutenberg University Mainz; Germany
| | - Marlies Pinnow
- Motivation Lab, Institute of Cognitive Neurosciences; Ruhr-University Bochum; Germany
| | - Katja Schnicker
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
| | - Tanja Legenbauer
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology; Johannes Gutenberg University Mainz; Germany
- Department of Research and Diagnostics, Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine; LWL-University Hospital; Germany
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27
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Agüera Z, Sánchez I, Granero R, Riesco N, Steward T, Martín-Romera V, Jiménez-Murcia S, Romero X, Caroleo M, Segura-García C, Menchon JM, Fernández-Aranda F. Short-Term Treatment Outcomes and Dropout Risk in Men and Women with Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2017; 25:293-301. [PMID: 28474473 DOI: 10.1002/erv.2519] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/17/2017] [Accepted: 03/20/2017] [Indexed: 12/20/2022]
Abstract
This study compared treatment outcomes between men and women with eating disorders (EDs) and analysed clinical predictors of treatment outcome. Our sample consisted of 131 male and 131 female ED patients who underwent cognitive behavioural therapy treatment. ED severity, personality and psychopathology were assessed using standard instruments. We found that the risk of dropout was higher for men with bulimia nervosa (BN) than for women with BN and that men with BN and other specified feeding and EDs were more likely to obtain full remission in comparison with their female counterparts. Predictive models of treatment outcome indicated that higher scores in novelty seeking were a shared factor associated with higher risk of dropout and not obtaining full remission for both men and women with ED. However, only in men, younger age and lower scores in reward dependence predicted higher dropout. Contrastingly, higher persistence scores were predictors of full remission. This study reinforces the effectiveness of using outpatient cognitive behavioural therapy as treatment as usual for men with ED. Nonetheless, placing greater emphasis on strategies targeting gender-specific issues could enhance outcomes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Zaida Agüera
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Trevor Steward
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Virginia Martín-Romera
- Departament de Psicologia Clínica i Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Xandra Romero
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain
| | - Mariarita Caroleo
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Cristina Segura-García
- Department of Health Sciences, University Magna Graecia, Catanzaro, Italy.,Ambulatory for Clinical Research and Treatment of Eating Disorders, University Hospital Mater Domini, Catanzaro, Italy
| | - José Manuel Menchon
- Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- CIBER Fisiología de la Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge - IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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28
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Goldschmidt AB. Are loss of control while eating and overeating valid constructs? A critical review of the literature. Obes Rev 2017; 18:412-449. [PMID: 28165655 PMCID: PMC5502406 DOI: 10.1111/obr.12491] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Binge eating is a marker of weight gain and obesity, and a hallmark feature of eating disorders. Yet its component constructs - overeating and loss of control (LOC) while eating - are poorly understood and difficult to measure. OBJECTIVE The objective of this study is to critically review the human literature concerning the validity of LOC and overeating across the age and weight spectrum. DATA SOURCES English-language articles addressing the face, convergent, discriminant and predictive validity of LOC and overeating were included. RESULTS Loss of control and overeating appear to have adequate face validity. Emerging evidence supports the convergent and predictive validity of the LOC construct, given its unique cross-sectional and prospective associations with numerous anthropometric, psychosocial and eating behaviour-related factors. Overeating may be best conceptualized as a marker of excess weight status. LIMITATIONS Binge eating constructs, particularly in the context of subjectively large episodes, are challenging to measure reliably. Few studies addressed overeating in the absence of LOC, thereby limiting conclusions about the validity of the overeating construct independent of LOC. Additional studies addressing the discriminant validity of both constructs are warranted. DISCUSSION Suggestions for future weight-related research and for appropriately defining binge eating in the eating disorders diagnostic scheme are presented.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
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29
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Castellini G, Franzago M, Bagnoli S, Lelli L, Balsamo M, Mancini M, Nacmias B, Ricca V, Sorbi S, Antonucci I, Stuppia L, Stanghellini G. Fat mass and obesity-associated gene (FTO) is associated to eating disorders susceptibility and moderates the expression of psychopathological traits. PLoS One 2017; 12:e0173560. [PMID: 28282466 PMCID: PMC5345831 DOI: 10.1371/journal.pone.0173560] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/23/2017] [Indexed: 01/30/2023] Open
Abstract
