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Bevione F, Martini M, Toppino F, Longo P, Abbate-Daga G, Brustolin A, Panero M. Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls. Nutrients 2024; 16:1156. [PMID: 38674849 PMCID: PMC11054498 DOI: 10.3390/nu16081156] [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: 01/25/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.
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Affiliation(s)
| | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, via Cherasco 15, 10126 Turin, Italy; (F.B.); (M.M.); (F.T.); (P.L.); (A.B.); (M.P.)
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2
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Szymczak P, Talbot D, Gritti ES, Jonason PK. Narcissus' belief about his body: Aspects of narcissism, body image, and eating disorder symptoms. PLoS One 2023; 18:e0293578. [PMID: 37943826 PMCID: PMC10635534 DOI: 10.1371/journal.pone.0293578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Narcissism may play a role in shaping body image concerns. Here we examined the relationships between narcissism (i.e., agentic extraversion, antagonism, narcissistic neuroticism, leadership/authority, exhibitionism/entitlement) and body image concerns and disturbances (i.e., drive for thinness, drive for muscularity, eating disorder symptoms, body mass index, current/desired fat, and current/desired muscularity). METHODS Mechanical Turk workers from the USA (N = 430; 64% male) completed the Narcissistic Admiration and Rivalry Questionnaire, the Hypersensitive Narcissism Scale, the Narcissistic Personality Inventory, the Drive for Muscularity Scale, the Drive for Thinness Scale, the Eating Disorder Examination Questionnaire-Short, and the Sex-Specific Somatomorphic Matrixes. RESULTS All narcissistic factors were associated with a greater drive for thinness (except for leadership/authority) and for muscularity, more eating disorder symptoms, a greater desired body fat (except for leadership/authority), and a greater current muscularity. Greater agentic extraversion and exhibitionism/entitlement were associated with lower levels of current body fat, and greater antagonism was associated with a greater desired muscularity. DISCUSSION Notably, individual differences in narcissism appeared to be important in understanding body image concerns, broadly speaking. We found that narcissism may be associated with body image concerns among both sexes differently, and especially that drive for thinness was more related to narcissism in men. Our results emphasize the importance of narcissism in formulating and treating body image-related disorders for both men and women. Ultimately, narcissistic features of personality may be risk factors for developing and perpetuating body image concerns, and therefore should be considered in assessment, formulation, diagnosis, and treatment of eating disorders.
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Affiliation(s)
- Piotr Szymczak
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - Daniel Talbot
- Department of Psychiatry, Westmead Hospital, Westmead, Australia
- University of Sydney, Camperdown, Australia
- University of Notre Dame, Fremantle, Australia
| | | | - Peter K. Jonason
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
- Department of General Psychology, University of Padua, Padua, Italy
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3
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Cosh SM, Eshkevari E, McNeil DG, Tully PJ. Classifying excessive exercise: Examining the relationship between compulsive exercise with obsessive-compulsive disorder symptoms and disordered eating symptoms. EUROPEAN EATING DISORDERS REVIEW 2023; 31:769-780. [PMID: 37353901 DOI: 10.1002/erv.3002] [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: 04/27/2023] [Revised: 05/11/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE There remains a lack of consensus around nosology for compulsive exercise (CE). Although widely observed in eating disorders (ED), CE shares theoretical overlap with obsessive-compulsive disorder (OCD), where exercise compulsions occur in response to obsessions. Yet, there is limited and mixed evidence of a relationship between CE with OCD. This study aims to explore the appropriate diagnostic classification of CE through examination of CE in relation to OCD, obsessional thinking, and ED symptoms. METHOD Two hundred and eighty one adults with mental health symptoms, dieting, and exercise behaviour completed measures of OCD, CE, and disordered eating symptoms. Regression and Receiver Operating Characteristic analyses examined relationships between dimensions of CE with OCD and ED symptoms, and the predictive ability of CE assessment for detecting threshold OCD and ED symptoms. RESULTS CE assessment was poor at predicting threshold OCD symptoms, probable Anorexia Nervosa, and Binge Eating Disorder and moderate at detecting probable disordered eating and Bulimia Nervosa. Associations between CE and OCD symptoms were not significant after adjustment for ED symptoms. Obsessional thinking was associated only with lack of exercise enjoyment. CONCLUSIONS Results indicate that excessive exercise might represent a distinct disorder, with some shared traits across CE, OCD and ED symptoms. Findings question the utility of adaptation of OCD diagnostic criteria for CE. Assessment and treatment implications are considered.
