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Sutphin TMS, Hicks AD, McCord D. Eating Behaviors Associated With Suicidal Behaviors and Overall Risk. J Psychiatr Pract 2024; 30:343-348. [PMID: 39357015 DOI: 10.1097/pra.0000000000000809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
OBJECTIVE Maladaptive eating behaviors remain prevalent in the US population, and a significant percentage of US college students acknowledge engaging in maladaptive eating. Formally defined eating disorders (EDs) have one of the highest mortality rates among all mental illnesses. Suicide risk is substantially elevated among individuals diagnosed with EDs, and even subclinical levels of maladaptive eating behaviors are associated with suicidality. The current study examined associations between specific problematic eating behaviors measured dimensionally (eg, purging, binging, laxative use) and specific suicide-related constructs and behaviors as well as overall suicide risk. METHODS College students (N=188; 62% women) completed the Eating Disorder Examination-Questionnaire, a well-established measure of dysfunctional eating, as well as several self-report measures of theoretical components of suicidality, and, finally, a semistructured clinical interview to specify suicide risk category. RESULTS Results showed a general pattern of moderate and strong associations between the subscales and the overall score of the Eating Disorder Examination-Questionnaire and core suicide constructs of the interpersonal-psychological theory of suicide. Many substantive correlations were found between specific eating behaviors and specific suicide-related behaviors; for example, purging was the highest correlate of overall suicide risk (ρ=0.36). DISCUSSION These results are discussed in terms of consistency with the interpersonal-psychological theory of suicide as well as practical implications for intervention.
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Hercus C, Baird A, Ibrahim S, Turnbull P, Appleby L, Singh U, Kapur N. Suicide in individuals with eating disorders who had sought mental health treatment in England: a national retrospective cohort study. Lancet Psychiatry 2024; 11:592-600. [PMID: 39025631 DOI: 10.1016/s2215-0366(24)00143-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Although studies have suggested a high risk of suicide in people with eating disorders, most studies have focused on suicidal ideation and attempts. There is little research on the characteristics of people with eating disorders who died by suicide, nor investigation of trends over time. We aimed to compare the characteristics of patients with eating disorders who died by suicide versus patients with other mental health diagnoses who died by suicide in England and to examine the trends in rates. METHODS In this national retrospective cohort study, data on all people (aged ≥10 years) who died by suicide in England, UK, between Jan 1, 1997, and Dec 31, 2021, while under the care (within the previous 12 months) of mental health services were obtained from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), in which clinical information is collected via a questionnaire completed by the mental health professional responsible for the patient's care. Incidence of suicide in, and demographic, clinical, and treatment characteristics of, patients with a diagnosis of eating disorder (as recorded by the treating clinician) who died by suicide were compared with patients with other mental health diagnoses who died by suicide within the same timeframe using univariable logistic regression analysis. People with related lived experience were involved in the study design, implementation, interpretation, and writing of the manuscript. FINDINGS Of 119 446 people for whom NCISH were notified of dying by suicide in England, 30 795 were under the recent care of mental health services, of whom 30 246 had known diagnoses and were included in analyses. Of these individuals, 10 373 (34%) were female and 19 873 (66%) were male; 2236 (8%) were of minority ethnicity; 382 (1%) had a diagnosis of eating disorder and 29 864 (99%) had another mental health diagnosis. Compared with patients with other mental health diagnoses who died by suicide, patients with eating disorders were younger (median age 33 years [range 15-90] vs 45 years [10-100]), more often female (343 [90%] female and 39 [10%] male in the eating disorders group; 10 030 [34%] female and 19 834 [66%] male in the other diagnoses group), and less likely to have evidence of conventional risk factors for suicide such as living alone (odds ratio [OR] 0·68, 95% CI 0·55-0·84). 22 (6%) of 382 were from a minority ethnic group. Patients with an eating disorder were characterised by a greater clinical complexity (eg, self-harm [OR 2·31, 95% CI 1·78-3·00], comorbidity [9·79, 6·81-14·1], and longer duration of illness [1·95, 1·56-2·43]), and were more likely to have died following overdoses (2·00, 1·62-2·45) than patients with other diagnoses. Childhood abuse (52 [37%] of 140) and domestic violence (18 [20%] of 91) were common in patients with eating disorders. Similar to patients with other diagnoses, most (244 [75%] of 326) of those with eating disorders who died by suicide were rated as low risk by clinicians at last contact. The number of suicide deaths in patients with eating disorders rose between 1997 and 2021 (incidence rate ratio [IRR] 1·03, 95% CI 1·02-1·05; p<0·0001), but rates fell when accounting for the greater number of patients entering mental health services (IRR 0·97, 0·95-1·00; p=0·033). INTERPRETATION This study was focused on people who sought help from mental health services. It did not consider subtypes of eating disorders or include a control group, but it does highlight possible areas for intervention. The comprehensive provision of evidence-based treatment for eating disorders and underlying conditions to address the clinical complexity in these patients might help to reduce suicide. Recognising limitations in clinical risk assessment, addressing early life experiences and current adversities, and appropriate prescribing might also be of benefit. Suicide prevention must remain a priority for eating disorder services and mental health care more widely. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Catherine Hercus
- Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia
| | - Alison Baird
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Saied Ibrahim
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Urvashnee Singh
- Esus Centre Integrated Eating Disorder Day Hospital, Perth, WA, Australia
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
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3
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Grilo CM. Treatment of Eating Disorders: Current Status, Challenges, and Future Directions. Annu Rev Clin Psychol 2024; 20:97-123. [PMID: 38211625 DOI: 10.1146/annurev-clinpsy-080822-043256] [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: 01/13/2024]
Abstract
Specific psychological treatments have demonstrated efficacy and represent the first-line approaches recommended for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Unfortunately, many patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments, and better or alternative treatments for eating disorders are needed. Less progress has been made in developing pharmacologic options for eating disorders. No medications approved for anorexia nervosa exist, and only one each exists for bulimia nervosa and for binge-eating disorder; available data indicate that most patients fail to benefit from available medications. Longer and combined treatments have generally not enhanced outcomes. This review presents emerging findings from more complex and clinically relevant adaptive treatment designs, as they offer some clinical guidance and may serve as models for future enhanced treatment research.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry and Department of Psychology, Yale University, New Haven, Connecticut, USA;
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Kasson E, Szlyk HS, Li X, Constantino-Pettit A, Smith AC, Vázquez MM, Wilfley DE, Taylor CB, Fitzsimmons-Craft EE, Cavazos-Rehg P. Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches. Int J Eat Disord 2024; 57:1518-1531. [PMID: 38445416 PMCID: PMC11262972 DOI: 10.1002/eat.24186] [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: 09/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa M Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Fochtmann LJ, Medicus J, Hong SH. Practice Assessment Tool for the Care of Patients With Eating Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:350-368. [PMID: 38988459 PMCID: PMC11231481 DOI: 10.1176/appi.focus.20240009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Eating disorders are characterized by significant disturbances in eating patterns associated with negative attitudes toward one's body, weight, and shape. They are associated with an increased risk of mortality and morbidity as well as significant health, economic, and psychosocial burdens. Additionally, individuals with eating disorders often hesitate to seek treatment and symptoms may be difficult to ascertain without structured assessment. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders aims to enhance knowledge and increase the appropriate use of interventions for eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with eating disorders. This practice assessment activity can also be used in fulfillment of Continuing Medical Education and ABPN Continuing Certification, Improvement in Medical Practice.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Advocacy, Policy, and Practice Advancement, American Psychiatric Association, Washington, DC (all authors)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Advocacy, Policy, and Practice Advancement, American Psychiatric Association, Washington, DC (all authors)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Advocacy, Policy, and Practice Advancement, American Psychiatric Association, Washington, DC (all authors)
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Nguyen N, Woodside DB, Lam E, Quehenberger O, German JB, Shih PAB. Fatty Acids and Their Lipogenic Enzymes in Anorexia Nervosa Clinical Subtypes. Int J Mol Sci 2024; 25:5516. [PMID: 38791555 PMCID: PMC11122126 DOI: 10.3390/ijms25105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Disordered eating behavior differs between the restricting subtype (AN-R) and the binging and purging subtype (AN-BP) of anorexia nervosa (AN). Yet, little is known about how these differences impact fatty acid (FA) dysregulation in AN. To address this question, we analyzed 26 FAs and 7 FA lipogenic enzymes (4 desaturases and 3 elongases) in 96 women: 25 AN-R, 25 AN-BP, and 46 healthy control women. Our goal was to assess subtype-specific patterns. Lauric acid was significantly higher in AN-BP than in AN-R at the fasting timepoint (p = 0.038) and displayed significantly different postprandial changes 2 h after eating. AN-R displayed significantly higher levels of n-3 alpha-linolenic acid, stearidonic acid, eicosapentaenoic acid (EPA), docosapentaenoic acid, and n-6 linoleic acid and gamma-linolenic acid compared to controls. AN-BP showed elevated EPA and saturated lauric acid compared to controls. Higher EPA was associated with elevated anxiety in AN-R (p = 0.035) but was linked to lower anxiety in AN-BP (p = 0.043). These findings suggest distinct disordered eating behaviors in AN subtypes contribute to lipid dysregulation and eating disorder comorbidities. A personalized dietary intervention may improve lipid dysregulation and enhance treatment effectiveness for AN.