Eating Disorders (EDs) show a multifactorial etiopathogenesis including environmental, psychological and biological factors. In the present study, we propose a model of interactions between genetic vulnerability-represented by Fat Mass and Obesity-Associated (FTO) gene-and stable psychopathological traits, such as bodily disorders and emotion dysregulation for EDs patients. The distribution of a polymorphism of the FTO (rs9939609 T>A) was evaluated in a series of 250 EDs patients and in a group of 119 healthy control subjects. Clinical data were collected through a face-to-face interview and several self-reported questionnaires were applied, including the Emotional Eating Scale and the IDentity and EAting disorders (IDEA) questionnaire for bodily disorders and self-identity. The A-allele was associated with an increased vulnerability to EDs (AA+AT genotypes frequency 72.8% in EDs vs. 52.9% in controls). The presence of the A-allele was associated with binge eating behavior, higher emotional eating and higher IDEA scores. Finally, the FTO rs9939609 SNP was found to influence the relationship between these variables, as an association between disorder of corporeality and emotional eating was found only in A-allele carriers. A-allele seems to represent a potential additive risk factor for EDs persons, with bodily disorders to develop emotional eating and binge eating behaviors.
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Affiliation(s)
- Giovanni Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences. University of Florence, Florence, Italy
| | - Marica Franzago
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
| | - Lorenzo Lelli
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
| | - Michela Balsamo
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
| | - Milena Mancini
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
| | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health. University of Florence, Florence, Italy
| | - Ivana Antonucci
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
| | - Giovanni Stanghellini
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio University” Chieti-Pescara, Chieti, Italy
- D. Portales’ University, Santiago, Chile
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30
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Linardon J, de la Piedad Garcia X, Brennan L. Predictors, Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive-Behavioural Therapy for Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2016; 25:3-12. [DOI: 10.1002/erv.2492] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
| | | | - Leah Brennan
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
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31
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Dingemans AE, van Son GE, Aardoom JJ, Bruidegom K, Slof-Op 't Landt MCT, van Furth EF. Predictors of psychological outcome in patients with eating disorders: A routine outcome monitoring study. Int J Eat Disord 2016; 49:863-73. [PMID: 27177503 DOI: 10.1002/eat.22560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder. METHOD The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models. RESULTS Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes. DISCUSSION Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:863-873).
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Affiliation(s)
| | | | - Jiska J Aardoom
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | - Kiki Bruidegom
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | | | - Eric F van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands
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32
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Goldschmidt AB, Accurso EC, Crosby RD, Cao L, Ellison J, Smith TL, Klein MH, Mitchell JE, Crow SJ, Wonderlich SA, Peterson CB. Association between objective and subjective binge eating and psychopathology during a psychological treatment trial for bulimic symptoms. Appetite 2016; 107:471-477. [PMID: 27554184 DOI: 10.1016/j.appet.2016.08.104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
Although loss of control (LOC) while eating is a core construct of bulimia nervosa (BN), questions remain regarding its validity and prognostic significance independent of overeating. We examined trajectories of objective and subjective binge eating (OBE and SBE, respectively; i.e., LOC eating episodes involving an objectively or subjectively large amount of food) among adults participating in psychological treatments for BN-spectrum disorders (n = 80). We also explored whether changes in the frequency of these eating episodes differentially predicted changes in eating-related and general psychopathology and, conversely, whether changes in eating-related and general psychopathology predicted differential changes in the frequency of these eating episodes. Linear mixed models with repeated measures revealed that OBE decreased twice as rapidly as SBE throughout treatment and 4-month follow-up. Generalized linear models revealed that baseline to end-of-treatment reductions in SBE frequency predicted baseline to 4-month follow-up changes in eating-related psychopathology, depression, and anxiety, while changes in OBE frequency were not predictive of psychopathology at 4-month follow-up. Zero-inflation models indicated that baseline to end-of-treatment changes in eating-related psychopathology and depression symptoms predicted baseline to 4-month follow-up changes in OBE frequency, while changes in anxiety and self-esteem did not. Baseline to end-of-treatment changes in eating-related psychopathology, self-esteem, and anxiety predicted baseline to 4-month follow-up changes in SBE frequency, while baseline to end-of-treatment changes in depression did not. Based on these findings, LOC accompanied by objective overeating may reflect distress at having consumed an objectively large amount of food, whereas LOC accompanied by subjective overeating may reflect more generalized distress related to one's eating- and mood-related psychopathology. BN treatments should comprehensively target LOC eating and related psychopathology, particularly in the context of subjectively large episodes, to improve global outcomes.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA.
| | - Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Ross D Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Jo Ellison
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Tracey L Smith
- VA South Central Mental Illness Research, Education & Clinical Center, VA HSR&D Center for Innovations in Quality, Effectiveness & Safety (IQuEST), Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - James E Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA; The Emily Program, St. Paul, MN, USA
| | - Stephen A Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA; Department of Clinical Neuroscience, The University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA
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33
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Manasse SM, Espel HM, Schumacher LM, Kerrigan SG, Zhang F, Forman EM, Juarascio AS. Does impulsivity predict outcome in treatment for binge eating disorder? A multimodal investigation. Appetite 2016; 105:172-9. [PMID: 27230611 DOI: 10.1016/j.appet.2016.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 01/20/2023]
Abstract
Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition - both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related predictors of 20-week outcome in a small open trial (n = 17) of a novel treatment for binge eating disorder. Overall, dimensions of impulsivity related to emotions (i.e., negative urgency) and food cues emerged as predictors of treatment outcomes (i.e., binge eating frequency and global eating pathology as measured by the Eating Disorders Examination), while more general measures of impulsivity were statistically unrelated to global eating pathology or binge frequency. Specifically, those with higher levels of negative urgency at baseline experienced slower and less pronounced benefit from treatment, and those with higher food-specific impulsivity had more severe global eating pathology at baseline that was consistent at post-treatment and follow-up. These preliminary findings suggest that patients high in negative urgency and with poor response inhibition to food cues may benefit from augmentation of existing treatments to achieve optimal outcomes. Future research will benefit from replication with a larger sample, parsing out the role of different dimensions of impulsivity in treatment outcome for eating disorders, and identifying how treatment can be improved to accommodate higher levels of baseline impulsivity.
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Affiliation(s)
| | - Hallie M Espel
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | | | | | - Fengqing Zhang
- Drexel University, Department of Psychology, Philadelphia, PA, USA
| | - Evan M Forman
- Drexel University, Department of Psychology, Philadelphia, PA, USA
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34
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Giner-Bartolomé C, Steward T, Wolz I, Jiménez-Murcia S, Granero R, Tárrega S, Fernández-Formoso JA, Soriano-Mas C, Menchón JM, Fernández-Aranda F. The Influence of Personality Traits on Emotion Expression in Bulimic Spectrum Disorders: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2016; 24:320-8. [DOI: 10.1002/erv.2446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Cristina Giner-Bartolomé
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
| | - Trevor Steward
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
| | - Ines Wolz
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
- Clinical Sciences Department; School of Medicine, University of Barcelona; Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
- Department of Psychobiology and Methodology; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Salomé Tárrega
- Department of Psychobiology and Methodology; Universitat Autònoma de Barcelona; Barcelona Spain
| | | | - Carles Soriano-Mas
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Department of Psychobiology and Methodology; Universitat Autònoma de Barcelona; Barcelona Spain
- CIBER Salud Mental (CIBERSAM); Instituto de Salud Carlos III; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Clinical Sciences Department; School of Medicine, University of Barcelona; Spain
- CIBER Salud Mental (CIBERSAM); Instituto de Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn); Instituto de Salud Carlos III, Barcelona; Spain
- Clinical Sciences Department; School of Medicine, University of Barcelona; Spain