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Affiliation(s)
- Suzanne M Cosh
- School of Psychology, University of New England, Armidale, New South Wales, Australia
| | - Ertimiss Eshkevari
- Statewide Eating Disorder Service, South Australian Department of Health and Wellbeing, Government of South Australia, Adelaide, South Australia, Australia
| | - Dominic G McNeil
- Institute for Health and Wellbeing, Federation University, Ballarat, Victoria, Australia
| | - Phillip J Tully
- School of Psychology, University of New England, Armidale, New South Wales, Australia
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Tang CSK, Gan KQ, Lui WK. The Associations between Obsessive Compulsive Personality Traits, Self-Efficacy, and Exercise Addiction. Behav Sci (Basel) 2023; 13:857. [PMID: 37887507 PMCID: PMC10603988 DOI: 10.3390/bs13100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/08/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
Exercise addiction refers to maladaptive exercise patterns involving compulsivity and addiction-like behaviors. Exercise addiction has been found to relate to negative physical and mental health outcomes such as heart abnormalities, physical injuries, and interpersonal conflicts. Based on the social cognitive theory, this study investigated the extent to which the interplay of obsessive compulsive personality disorder (OCPD) traits and self-efficacy beliefs would influence the development and maintenance of exercise addiction. A total of 1228 college students in the United States responded to an online survey. Based on cut-off scores of the Revised Exercise Addiction Inventory, the prevalence estimates of exercise addiction were 4.0% for males and 1.8% for females. Results showed that males are more prone to exercise addiction than females. Also, OCPD traits and self-efficacy significantly predicted exercise addiction after controlling for age and sex. Self-efficacy acted as a moderator in influencing the relationship between OCPD traits and exercise addiction, especially for females. At high levels of self-efficacy, more OCPD traits were significantly associated with a higher risk of exercise addiction. However, at low levels of self-efficacy, there was no association between OCPD traits and exercise addiction. The findings suggest that public education and intervention for exercise addiction should attend to the interplay between personality factors and sex.
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Affiliation(s)
- Catherine So Kum Tang
- Department of Counselling & Psychology, Hong Kong Shue Yan University, 10 Wai Tsui Crescent, Braemar Hill, North Point, Hong Kong, China
| | - Kai Qi Gan
- Department of Psychology, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Wai Kin Lui
- Department of Counselling & Psychology, Hong Kong Shue Yan University, 10 Wai Tsui Crescent, Braemar Hill, North Point, Hong Kong, China
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Anthonisamy AN, Misra S, Barua A. Prevalence of night eating syndrome among inbound call centre employees in Kuala Lumpur, Malaysia. Nutr Health 2023; 29:505-512. [PMID: 35188808 DOI: 10.1177/02601060221081198] [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] [Indexed: 11/15/2022]
Abstract
Background: Night eating syndrome (NES) is described as a disordered eating pattern relative to sleep, where consumption of food occurs in the evening and night. Numerous studies had been conducted in various populations but studies on (NES) among call centre employees are limited. Aim: This study aimed to determine the prevalence of NES and its determinants among selected inbound call centre employees in Kuala Lumpur, Malaysia. Methods: In this cross-sectional study, a total of 217 inbound call centre employees were recruited through random sampling. A self-administered socio-demographic and work-related questionnaire was used to collect data on the background of the respondents. Information on NES and well-being was obtained by using the Night Eating Questionnaire (NEQ) and World Health Organisation-Five Well-Being Index (WHO-5) respectively. Data on dietary intakes, smoking habits, alcohol intakes and life stress were acquired using a Simple Lifestyle Indicator Questionnaire (SLIQ) while eating behaviour of the respondents was studied using the Three-Factor Eating Questionnaire (TFEQ-18). Results: The mean age of the respondents was 24.1 ± 6.0 years. The prevalence of NES was 12.0% (95% CI = 8.12-17.24). The binary logistic regression identified that NES is significantly associated with adequate exercise (AOR = 4.250, p = 0.012) and emotional eating (AOR = 6.510, p = 0.014). Conclusion: This study showed that the prevalence of NES was high in the call centre and repeated nocturnal eating can have multiple adverse health effects. Therefore, promoting healthy eating habits are crucial to reduce the impacts of NES.
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Affiliation(s)
- A N Anthonisamy
- Postgraduate Studies, Department of Community Medicine, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - S Misra
- Department of Nutrition & Dietetics, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
| | - A Barua
- Postgraduate Studies, Department of Community Medicine, Faculty of Medicine and Health, International Medical University, Kuala Lumpur, Malaysia
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6
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Cresswell C, Watson HJ, Jones E, Howell JA, Egan SJ. The role of compulsive exercise in the relationship between perfectionism and eating disorder pathology in underweight adolescents with eating disorders. Eat Behav 2022; 47:101683. [PMID: 36410135 DOI: 10.1016/j.eatbeh.2022.101683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Perfectionism has a strong association with eating disorders. Research in non-clinical adults has suggested that perfectionism has both direct and indirect effects on eating disorder symptoms, and that compulsive exercise is a potential mediator. The aim of this study was to understand whether perfectionism is associated with eating disorder symptoms, both directly and indirectly through compulsive exercise in underweight adolescents with eating disorders. Participants were 149 female adolescents (M = 14.90 years, age range 13-17) with eating disorders from the Helping to Outline Paediatric Eating Disorders (HOPE) Project, an ongoing, registry study of individuals consecutively referred individuals to a statewide eating disorder service. The majority had a diagnosis of anorexia nervosa restricting type (66 %), followed by unspecified feeding or eating disorder (21 %), and anorexia nervosa binge-eating purging type (13 %). To test the model, path analyses with bootstrapping were conducted. All paths were statistically significant, including the indirect effect from perfectionism to eating disorder pathology via the mediator of compulsive exercise, and the direct effect of perfectionism on eating disorder pathology. Overall, this research provides further evidence that compulsive exercise may be one factor that can explain the relationship between perfectionism and eating disorder symptoms. Future research should seek to determine the relative efficacy of approaches for the treatment of eating disorders in adolescents which target perfectionism and compulsive exercise.