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Affiliation(s)
- Nhien Nguyen
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA
| | - D. Blake Woodside
- Centre for Mental Health, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Eileen Lam
- Centre for Mental Health, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Oswald Quehenberger
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA
| | - J. Bruce German
- Department of Food Science & Technology, University of California, Davis, Davis, CA 95616, USA;
| | - Pei-an Betty Shih
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA
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Samara MT, Michou N, Lappas AS, Argyrou A, Mathioudaki E, Bakaloudi DR, Tsekitsidi E, Polyzopoulou ZA, Christodoulou N, Papazisis G, Chourdakis M. Is cognitive behavioral therapy more effective than pharmacotherapy for binge spectrum disorders? A systematic review and meta-analysis. Aust N Z J Psychiatry 2024; 58:308-319. [PMID: 38179705 DOI: 10.1177/00048674231219593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Binge spectrum disorders are prevalent worldwide. Psychiatric and medical comorbidities are common, and societal costs are significant. Evidence-based treatment remains underutilized. Cognitive behavioral therapy is the recommended first-line treatment, but pharmacotherapy may be easier to access. INTERVENTIONS Meta-analytic evidence directly comparing cognitive behavioral therapy with pharmacotherapy is lacking. We aimed to compare the effects of cognitive behavioral therapy interventions with any pharmacological treatment for binge spectrum disorders. We searched PubMed, Embase, CENTRAL, ClinicalTrials.gov and reference lists for randomized controlled trials comparing cognitive behavioral therapy with any pharmacotherapy for bulimia nervosa/binge eating disorder and performed pairwise meta-analytic evaluations. PRIMARY OUTCOMES Primary outcomes are remission and frequency of binges. Secondary outcomes are frequency of purges, response, eating disorder psychopathology, weight/body mass index, depression, anxiety, quality of life and dropouts. RESULTS Eleven randomized controlled trials comparing cognitive behavioral therapy with fluoxetine/imipramine/desipramine/methylphenidate/sibutramine were identified (N = 531). Cognitive behavioral therapy was superior to antidepressants in terms of remission, frequency of binges and eating disorder psychopathology. There were no statistically significant differences for any of the individual cognitive behavioral therapy vs drug comparisons in terms of response/depression/anxiety/weight/quality of life/dropouts. Cognitive behavioral therapy was not superior to sibutramine/methylphenidate for the primary outcomes. CONCLUSIONS Data are scarce, comparisons underpowered and, considering the inherent methodological limitations of psychotherapy trials, questions arise regarding the presumed superiority of cognitive behavioral therapy. Further research is needed.