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Palavras MA, Hay PJ, Lujic S, Claudino AM. Comparing symptomatic and functional outcomes over 5 years in two nonclinical cohorts characterized by binge eating with and without objectively large episodes. Int J Eat Disord 2015; 48:1158-65. [PMID: 26414868 DOI: 10.1002/eat.22466] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 08/27/2015] [Accepted: 08/30/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim was to compare symptomatic and functional outcomes over 5 years in women with regular subjective (SBEs), objective (OBEs), and no regular binge eating episodes. METHOD Data were derived from two cohorts of 330 women with high levels of eating disorders symptoms followed over 5 years. Three groups were formed: (a) regular SBEs but no regular OBEs (N = 68), (b) regular OBEs with or without regular SBEs (N = 154), and (c) with no regular binge eating episodes (N = 108). RESULTS At baseline, the groups did not differ significantly in restraint scores and quality of life. People in the OBE group scored higher than those in the SBE group in body mass index (BMI). Those who had no regular binge eating had lower global Eating Disorder Examination Questionnaire (EDE-Q) and weight and shape concern scores than those with regular SBEs, and lower eating concern scores than either binge eating groups. Across the follow-up, there were no significant effects of being in either binge eating or the nonbinge eating group on the rates of change in BMI, general psychological distress, quality of life, or EDE-Q scores with the exception that OBE group had a significantly different rate of change in eating concern and psychological distress compared to the group without regular binge eating. DISCUSSION Individuals that report regular SBEs without regular OBEs represent a group with similar mental hardship and outcomes to those with regular OBEs. The findings support inclusion of regular SBEs in criteria for eating disorder diagnostic categories characterized by recurrent binge eating.
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Affiliation(s)
- Marly A Palavras
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.,Ministry of Education (CAPES) Foundation, São Paulo, Brazil.,School of Medicine, Western Sydney University, Sydney, Australia
| | - Phillipa J Hay
- School of Medicine, Western Sydney University, Sydney, Australia.,Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.,School of Medicine, James Cook University, Sydney, Australia
| | - Sanja Lujic
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia.,Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Angélica M Claudino
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Amianto F, Ercole R, Abbate Daga G, Fassino S. Exploring Parental Bonding in BED and Non-BED Obesity Compared with Healthy Controls: Clinical, Personality and Psychopathology Correlates. EUROPEAN EATING DISORDERS REVIEW 2015; 24:187-96. [DOI: 10.1002/erv.2419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 09/25/2015] [Accepted: 10/26/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Federico Amianto
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Roberta Ercole
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Giovanni Abbate Daga
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
| | - Secondo Fassino
- Neurosciences Department of University of Torino, Psychiatry Section, Regional Pilot Centre for Eating Disorders; Italy
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Giner-Bartolomé C, Fagundo AB, Sánchez I, Jiménez-Murcia S, Santamaría JJ, Ladouceur R, Menchón JM, Fernández-Aranda F. Can an intervention based on a serious videogame prior to cognitive behavioral therapy be helpful in bulimia nervosa? A clinical case study. Front Psychol 2015; 6:982. [PMID: 26236261 PMCID: PMC4500862 DOI: 10.3389/fpsyg.2015.00982] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several studies have highlighted the implications of impulsivity and novelty seeking for both the maintenance and the process of recovery from bulimia nervosa (BN). Cognitive behavioral therapy (CBT) is the treatment of choice for BN, but for some cases, this treatment alone might not be sufficient for reducing the high levels of impulsivity. The paper presents a case report of a patient with BN, examining the effectiveness of using a videogame (VG; Playmancer) as an additional intervention designed to address impulsivity. DESIGN Psychometric and neuropsychological measures were collected at baseline. After this assessment, Playmancer was applied prior to CBT, following an "A-B-A-C-A" single case experimental design. Impulsivity levels were assessed with the Conner's Continuous Performance Test II (CPT-II). After the Playmancer treatment, the patient started CBT, and the levels of impulsivity were recorded again. Finally, psychometric and neuropsychological measures were collected after treatment. Weekly frequency of binges and vomiting were also recorded during the entire procedure. RESULTS After the VG intervention, psychometric measures such as anxiety levels, impulsivity and novelty seeking decreased. Regarding the neuropsychological measures, impulsivity levels (measured with the CPT-II) progressively decreased throughout the intervention, and an improvement in decision making capacities was observed. Furthermore, the frequency of binges also decreased during and after the VG intervention. DISCUSSION This case report suggests that using the Playmancer VG to reduce impulsivity prior to CBT may enhance the final results of the treatment for BN.