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Affiliation(s)
- Camilla Cresswell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
| | - Hunna J Watson
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, United States; Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Emily Jones
- Eating Disorders Program, Child and Adolescent Health Service, Perth, Australia
| | - Joel A Howell
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
| | - Sarah J Egan
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia; enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.
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Yang P, Wang T, Herold F, Müller NG, Taylor A, Szabo A, Granziol U, Cook B, Landolfi E, Solmi M, Zou L. Relationships between personality traits and disordered eating among Chinese female exercisers: the role of symptoms of exercise dependence and obsessive-compulsiveness. J Eat Disord 2022; 10:169. [PMID: 36397179 PMCID: PMC9670462 DOI: 10.1186/s40337-022-00679-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although numerous studies have examined associations between personality traits and eating disorders in females, few studies have been conducted on female exercisers. Given the high risk of disordered eating in female exercisers, this study investigated the associations between the Big Five personality traits and disordered eating in female exercisers, and further explored the potential mediators, namely exercise dependence symptoms, and obsessive-compulsive symptoms underlying this association. METHODS A total of 295 female exercisers aged between 18 to 67 years (M = 22.11, SD = 6.65) participated in this study. RESULTS Negative and statistically significant correlations between conscientiousness (r = - 0.17, p < 0.01), emotional stability (r = - 0.27, p < 0.001) and agreeableness (r = - 0.18, p < 0.01) and disordered eating were observed in our sample of female exercisers. The multiple mediation analyses revealed that exercise dependence symptoms and obsessive-compulsive symptoms mediate the relationship between conscientiousness (β = 0.016, CI = [0.003, 0.031]), emotional stability (β = -0.012, CI = [- 0.028, - 0.002]), and disordered eating in female exercisers, whereas obsessive-compulsive symptoms (β = - 0.041, CI = [- 0.088, - 0.001]) but not exercise dependence symptoms are a mediator of the relationship between agreeableness and disordered eating. CONCLUSIONS Our findings can be used to improve the screening procedures for eating disorders in female exercisers as they contribute to a better understanding of the psychological mechanisms that underlie the associations between the Big Five personality traits and disordered eating.
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Affiliation(s)
- Peiying Yang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ting Wang
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China
| | - Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Alyx Taylor
- School of Rehabilitation, Sport and Psychology, AECC University College, Bournemouth, BH5 2DF, UK
| | - Attila Szabo
- Institute of Health Promotion and Sport Science, ELTE, Eötvös Loránd Unbiversity, Budapest, Hungary
| | - Umberto Granziol
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Emilio Landolfi
- Faculty of Health Sciences, School of Kinesiology, University of the Fraser Valley, Abbotsford, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Department of Child and Adolescent Psychiatry, Charité, Universitätsmedizin, Berlin, Germany
| | - Liye Zou
- Body-Brian-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen, 518060, China.
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Acikel SB, Cikili Y. Are the obsessive-compulsive traits a moderator for the relationship between autism and anorexia? A cross-sectional study among university students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1975-1980. [PMID: 33180674 DOI: 10.1080/07448481.2020.1841769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 08/05/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveIt is known that there is a high comorbidity between eating disorders and autistic traits among both the clinical and non-clinical populations. In this study, it is aimed to investigate the relationship between ASD and AN, and the effects of obsessive-compulsive traits. Participants: The study has been conducted in a non-clinical sample. A total of 290 university students have been included. Methods: Autism Quotient (AQ), Eating Attitudes Test (EAT) and Maudsley Obsessive-Compulsive Inventory (MOCI) have been used. Results: There is a positive relationship between EAT-40, MOCI scores, and AQ total scores. However, after controlling the sex and MOCI scores relation in total AQ and EAT-40 scores, they have become statistically insignificant. In regression, only MOCI scores and AQ Communication subscale scores have been able to predict the EAT-40 scores. Conclusions: It has been found that the relationship between autistic traits and eating attitudes is moderated by obsessive-compulsive traits.