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Affiliation(s)
- Myrto T Samara
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Niki Michou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas S Lappas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
- Aneurin Bevan University Health Board, Wales, UK
| | - Aikaterini Argyrou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elissavet Mathioudaki
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Zoi A Polyzopoulou
- Department of Psychology, University of Western Macedonia, Florina, Greece
| | - Nikos Christodoulou
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Cook-Cottone C, Harriger JA, Tylka TL, Wood-Barcalow NL. Virtually possible: strategies for using telehealth in eating disorder treatment learned from the COVID-19 pandemic. Eat Disord 2024; 32:99-119. [PMID: 37772856 DOI: 10.1080/10640266.2023.2261762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
The COVID-19 pandemic resulted in an abrupt shift from in-person to virtual treatment, and clinicians continue to offer telehealth due to its advantages. Telehealth may be a viable, effective, and safe treatment modality for many clients with eating disorders. We consider contemporary issues regarding the use of telehealth in eating disorder treatment and identify strategies to enhance its delivery. First, we emphasize key factors when choosing therapy delivery (telehealth, in-person, or hybrid). Second, we address telehealth-specific planning, preparation, safety, and privacy considerations. Third, we discuss how eating disorder assessment and evidence-based interventions can be adapted for telehealth delivery. Fourth, we raise telehealth-specific challenges related to group-based delivery and the therapeutic alliance offering alternative avenues for connection and engagement. We conclude with a discussion of how additional research is needed to refine the presented strategies, develop new strategies, and assess their efficacy and effectiveness.
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Affiliation(s)
- Catherine Cook-Cottone
- Department of Counseling, School, and Educational Psychology, University at Buffalo, State University of New York
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Danon M, Duriez P, Gorwood P. Three clinical indicators of borderline personality disorder in anorexia nervosa: A pilot study. L'ENCEPHALE 2024; 50:4-10. [PMID: 36411120 DOI: 10.1016/j.encep.2022.09.006] [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: 06/02/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%-40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity. METHODS After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R). RESULTS B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score. CONCLUSIONS The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.
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Affiliation(s)
- M Danon
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France.
| | - P Duriez
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
| | - P Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
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10
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Lin JA, Stamoulis C, DiVasta AD. Associations between nutritional intake, stress and hunger biomarkers, and anxiety and depression during the treatment of anorexia nervosa in adolescents and young adults. Eat Behav 2023; 51:101822. [PMID: 38504970 PMCID: PMC10948047 DOI: 10.1016/j.eatbeh.2023.101822] [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] [Indexed: 03/21/2024]
Abstract
Adolescents and young adults (AYA) with anorexia nervosa (AN) frequently have co-occurring anxiety and depression, which can negatively impact prognosis. To inform treatment of co-occurring anxiety and depression, we assessed the association of nutritional intake and hunger/stress hormones on anxiety and depression using a six-month longitudinal study of 50 AYA females receiving care for AN. At baseline and six months, we measured anxiety (Spielberger State/Trait Anxiety Inventory [STAI]), depression (Beck Depression Inventory [BDI]), body mass index (BMI), 3-day dietary intake (total calories and proportion of fat, carbohydrate, protein), and serum cortisol, leptin, and adiponectin. We performed mixed effects linear regression analyses, adjusting for age, duration of AN, and percentage of median BMI (%mBMI). At baseline, median age was 16.3 (interquartile range [IQR]=2.5) years, duration of AN was 6 (IQR=8.8) months and %mBMI was 87.2 (IQR=10.5)%. Fifty-six percent had clinically significant anxiety; 30% had depression. Over 6 months, participants had significant improvements in %mBMI (+2.2[IQR=9.2]%, p<.01), STAI (-9.0[IQR=25.0], p<.01), and BDI (-5.0[IQR=13.8], p<.01) scores. Participants with larger improvements in caloric intake had greater improvements in STAI (p=.03) and BDI scores (p=.04). Larger improvement in BDI was significantly associated with increased fat intake (p<.01), but not carbohydrate or protein intake. Change in STAI was not associated with changes in fat, carbohydrate, or protein intake. Changes in STAI or BDI scores were not associated with changes in cortisol, leptin, or adiponectin. Increased caloric intake may augment treatment of co-occurring anxiety and depression, and increased fat intake may improve depression for AYA with AN.
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Affiliation(s)
- Jessica A. Lin
- Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Department of Pediatrics, University of Cincinnati Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital
| | - Catherine Stamoulis
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital Department of Pediatrics, Harvard Medical School
| | - Amy D. DiVasta
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital Department of Pediatrics, Harvard Medical School
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Soullane S, Israël M, Steiger H, Chadi N, Low N, Dewar R, Ayoub A, Auger N. Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders. Int J Eat Disord 2023; 56:2223-2231. [PMID: 37646466 DOI: 10.1002/eat.24052] [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: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.