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Affiliation(s)
- Cristina Giner-Bartolomé
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
| | - Juan J Santamaría
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain
| | | | - José M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain ; Ciber Salud Mental, Instituto de Salud Carlos III , Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL , Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición, Instituto de Salud Carlos III , Barcelona, Spain ; Clinical Sciences Department, School of Medicine, University of Barcelona , Barcelona, Spain
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Castellini G, Stanghellini G, Godini L, Lucchese M, Trisolini F, Ricca V. Abnormal Bodily Experiences Mediate the Relationship between Impulsivity and Binge Eating in Overweight Subjects Seeking Bariatric Surgery. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 84:124-126. [PMID: 25720444 DOI: 10.1159/000365765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/04/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Florence, Italy
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Leombruni P, Rocca G, Fassino S, Gastaldi F, Nicotra B, Siccardi S, Lavagnino L. An exploratory study to subtype obese binge eaters by personality traits. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:114-8. [PMID: 24458141 DOI: 10.1159/000356810] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 10/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Obesity and binge eating disorder (BED) are prevalent conditions that severely affect the quality of life of many people in developed countries, but an effective treatment remains elusive. Personality traits have been studied extensively in this population, leading to different, and at times conflicting, results. Subtyping BED people along these features could add to our knowledge of the disorder. METHODS We applied a two-step cluster analysis, followed by bootstrapping validation, to the Temperament and Character Inventory scores of 462 subjects affected by obesity and BED or subthreshold BED. RESULTS We found two clusters of subjects; however, the categorization in clusters 1 and 2 did not appear to strictly overlap with the distinction between BED and subthreshold BED. The first cluster showed higher harm avoidance and a lower self-directedness. Cluster 1 patients had higher depression, higher eating impulsivity, greater problems with their body image and poorer quality of life than cluster 2 patients. CONCLUSIONS Our results seem to confirm the heterogeneity of the binge eater population and suggest the importance of harm avoidance and self-directedness to subtype these subjects. These results could generate exploratory works regarding personality in obese people with BED to discover more targeted treatments.
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Affiliation(s)
- Paolo Leombruni
- 'Rita Levi Montalcini' Neuroscience Department, University of Turin, Turin, Italy
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Dingemans AE, Danner UN, Donker JM, Aardoom JJ, van Meer F, Tobias K, van Elburg AA, van Furth EF. The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:29-36. [PMID: 24281361 DOI: 10.1159/000355240] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 08/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse. Deficits in cognitive flexibility, i.e., set-shifting and central coherence, might perpetuate the symptoms. Cognitive remediation therapy (CRT) was developed to improve cognitive flexibility, thereby increasing the likelihood of improved outcome. The focus of CRT is on how patients think, rather than on what patients think. The present study investigated the effectiveness of CRT for patients with a severe or enduring eating disorder by means of a randomized controlled trial comparing intensive treatment as usual (TAU) to CRT plus TAU. METHODS Eighty-two patients were randomly assigned to CRT plus TAU (n = 41) or TAU alone (n = 41). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology, motivation, quality of life and self-esteem. Assessments were performed at baseline (n = 82) and after 6 weeks (T1; n = 75) and 6 months (T2; n = 67). Data were analyzed by means of linear mixed model analyses. RESULTS Patients who received CRT in addition to TAU improved significantly more with regard to eating disorder-related quality of life at the end of treatment (T1) and eating disorder psychopathology at follow-up (T2), compared to those who received TAU only. Moreover, moderator analyses revealed that patients with poor baseline set-shifting abilities benefited more from CRT than patients with no deficits in set-shifting abilities at baseline; the quality of life of the former group was higher than that of the latter at follow-up. CONCLUSIONS CRT seems to be promising in enhancing the effectiveness of concurrent treatment.