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Affiliation(s)
- S Burak Acikel
- Department of Child and Adolescent Psychiatry, Konya City Hospital, Konya, Turkey
| | - Yahya Cikili
- Ahmet Kelesoglu Education Faculty, Department of Special Education, Necmettin Erbakan University, Konya, Turkey
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Swami V, Barron D, Furnham A. Associations between Schizotypal Facets and Symptoms of Disordered Eating in Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11157. [PMID: 36141444 PMCID: PMC9517632 DOI: 10.3390/ijerph191811157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Research has suggested that schizotypy-a personality organisation representing latent vulnerability for schizophrenia-spectrum disorders-may be elevated in women with symptoms of disordered eating. However, studies have not fully considered associations between symptoms of disordered eating and multidimensional schizotypy. To overcome this limitation, we asked an online sample of 235 women from the United States to complete measures of symptoms of disordered eating (drive for thinness, body dissatisfaction, and bulimic symptoms) and multidimensional schizotypy. Correlational analyses indicated significant associations between drive for thinness and bulimic symptoms, respectively, and most schizotypal facets. Body dissatisfaction was significantly associated with only two schizotypal facets. Overall, the strength of correlations was weak-to-moderate. Regression results indicated that only the schizotypal feature of excessive social anxiety was significantly associated with all risk for disordered eating factors. These results are consistent with aetiological models of disordered eating that highlight socio-affective difficulties as risk factors for symptoms of disordered eating.
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Affiliation(s)
- Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge CB1 1PT, UK
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur 50490, Malaysia
| | - David Barron
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur 50490, Malaysia
| | - Adrian Furnham
- Centre for Psychological Medicine, Perdana University, Kuala Lumpur 50490, Malaysia
- Department of Leadership and Organizational Behaviour, Norwegian Business School, 0484 Oslo, Norway
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10
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Giles S, Hughes EK, Fuller‐Tyszkiewicz M, Treasure J, Fernandez‐Aranda F, Karwautz AFK, Wagner G, Anderluh M, Collier DA, Krug I. Bridging of childhood obsessive‐compulsive personality disorder traits and adult eating disorder symptoms: A network analysis approach. EUROPEAN EATING DISORDERS REVIEW 2022; 30:110-123. [DOI: 10.1002/erv.2885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/28/2021] [Accepted: 12/30/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Sarah Giles
- Melbourne School of Psychological Sciences The University of Melbourne Melbourne Victoria Australia
| | - Elizabeth K. Hughes
- Melbourne School of Psychological Sciences The University of Melbourne Melbourne Victoria Australia
- Department of Paediatrics The University of Melbourne Melbourne Victoria Australia
- Centre for Adolescent Health Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Matthew Fuller‐Tyszkiewicz
- School of Psychology Centre for Social and Early Emotional Development Deakin University Melbourne Victoria Australia
- School of Psychology Deakin University Geelong Victoria Australia
| | - Janet Treasure
- Department of Psychological Medicine King's College London Institute of Psychiatry and Neuroscience Section of Eating Disorders London UK
| | - Fernando Fernandez‐Aranda
- Instituto Salud Carlos III Ciber Fisiopatología Obesidad y Nutrición (CIBERobn) Barcelona Spain
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- Psychiatry and Mental Health Group Neuroscience Program Institut d’Investigació Biomèdica de Bellvitge ‐ IDIBELL L’Hospitalet de Llobregat Spain
- Department of Clinical Sciences School of Medicine and Health Sciences University of Barcelona Barcelona Spain
| | - Andreas F. K. Karwautz
- Department of Child and Adolescent Psychiatry Eating Disorders Unit Medical University of Vienna Vienna Austria
| | - Gudrun Wagner
- Department of Child and Adolescent Psychiatry Eating Disorders Unit Medical University of Vienna Vienna Austria
| | - Marija Anderluh
- Department of Child Psychiatry University Children's Hospital University Medical Centre Ljubljana Ljubljana Slovenia
| | - David A. Collier
- Department of Psychological Medicine King's College London Institute of Psychiatry and Neuroscience Section of Eating Disorders London UK
| | - Isabel Krug
- Melbourne School of Psychological Sciences The University of Melbourne Melbourne Victoria Australia
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11
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"All that glitters is not gold": sialomegaly, xerostomia, and dry eye is not always Sjögren's syndrome. Reumatologia 2021; 59:346-352. [PMID: 34819710 PMCID: PMC8609384 DOI: 10.5114/reum.2021.110321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/02/2021] [Indexed: 11/17/2022] Open
Abstract
Although dry mouth, dry eye, and swollen salivary glands are the hallmark manifestations of Sjögren's syndrome (pSS), a wide spectrum of other conditions should be considered for differential diagnosis. The diagnostic challenge is mainly encountered in patients presenting with dry eyes and/or dry mouth, who do not meet the full established classification criteria for pSS. Presented case-based review highlights the relationship between dry eye, parotid swelling, and psychiatric disorders. The obsessive-compulsive disorder may be separately be a cause of dryness symptoms even were not using any psychiatric drugs. The presented review widely discussed this problem and the aim is to shed new light on the interpretation of the dryness symptom and the necessity of individual patient assessment, excluding causes other than pSS before making a final diagnosis and making a decision on the treatment method.