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Affiliation(s)
- Safiya Soullane
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mimi Israël
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ron Dewar
- Cancer Care Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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12
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Lin JA, Jhe G, Adhikari R, Vitagliano JA, Rose KL, Freizinger M, Richmond TK. Triggers for eating disorder onset in youth with anorexia nervosa across the weight spectrum. Eat Disord 2023; 31:553-572. [PMID: 37039575 DOI: 10.1080/10640266.2023.2201988] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
To aid in more targeted eating disorder (ED) prevention efforts, we sought to identify sociodemographic and weight-related risk factors for identified triggers for the onset of anorexia nervosa (AN) in youth. We conducted a retrospective chart review of youth admitted for medical treatment of AN between January 2015 and February 2020. From multidisciplinary admission notes, we extracted patient-reported reasons for diet/exercise changes. We used qualitative thematic analysis to identify ED triggers, then categorized each trigger as binary variables (presence/absence) for logistic regression analysis of risks associated with each trigger. Of 150 patients, mean (SD) age was 14.1(2.3) years. A total of 129 (86%) were female and 120 (80%) were Non-Hispanic White. Triggers included environmental stressors (reported by 30%), external pressures of the thin/fit ideal (29%), internalized thin/fit ideal (29%), weight-related teasing (19%), and receiving health education (14%). Younger age was associated with higher odds of weight-related teasing (p = .04) and health education (p = .03). Males had greater odds of internalized thin/fit ideal than females (p = .04). Those with premorbid body mass indices ≥85th percentile for age and sex had greater odds of reporting positive reinforcement (p = .03) and weight-related teasing (p = .04) than those with weights <85th percentile. We use these findings to detail potential targets for advancing ED prevention efforts.
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Affiliation(s)
- Jessica A Lin
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Grace Jhe
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Julia A Vitagliano
- Health and Social Behavior, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kelsey L Rose
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, Vermont, USA
| | - Melissa Freizinger
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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13
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Nagata JM, Smith-Russack Z, Paul A, Saldana GA, Shao IY, Al-Shoaibi AAA, Chaphekar AV, Downey AE, He J, Murray SB, Baker FC, Ganson KT. The social epidemiology of binge-eating disorder and behaviors in early adolescents. J Eat Disord 2023; 11:182. [PMID: 37833810 PMCID: PMC10571438 DOI: 10.1186/s40337-023-00904-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Binge-eating disorder (BED) is the most common eating disorder phenotype and is linked to several negative health outcomes. Yet, little is known about the social epidemiology of BED, particularly in early adolescence. The objective of this study was to examine the associations between sociodemographic characteristics and BED and binge-eating behaviors in a large, national cohort of 10-14-year-old adolescents in the United States (U.S.) METHODS: We conducted a cross-sectional analysis of two-year follow-up data from the Adolescent Brain Cognitive Development (ABCD) Study (2018 - 2020) that included 10,197 early adolescents (10 - 14 years, mean 12 years) in the U.S. Multivariable logistic regression models were used to assess the associations between sociodemographic characteristics and BED and binge-eating behaviors, defined based on the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS In this early adolescent sample (48.8% female, 54.0% White, 19.8% Latino/Hispanic, 16.1% Black, 5.4% Asian, 3.2% Native American, 1.5% Other), the prevalence of BED and binge-eating behaviors were 1.0% and 6.3%, respectively. Identifying as gay or bisexual (compared to heterosexual; adjusted odds ratio [AOR]: 2.25, 95% CI 1.01-5.01) and having a household income of less than $75,000 (AOR: 2.05, 95% CI: 1.21-3.46) were associated with greater odds of BED. Being male (AOR: 1.28, 95% CI: 1.06-1.55), of Native American (AOR: 1.60, 95% CI: 1.01-2.55) descent, having a household income less than $75,000 (AOR: 1.34, 95% CI: 1.08-1.65), or identifying as gay or bisexual (AOR for 'Yes' Response: 1.95, 95% CI: 1.31-2.91 and AOR for 'Maybe' Response: 1.81, 95% CI: 1.19-2.76) were all associated with higher odds of binge-eating behaviors. CONCLUSION Several sociodemographic variables showed significant associations with binge-eating behaviors, which can inform targeted screening, prevention, and education campaigns for BED among early adolescents.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
| | - Zacariah Smith-Russack
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Angel Paul
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Geomarie Ashley Saldana
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Iris Y Shao
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Abubakr A A Al-Shoaibi
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Anita V Chaphekar
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Amanda E Downey
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, 675 18th Street, San Francisco, CA, 94143, USA
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, 2001 Longxiang Boulevard, Longgang District, Shenzhen, 518172, China
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
- School of Physiology, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