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Fischer S, Meyer AH, Dremmel D, Schlup B, Munsch S. Short-term Cognitive-Behavioral Therapy for Binge Eating Disorder: Long-term efficacy and predictors of long-term treatment success. Behav Res Ther 2014; 58:36-42. [DOI: 10.1016/j.brat.2014.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/25/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Castellini G, Godini L, Amedei SG, Faravelli C, Lucchese M, Ricca V. Psychological effects and outcome predictors of three bariatric surgery interventions: a 1-year follow-up study. Eat Weight Disord 2014; 19:217-24. [PMID: 24737175 DOI: 10.1007/s40519-014-0123-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Weight loss surgery efficacy has been demonstrated for morbid obesity. Different outcomes have been hypothesized, according to specific bariatric surgery interventions and psychological characteristics of obese patients. The present study compared three different surgery procedures, namely laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD), in terms of weight loss efficacy and psychological outcomes. METHODS Eighty-three subjects seeking bariatric surgery have been evaluated before and 12 months after surgery intervention, by means of a clinical interview and different self-reported questionnaires, including Eating Disorder Examination Questionnaire, Emotional Eating Scale, Binge Eating Scale, Beck Depression Inventory, Symptom Checklist and State-Trait Anxiety Inventory. RESULTS BPD group (26 subjects) showed the greatest weight loss, followed by RYGB (30 subjects), and LAGB group (27 subjects). All the treatments were associated with a significant improvement of anxiety, depression, and general psychopathology, and a similar pattern of reduction of binge eating symptomatology. BPD group reported a greater reduction of eating disorder psychopathology, compared to the other groups. Pre-treatment emotional eating severity was found to be a significant outcome modifier for the three treatment interventions. CONCLUSIONS These results suggest that all the three types of bariatric surgery significantly improved psychopathology and eating disordered behaviors. They also support the importance of a pre-treatment careful psychological assessment in order to supervise the post-surgical outcome.
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Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Viale Morgagni 85, 50134, Florence, Italy
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Le Grange D, Fitzsimmons-Craft EE, Crosby RD, Hay P, Lacey H, Bamford B, Stiles-Shields C, Touyz S. Predictors and moderators of outcome for severe and enduring anorexia nervosa. Behav Res Ther 2014; 56:91-8. [DOI: 10.1016/j.brat.2014.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
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Castellini G, Godini L, Amedei SG, Galli V, Alpigiano G, Mugnaini E, Veltri M, Rellini AH, Rotella CM, Faravelli C, Lucchese M, Ricca V. Psychopathological similarities and differences between obese patients seeking surgical and non-surgical overweight treatments. Eat Weight Disord 2014; 19:95-102. [PMID: 24014259 DOI: 10.1007/s40519-013-0058-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/21/2013] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the psychopathological characteristics of obese patients seeking bariatric surgery with those seeking a medical approach. METHODS A total of 394 consecutive outpatients seeking bariatric surgery were compared with 683 outpatients seeking a medical treatment. All patients were referred to the same institution. RESULTS Obesity surgery patients reported higher body mass index (BMI), objective/subjective binging and more severe general psychopathology, while obesity medical patients showed more eating and body shape concerns. Depression was associated with higher BMI among obesity surgery clinic patients, whereas eating-specific psychopathology was associated with higher BMI and objective binge-eating frequency among obesity medical clinic patients. CONCLUSIONS Patients seeking bariatric surgery showed different psychopathological features compared with those seeking a non-surgical approach. This suggests the importance for clinicians to consider that patients could seek bariatric surgery on the basis of the severity of the psychological distress associated with their morbid obesity, rather than criteria only based on clinical indication.