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12
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Song W, Wang W, Yu S, Lin GN. Dissection of the Genetic Association between Anorexia Nervosa and Obsessive-Compulsive Disorder at the Network and Cellular Levels. Genes (Basel) 2021; 12:491. [PMID: 33801746 PMCID: PMC8065602 DOI: 10.3390/genes12040491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) exhibit a high co-morbidity rate, similar symptoms, and a shared genetic basis. However, an understanding of the specific underlying mechanisms of these commonalities is currently limited. Here, we collected Genome-Wide Association Analysis results for AN and OCD, and obtained genes hit by the top SNPs as the risk genes. We then carried out an integrative coexpression network analysis to explore the convergence and divergence of AN and OCD risk genes. At first, we observed that the AN risk genes were enriched in coexpression modules that involved extracellular matrix functions and highly are expressed in the postnatal brain, limbic system, and non-neuronal cell types, while the OCD risk genes were enriched in modules of synapse function, the prenatal brain, cortex layers, and neurons. Next, by comparing the expressions from the eating disorder and OCD postmortem patient brain tissues, we observed both disorders have similar prefrontal cortex expression alterations influencing the synapse transmission, suggesting that the two diseases could have similar functional pathways. We found that the AN and OCD risk genes had distinct functional and spatiotemporal enrichment patterns but carried similar expression alterations as a disease mechanism, which may be one of the key reasons they had similar but not identical clinical phenotypes.
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Affiliation(s)
| | | | | | - Guan Ning Lin
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China; (W.S.); (W.W.); (S.Y.)
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13
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Meijboom FLB, Kostrzewa E, Leenaars CHC. Joining forces: the need to combine science and ethics to address problems of validity and translation in neuropsychiatry research using animal models. Philos Ethics Humanit Med 2020; 15:1. [PMID: 31969164 PMCID: PMC6977256 DOI: 10.1186/s13010-019-0085-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/25/2019] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Current policies regulating the use of animals for scientific purposes are based on balancing between potential gain of knowledge and suffering of animals used in experimentation. The balancing process is complicated, on the one hand by plurality of views on our duties towards animals, and on the other hand by more recent discussions on uncertainty in the probability of reaching the final aim of the research and problems of translational failure. METHODS The study combines ethical analysis based on a literature review with neuropsychiatry-related preclinical research as a case study. RESULTS Based on the analysis and the case study we show that neuropsychiatry-related preclinical research is an especially interesting case from an ethical perspective. The 3R principles (Replacement, Reduction and Refinement) are used to minimize the negative consequences for the animals used in research. However, neuropsychiatric research is characterized by specific challenges in assessing the probability of success of reaching the final aim, due to our limited mechanistic knowledge of human neuropsychiatric illness. Consequently, the translational value of the currently used animal models may be difficult to prove, which undermines the validity of these models and complicated the ethical assessment. CONCLUSIONS We conclude that a combined approach that deals with both science and the ethical dimensions is necessary to address the problems of validity and translation in neuropsychiatry-related preclinical research. We suggest this approach to comprise first, improved experimental methods, e.g. by using systematic reviews, second, a more patients-based approach that leads to models that reflect interindividual variation better, and third, more interdisciplinary cooperation.
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Affiliation(s)
- Franck L B Meijboom
- Ethiek Instituut, Universiteit Utrecht, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
- Faculty of Veterinary Medicine, Universiteit Utrecht, Yalelaan 2, 3584 CM, Utrecht, The Netherlands.
| | - Elzbieta Kostrzewa
- Ethiek Instituut, Universiteit Utrecht, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
| | - Cathalijn H C Leenaars
- Faculty of Veterinary Medicine, Universiteit Utrecht, Yalelaan 2, 3584 CM, Utrecht, The Netherlands
- SYRCLE, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
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14
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Hebebrand J, Milos G, Wabitsch M, Teufel M, Führer D, Bühlmeier J, Libuda L, Ludwig C, Antel J. Clinical Trials Required to Assess Potential Benefits and Side Effects of Treatment of Patients With Anorexia Nervosa With Recombinant Human Leptin. Front Psychol 2019; 10:769. [PMID: 31156489 PMCID: PMC6533856 DOI: 10.3389/fpsyg.2019.00769] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/20/2019] [Indexed: 12/16/2022] Open
Abstract
The core phenotype of anorexia nervosa (AN) comprises the age and stage dependent intertwining of both its primary and secondary (i.e., starvation induced) somatic and mental symptoms. Hypoleptinemia acts as a key trigger for the adaptation to starvation by affecting diverse brain regions including the reward system and by induction of alterations of the hypothalamus-pituitary-“target-organ” axes, e.g., resulting in amenorrhea as a characteristic symptom of AN. Particularly, the rat model activity-based anorexia (ABA) convincingly demonstrates the pivotal role of hypoleptinemia in the development of starvation-induced hyperactivity. STAT3 signaling in dopaminergic neurons in the ventral tegmental area (VTA) plays a crucial role in the transmission of the leptin signal in ABA. In patients with AN, an inverted U-shaped relationship has been observed between their serum leptin levels and physical activity. Albeit obese and therewith of a very different phenotype, humans diagnosed with rare congenital leptin deficiency have starvation like symptoms including hypothalamic amenorrhea in females. Over the past 20 years, such patients have been successfully treated with recombinant human (rh) leptin (metreleptin) within a compassionate use program. The extreme hunger of these patients subsides within hours upon initiation of treatment; substantial weight loss and menarche in females ensue after medium term treatment. In contrast, metreleptin had little effect in patients with multifactorial obesity. Small clinical trials have been conducted for hypothalamic amenorrhea and to increase bone mineral density, in which metreleptin proved beneficial. Up to now, metreleptin has not yet been used to treat patients with AN. Metreleptin has been approved by the FDA under strict regulations solely for the treatment of generalized lipodystrophy. The recent approval by the EMA may offer, for the first time, the possibility to treat extremely hyperactive patients with AN off-label. Furthermore, a potential dissection of hypoleptinemia-induced AN symptoms from the primary cognitions and behaviors of these patients could ensue. Accordingly, the aim of this article is to review the current state of the art of leptin in relation to AN to provide the theoretical basis for the initiation of clinical trials for treatment of this eating disorder.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zürich, Zurich, Switzerland