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14
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Murray SB, Diaz-Fong JP, Duval CJ, Balkchyan AA, Nagata JM, Lee DJ, Ganson KT, Toga AW, Siegel SJ, Jann K. Sex differences in regional gray matter density in pre-adolescent binge eating disorder: a voxel-based morphometry study. Psychol Med 2023; 53:6077-6089. [PMID: 36305572 DOI: 10.1017/s0033291722003269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation. METHODS Pre-adolescent, 9-10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies. RESULTS Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED. CONCLUSIONS Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Joel P Diaz-Fong
- Department of Psychiatry & Behavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, CA, USA
| | - Christina J Duval
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Ane A Balkchyan
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Darrin J Lee
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
- USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Steven J Siegel
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kay Jann
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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15
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Eaton CM. Infant Feeding Experiences of Women Who Recovered From Anorexia Nervosa. J Obstet Gynecol Neonatal Nurs 2023; 52:384-393. [PMID: 37524312 DOI: 10.1016/j.jogn.2023.06.005] [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: 03/28/2023] [Revised: 06/28/2023] [Accepted: 06/03/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To describe the infant feeding experiences of women who recovered from anorexia nervosa (AN). DESIGN Descriptive phenomenology. SETTING Personal interviews. PARTICIPANTS Sixteen women with histories of AN. METHODS I used Colaizzi's descriptive phenomenological method. In individual audio-recorded interviews, I asked participants to describe their experiences of being mothers who recovered from AN and how this affected feeding their infants. RESULTS The direct and indirect effects of histories of AN permeated the participants' infant feeding experiences. Participants did not anticipate the overarching challenges of infant feeding in relation to AN, and nurses and clinicians lack guidelines for screening and management. I coded and analyzed 16 transcripts that revealed five overarching themes: Unbound: My Past Does Not Have to Predict the Future, Navigating the Rollercoaster of Pregnancy and the Postpartum Body, Ripples of Trauma in Infant Feeding, The Maddening Maze: Remnants of Anorexia, and Perfectly Imperfect: Recovery and Mothering. CONCLUSION Results elucidate the complexity of the infant feeding experiences of women who recovered from AN and the importance of screening for a history of AN. Nurses and women's health care providers should discuss the implications of such a history on prenatal planning, pregnancy, postpartum recovery, and the overall experience of infant feeding. This may help nurses and clinicians provide care for women with known histories of AN by improving the detection of possible symptoms and identifying referral sources for appropriate intervention.
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16
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Grilo CM, Juarascio A. Binge-Eating Disorder Interventions: Review, Current Status, and Implications. Curr Obes Rep 2023; 12:406-416. [PMID: 37439970 PMCID: PMC10528223 DOI: 10.1007/s13679-023-00517-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW Binge-eating disorder (BED) is a serious psychiatric problem associated with substantial morbidity that, unfortunately, frequently goes unrecognized and untreated. This review summarizes the current status of behavioral, psychological, pharmacological, and combined treatments for BED in adults with a particular focus on recent findings and advances. RECENT FINDINGS Certain specific psychological treatments, notably CBT and IPT, and to some extent DBT, have demonstrated efficacy and are associated with durable benefits after treatment. Certain specific lower-cost scalable interventions, notably CBTgsh, have demonstrated efficacy and have potential for broader uptake. An important advance is the emerging RCT data indicating that BWL, a generalist and available behavioral lifestyle intervention, has effectiveness that approximates that of CBT for reducing binge eating and eating-disorder psychopathology but with the advantage of also producing modest weight loss. There exists only one pharmacological agent (LDX) with approval by the FDA for "moderate-to-severe" BED. Research with other "off label" medications has yielded modest and mixed outcomes with a few medications statistically superior to placebo over the short-term and almost no longer-term data. Nearly all research combining medications and psychological treatments has failed to enhance outcomes (combined appears superior to pharmacotherapy-only but not to psychotherapy-only). Many people with BED suffer in silence and shame, go untreated, and rarely receive evidence-based treatments. Patients and practitioners need to recognize that research has identified several effective interventions for BED, and these can work quickly for many patients. Future research should identify treatments for those who do not derive benefit from initial interventions, identify additional pharmacological options, test agents with relevant mechanisms of action, and utilize innovative adaptative "SMART" designs to identify treatments to enhance outcomes among initial responders and to test alternative treatments to assist initial non-responders.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Yale Program for Obesity Weight and Eating Research (POWER), New Haven, CT, USA.