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Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Largo Brambilla 3, 50134, Florence, Italy
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The impact of meal consumption on emotion among individuals with eating disorders. Eat Weight Disord 2014; 19:347-54. [PMID: 24235092 DOI: 10.1007/s40519-013-0084-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE This pilot study sought to determine how meal consumption impacts affective states for treatment-seeking individuals with eating disorders (ED). METHODS Participants with heterogeneous ED diagnoses completed the State-Trait Anxiety Inventory, Positive and Negative Affect Schedule, and Profile of Mood States measures before and immediately after meal consumption. RESULTS Meal consumption was associated with significant decreases in negative affect and total mood disturbance for individuals with binge eating disorder (BED). Decreases in negative affect across meal time for individuals with BED were significantly different from increases in negative affect for participants with anorexia nervosa (AN) and bulimia nervosa (BN). CONCLUSION Findings indicate that individuals with BED have significantly different affective responses to eating non-binge meals than individuals with AN or BN. Data suggest changes in negative affect following meal consumption may be specific to certain ED diagnoses. Results provide preliminary evidence consistent with the idea that emotion states may function as maintenance mechanisms for psychopathology among ED diagnoses. Limitations and future directions pertaining to food-mood relationships for individuals with ED are discussed.
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Baseline eating disorder severity predicts response to an acceptance and commitment therapy-based group treatment. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2013. [DOI: 10.1016/j.jcbs.2013.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vaz-Leal FJ, Rodríguez-Santos L, García-Herráiz MA, Chimpén-López CA, Rojo-Moreno L, Beato-Fernández L, Ramos-Fuentes MI. The role of depression and impulsivity in the psychopathology of bulimia nervosa. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:25-31. [PMID: 23972724 DOI: 10.1016/j.rpsm.2013.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). MATERIALS AND METHODS Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. RESULTS BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN.
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Affiliation(s)
- Francisco J Vaz-Leal
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España.
| | - Laura Rodríguez-Santos
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - M Angustias García-Herráiz
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - Carlos A Chimpén-López
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
| | - Luís Rojo-Moreno
- Facultad de Medicina, Universidad de Valencia/Unidad de Trastornos de la Conducta Alimentaria, Hospital La Fe, Valencia, España
| | - Luís Beato-Fernández
- Facultad de Medicina, Unidad de Trastornos de la Conducta Alimentaria, Hospital General de Ciudad Real, Universidad de Castilla-La Mancha, Ciudad Real, España
| | - María Isabel Ramos-Fuentes
- Facultad de Medicina, Universidad de Extremadura/Unidad de Trastornos de la Conducta Alimentaria, Complejo Hospitalario Universitario, Servicio Extremeño de Salud, Badajoz, España
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Watson HJ, Fursland A, Bulik CM, Nathan P. Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa. Int J Eat Disord 2013; 46:119-26. [PMID: 22911884 DOI: 10.1002/eat.22052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. METHOD Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared. RESULTS Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. DISCUSSION Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.
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Affiliation(s)
- Hunna J Watson
- Center for Clinical Interventions, Department of Health in Western Australia, Perth, Australia.
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Current world literature. Curr Opin Psychiatry 2012; 25:565-73. [PMID: 23037966 DOI: 10.1097/yco.0b013e328359edae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Binge eating disorder (BED) is the most prevalent eating disorder in adults, and individuals with BED report greater general and specific psychopathology than non-eating disordered individuals. The current paper reviews research on psychological treatments for BED, including the rationale and empirical support for cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), dialectical behavior therapy (DBT), behavioral weight loss (BWL), and other treatments warranting further study. Research supports the effectiveness of CBT and IPT for the treatment of BED, particularly for those with higher eating disorder and general psychopathology. Guided self-help CBT has shown efficacy for BED without additional pathology. DBT has shown some promise as a treatment for BED, but requires further study to determine its long-term efficacy. Predictors and moderators of treatment response, such as weight and shape concerns, are highlighted and a stepped-care model proposed. Future directions include expanding the adoption of efficacious treatments in clinical practice, testing adapted treatments in diverse samples (e.g., minorities and youth), improving treatment outcomes for nonresponders, and developing efficient and cost-effective stepped-care models.
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Affiliation(s)
- Juliette M. Iacovino
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA,
| | - Dana M. Gredysa
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA
| | - Myra Altman
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
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