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Hospital, Ulm, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, Medical Center and Central Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christine Ludwig
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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15
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Rowland NE, Atalayer D, Cervantez MR, Minaya DM, Splane EC. Cost-based anorexia: A novel framework to model anorexia nervosa. Appetite 2018; 130:50-58. [PMID: 30075177 DOI: 10.1016/j.appet.2018.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder that is thought to emerge through biological predisposition(s) within sociocultural context(s). Practical and ethical concerns limit study of the etiology of this disorder in humans, and in particular the biological aspects. Laboratory animal models have a pivotal role in advancing our understanding of the neurobiological, physiological and behavioral aspects of this disorder, and developing new treatment strategies. One shortcoming of animal models, including activity based anorexia (ABA) in rodents, is that they cannot fully capture the contextual aspects of AN. In this article we discuss the merits of an alternate approach, cost-based anorexia (CBA). CBA is conceptually founded in behavioral economics and its magnitude is influenced by several relevant contextual aspects of feeding.
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Affiliation(s)
- Neil E Rowland
- Department of Psychology, University of Florida, Gainesville, FL, 32611-2250, USA.
| | - Deniz Atalayer
- Department of Psychology, Sabancı University, Istanbul, Turkey
| | - Melissa R Cervantez
- Department of Psychology, University of Florida, Gainesville, FL, 32611-2250, USA
| | - Dulce M Minaya
- Department of Psychology, University of Florida, Gainesville, FL, 32611-2250, USA
| | - Emily C Splane
- Department of Social Sciences, Flagler College, St. Augustine, FL, USA
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16
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Young S, Touyz S, Meyer C, Arcelus J, Rhodes P, Madden S, Pike K, Attia E, Crosby RD, Hay P. Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa. J Eat Disord 2018; 6:2. [PMID: 29441204 PMCID: PMC5799909 DOI: 10.1186/s40337-018-0188-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. METHOD A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. RESULTS Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. CONCLUSIONS These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment. TRIAL REGISTRATION ACTRN12610000585022. Taking a LEAP forward in the treatment of anorexia nervosa: a randomized controlled trial. NHMRC grant: 634922.
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Affiliation(s)
- Sarah Young
- Griffith Taylor Building, School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Meyer
- WMG, University of Warwick, United Kingdom & University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Leicestershire Adult Eating Disorders Service, Leicestershire Partnership NHS Trust, Bennion Centre, Glenfield Hospital, Leicester, UK
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Sloane Madden
- School of Medicine, University of Sydney, Sydney, Australia
- Eating Disorders Service at the Sydney Children’s Hospitals Network, Westmead, Australia
| | - Kathleen Pike
- Division of Behavioral Health Services and Policy Research, Columbia University, New York, USA
| | - Evelyn Attia
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Weill Cornell Medical College, New York, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota USA
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Campbelltown, Australia
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17
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Levallius J, Collin C, Birgegård A. Now you see it, Now you don't: compulsive exercise in adolescents with an eating disorder. J Eat Disord 2017; 5:9. [PMID: 28392917 PMCID: PMC5376699 DOI: 10.1186/s40337-016-0129-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/01/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Compulsive exercise (CE) has been proposed as significant in the etiology, development and maintenance of eating disorders (EDs), resulting in more severe and enduring pathology. However, few studies have investigated CE longitudinally in adolescents with EDs. We aimed to test if adolescents show the same associations between CE and other clinical variables as previous research has found in adults. METHODS Three thousand one hundred sixteen girls and 139 boys from a clinical ED database were investigated regarding prevalence and frequency of CE and its relation to psychiatric symptoms, associated features and outcome. Denial of illness is common among adolescents and was therefore adjusted for. RESULTS Adjusted CE prevalence in girls was 44%, and CE was most prevalent in bulimia nervosa. As previously found in adults, those with CE scored significantly higher than non-CE on total ED severity, level of restriction and negative perfectionism. However, there were only minor differences between CE and non-CE patients on emotional distress, hyperactivity, suicidality and self-esteem. Among boys, adjusted CE prevalence was 38%, and CE boys scored significantly higher than non-CE on total ED severity. Initial CE did not influence 1-year outcome, although cessation of CE was associated with remission. CONCLUSIONS CE is a common clinical feature in adolescents with EDs and cessation is associated with remission. When controlling for denial of illness, CE had less detrimental impact than predicted. We recommend controlling for denial in studies on ED adolescents and further exploration of classification and treatment implications of CE.