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
- Drexel University Center for Weight, Eating and Lifestyle Science (WELL), Philadelphia, PA, USA
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Duriez P, Goueslard K, Treasure J, Quantin C, Jollant F. Risk of non-fatal self-harm and premature mortality in the three years following hospitalization in adolescents and young adults with an eating disorder: A nationwide population-based study. Int J Eat Disord 2023; 56:1534-1543. [PMID: 37092760 DOI: 10.1002/eat.23974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Eating disorders (ED) are associated with high rates of suicide attempts and premature mortality. However, data in large samples of adolescents and young adults are limited. This study aims to assess the risk of self-harm and premature mortality in young people hospitalized with an ED. METHODS Individuals aged 12 to 25 years old hospitalized in 2013-2014 in France with anorexia nervosa and/or bulimia nervosa as a primary or associated diagnosis were identified from French national health records. They were compared to two control groups with no mental disorders, and with any other mental disorder than ED. The main outcomes were any hospitalization for deliberate self-harm and mortality in the 3 years following hospitalization. Logistic regression models were used. RESULTS This study included 5, 452 patients hospitalized with an ED, 14,967 controls with no mental disorder, and 14,242 controls with a mental disorder other than an ED. During the three-year follow-up, 13.0% were hospitalized for deliberate self-harm (vs. 0.2 and 22.0%, respectively) and 0.8% died (vs. 0.03 and 0.4%). After adjustment, hospitalization with an ED was associated with more self-harm hospitalizations (hazard ratio [HR] = 46.0, 95% confidence interval [32.3-65.3]) and higher all-cause mortality (HR = 12.6 [4.3-37.3]) relative to youths without any mental disorder; less self-harm hospitalizations (HR = 0.5 [0.5-0.6]) but higher mortality (HR = 1.6 [1.0-2.4]) when compared to youths with any other mental disorder. CONCLUSION Young patients hospitalized with an ED are at high risk of self-harm and premature mortality. It is urgent to evaluate and implement the best strategies for post-discharge care and follow-up. PUBLIC SIGNIFICANCE We found that the risk of being hospitalized for a suicide attempt is 46 times higher and mortality 13 times higher than the general population in adolescents and young adults during the 3 years following hospitalization with an eating disorder. Eating disorders are also associated with a 1.5 higher risk of premature mortality relative to other mental disorders. This risk is particularly high in the 6 months following hospitalization. It is therefore crucial to implement careful post-discharge follow-up in patients hospitalized for eating disorders.
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Affiliation(s)
- Philibert Duriez
- CMME, Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris, France
- UMR_S1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm, Paris, France
- Faculty of Medicine, Université de Paris, Paris, France
| | - Karine Goueslard
- Service de Biostatistiques et d'Information Médicale (DIM), CHRU Dijon, Dijon, France
| | - Janet Treasure
- Psychology and Neuroscience, Section of Eating Disorders, Institute of Psychiatry, London, UK
| | - Catherine Quantin
- CIC 1432, INSERM, Dijon, France
- Clinical Epidemiology Clinical Trials Unit, Clinical Investigation Center, CHU Dijon, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Fabrice Jollant
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU Bicêtre, Le Kremlin-Bicêtre, France
- Department of Psychiatry, CHU de Nîmes, Nîmes, France
- Department of Psychiatry, Faculty of Medicine, and McGill Group For Suicide Studies, McGill University, Montréal, Québec, Canada
- Team MOODS, Centre de recherche en Épidémiologie et Santé des Populations (CESP), Inserm, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Kustov GV, Zinchuk MS, Popova SB, Mishin IN, Voinova NI, Yakovlev AA, Akzhigitov RG. Factors associated with lifetime history of eating disorder in non-psychotic patients with suicidal ideation. CONSORTIUM PSYCHIATRICUM 2023; 4:53-63. [PMID: 38250641 PMCID: PMC10795959 DOI: 10.17816/cp6555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/23/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Data on the sociodemographic, biographical, and clinical factors associated with a lifetime diagnosis of eating disorders (ED) in patients with non-psychotic mental disorders (NPMD) and suicidal ideation (SI) are scarce. METHODS A cohort study was conducted at the Moscow Research and Clinical Center for Neuropsychiatry. The sample consisted of consecutive patients with non-psychotic mental disorders and SI, aged 1845 years. Participants with a lifetime diagnosis of anorexia