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Affiliation(s)
- Johanna Levallius
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
| | - Christina Collin
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Resource Center for Eating Disorders, Center for Psychiatry Research, Karolinska Institutet, SE-113 64 Stockholm, Sweden.,Resource Center for Eating Disorders, Stockholm Health Care Services, Stockholm County Council, SE-113 64 Stockholm, Sweden
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18
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Raynal P, Melioli T, Chabrol H. Personality profiles in young adults with disordered eating behavior. Eat Behav 2016; 22:119-123. [PMID: 27289047 DOI: 10.1016/j.eatbeh.2016.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/07/2016] [Accepted: 06/01/2016] [Indexed: 12/21/2022]
Abstract
Personality traits are closely related to eating disorders (ED) and might be involved in their development and maintenance. Nevertheless little is known regarding the association between personality traits and disordered eating in subclinical populations. College students answered questionnaires assessing disordered eating behaviors (DEB) and the following personality disorder (PD) traits: schizotypal, autistic, obsessional, borderline and cyclothymic. Participants with DEB (n=101, 87% women) displayed significantly higher scores for several variables including schizotypy, cyclothymic, borderline and obsessional traits compared to other participants (n=378). Cluster analysis in the DEB subsample led to the identification of three groups: 1) a cluster with a high level of traits (HT); 2) a cluster scoring high on schizotypal, borderline and cyclothymic traits (SBC); 3) a cluster with a low level of traits (LT). Symptoms of depression, suicidal ideations, trait anger and obsessive-compulsive symptoms were higher in the HT and the SBC clusters compared to the LT cluster. Given that two thirds of participants suffering from DEB appeared to display a morbid personality profile, it appears of prime importance to take into account PD traits of individuals with DEB.
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Affiliation(s)
- Patrick Raynal
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France.
| | - Tiffany Melioli
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse, UT2J, France
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19
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Blasczyk-Schiep S, Sokoła K, Fila-Witecka K, Kazén M. Are all models susceptible to dysfunctional cognitions about eating and body image? The moderating role of personality styles. Eat Weight Disord 2016; 21:211-20. [PMID: 26525971 DOI: 10.1007/s40519-015-0228-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/21/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We investigated dysfunctional cognitions about eating and body image in relation to personality styles in a group of professional models. METHOD Dysfunctional cognitions in professional models (n = 43) and a control group (n = 43) were assessed with the 'Eating Disorder Cognition Questionnaire' (EDCQ), eating attitudes with the 'Eating Attitudes Test' (EAT), and personality with the 'Personality Styles and Disorders Inventory' (PSDI-S). RESULTS Models had higher scores than controls on the EDCQ and EAT and on nine scales of the PSDI-S. Moderation analyses showed significant interactions between groups and personality styles in predicting EDCQ scales: The ambitious/narcissistic style was related to "negative body and self-esteem", the conscientious/compulsive style to "dietary restraint", and the spontaneous/borderline style to "loss of control in eating". CONCLUSIONS The results indicate that not all models are susceptible to dysfunctional cognitions about eating and body image. Models are at a higher risk of developing negative automatic thoughts and dysfunctional assumptions relating to body size, shape and weight, especially if they have high scores on the above personality styles.
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Affiliation(s)
- Sybilla Blasczyk-Schiep
- Wrocław Department, Warsaw School of Social Psychology, Warsaw School of Social Sciences and Humanities, Ostrowskiego Street 30b, 53-238, Wroclaw, Poland.
| | - Kaja Sokoła
- Wrocław Department, Warsaw School of Social Psychology, Warsaw School of Social Sciences and Humanities, Ostrowskiego Street 30b, 53-238, Wroclaw, Poland
| | - Karolina Fila-Witecka
- Wrocław Department, Warsaw School of Social Psychology, Warsaw School of Social Sciences and Humanities, Ostrowskiego Street 30b, 53-238, Wroclaw, Poland
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20
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A new social-family model for eating disorders: A European multicentre project using a case–control design. Appetite 2015; 95:544-53. [DOI: 10.1016/j.appet.2015.08.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 01/05/2023]
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21
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Stiles-Shields C, DclinPsy BB, Lock J, Le Grange D. The effect of driven exercise on treatment outcomes for adolescents with anorexia and bulimia nervosa. Int J Eat Disord 2015; 48:392-6. [PMID: 24729068 DOI: 10.1002/eat.22281] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/27/2014] [Accepted: 03/24/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study investigated the prevalence of driven exercise (DE) and its role in treatment outcome for adolescents with bulimia nervosa (BN) and anorexia nervosa (AN). METHOD Participants were 201 adolescents with an eating disorder (ED) (80 with BN and 121 with AN) presenting for outpatient treatment at two specialist clinics. All adolescents participated in one of two randomized controlled trials. Descriptive statistics were conducted to evaluate the presence and frequency of baseline DE. Exploratory hierarchical regressions were used to evaluate the effect of baseline DE on treatment outcomes. RESULTS About 66.3% of adolescents with BN and 23.1% of adolescents with AN presented with baseline DE. The presence of baseline DE predicted significantly worse outcomes for adolescents with AN in terms of ED symptom severity (ps < .004); however, baseline DE did not significantly predict any of the evaluated outcomes for adolescents with BN (ps < .05). DISCUSSION The results of this secondary exploratory data suggest that DE is prevalent for adolescents with BN and AN. However, DE may be related to different constructs for adolescents with AN than those with BN, suggesting differences in treatment needs.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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22
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Guarda AS, Schreyer CC, Boersma GJ, Tamashiro KL, Moran TH. Anorexia nervosa as a motivated behavior: Relevance of anxiety, stress, fear and learning. Physiol Behav 2015; 152:466-72. [PMID: 25846837 DOI: 10.1016/j.physbeh.2015.04.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 04/02/2015] [Indexed: 12/12/2022]
Abstract
The high comorbidity between anorexia nervosa (AN) and anxiety disorders is well recognized. AN is a motivated behavioral disorder in which habit formation is likely to contribute to the persistence of abnormal eating and exercise behaviors. Secondary alterations in brain circuitry underlying the reward value of food and exercise, along with disturbances in neuroendocrine hunger and satiety signaling arising from starvation and excessive exercise, are likely contributors to the maintenance of anorectic behaviors in genetically vulnerable individuals. The potential role of fear conditioning in facilitating onset of AN, or of impaired fear extinction in contributing to the high relapse rates observed following weight restoration, is of interest. Evidence from animal models of anxiety and human laboratory studies indicate that low estrogen impairs fear extinction. Low estradiol levels in AN may therefore play a role in perpetuating fear of food and fat in recently weight restored patients. Translational models including the activity based anorexia (ABA) rodent model of AN, and neuroimaging studies of fear extinction and conditioning, could help clarify the underlying molecular mechanisms and neurocircuitry involved in food avoidance behaviors in AN. Moreover, the adaptation of novel treatment interventions with efficacy in anxiety disorders may contribute to the development of new treatments for this impairing disorder.
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Affiliation(s)
- Angela S Guarda
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Gretha J Boersma
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Kellie L Tamashiro
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
| | - Timothy H Moran
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
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23
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El Ghoch M, Bazzani P, Dalle Grave R. Management of ischiopubic stress fracture in patients with anorexia nervosa and excessive compulsive exercising. BMJ Case Rep 2014; 2014:bcr-2014-206393. [PMID: 25301426 DOI: 10.1136/bcr-2014-206393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This case report describes a 28-year-old non-athlete female patient with anorexia nervosa who was diagnosed with an ischiopubic ramus stress fracture and treated successfully as an inpatient with a cognitive behaviour-based therapy. The patient's clinical picture, diagnosis and treatment are described, and a brief review of the relevant literature is included. The importance of this case report stems from the rarity of descriptions of this kind of injury in such patients, despite their inherent risk, and the originality of the treatment applied. This, in addition to the usual approach to medical management, exploited specific cognitive and behavioural procedures and strategies to address the patient's excessive compulsive exercising, promoting rest and movement avoidance in order to allow the fracture to heal, while simultaneously addressing the underlying psychopathology.
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Affiliation(s)
- Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
| | - Paola Bazzani
- Department of Radiology, Villa Garda Hospital, Garda, Verona, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Verona, Italy
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24
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New diagnostic perspectives on obsessive-compulsive personality disorder and its links with other conditions. Curr Opin Psychiatry 2014; 27:62-7. [PMID: 24257122 DOI: 10.1097/yco.0000000000000030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review examines the conceptualization of obsessive-compulsive personality disorder (OCPD), its epidemiology and efforts to better understand the relationships between OCPD and other conditions. RECENT FINDINGS The alternative Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders conceptualization of OCPD is radically different in that it combines categorical and dimensional diagnostic approaches and introduces a hierarchy of diagnostic criteria. OCPD is one of the most common personality disorders in the general population. The relationship between OCPD and obsessive-compulsive disorder (OCD) is important, but to a large extent obfuscated by the overlap between their diagnostic criteria. Frequent changes in the OCPD diagnostic criteria make it difficult to ascertain the 'true' relationship between OCPD and OCD. It is not uncommon for OCPD to occur with anorexia nervosa, depression, hypochondriasis, certain other personality disorders and Parkinson's disease, but further research is necessary to understand the implications of these links. SUMMARY OCPD is yet to be conceptualized consistently and in the manner that would make a clear and well supported distinction between its core and peripheral features. Future studies need to separate a genuine from overlap-driven co-occurrence of OCPD and other conditions, as that would give a better insight into the way in which OCPD relates to other disorders.
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