and/or bulimia (then in remission or recovery) were compared with those without ED in terms of their sociodemographic profile, clinical characteristics, lifetime traumatic events, and some behavioral patterns. All participants underwent the Russian version of the Self-Injurious Thoughts and Behaviors Interview and completed the Brief Reasons for Living Inventory, the State and Trait Anxiety Inventory, and the Beck Depression Inventory. RESULTS A total of 892 patients with non-psychotic mental disorders and SI were included in the study. The mean age was 25.7 years, and 84% were assigned female at birth. Same-sex experience was more common in the ED group. Patients with an ED were more likely to have a history of physical and sexual abuse and to have witnessed domestic violence. The proportion of participants with piercings, tattoos, or severe body modifications was significantly higher in the ED group. Patients with a lifetime ED were more likely to engage in nonsuicidal self-injurious behaviors and to have a history of suicide attempts. CONCLUSION Lifetime ED in NPMD patients with SI is associated with younger age, being assigned female at birth, having an alternative gender identity, having same-sex experience, having more than one psychiatric diagnosis, having been diagnosed with bipolar disorder, experiencing severe depression and anxiety, being exposed to multiple traumatic experiences, having various body modifications, practicing NSSI, and having a lifetime story of suicide attempts.
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Affiliation(s)
- George V. Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Mikhail S. Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Sofya B. Popova
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Ilya N. Mishin
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Nadezhda I. Voinova
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
| | - Alexander A. Yakovlev
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
- Department of Functional Biochemistry of Nervous System, Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences
| | - Renat G. Akzhigitov
- Moscow Research and Clinical Center for Neuropsychiatry of Moscow Healthcare Department
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19
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Polskaya NA, Basova AY, Razvaliaeva AY, Yakubovskaya DK, Vlasova NV, Abramova AA. Non-suicidal self-injuries and suicide risk in adolescent girls with eating disorders: associations with weight control, body mass index, and interpersonal sensitivity. CONSORTIUM PSYCHIATRICUM 2023; 4:65-77. [PMID: 38250646 PMCID: PMC10795949 DOI: 10.17816/cp6803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Eating disorders (EDs) are associated with a risk of premature death, as well as suicidal and self-injurious behavior. A low or high body mass index (BMI) and weight control behavior can also have an impact on self-injurious and suicidal behavior. While some studies show that interpersonal sensitivity is a risk factor for EDs, affective disorders, and self-injurious behavior, in-depth studies of these issues have not been done. AIM The present study investigates how self-injurious and suicidal behavior relate to weight control behavior, BMI, and interpersonal sensitivity in adolescent girls from a clinical population with diagnosed EDs compared with adolescent girls from the general population. METHODS The main group was comprised of 31 girls with a diagnosis of ED (as the main diagnosis or co-occurring with affective disorders, M=151.13 years), being treated in in the Eating Disorder Clinic of the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva. The comparison group consisted of 27 adolescent girls recruited from Proton Educational Center (M=15.511.09 years). The measures included a qualitative survey that yielded data on weight control behavior, and self-injurious behavior, a Blitz questionnaire probing the suicide risk (used only in the main group), and the Interpersonal Sensitivity Measure. Height and weight data were also recorded for BMI calculation. RESULTS The qualitative analysis of weight control behavior yielded the following results: purging behavior, restrictive behavior, and corrective behavior. Participants in the main group used purging and restrictive behavior more often, whereas participants in the comparison group used strategies associated with a healthy lifestyle. The main group and participants who practiced purging and restrictive weight control in the overall sample had the smallest BMI. Self-injurious behavior was approximately evenly distributed both amongst the main and comparison groups. Self-cutting was the most prevalent type of self-injury. In the main group, self-injury was associated with a smaller BMI, while in the comparison group it was associated with an increase in the fear of rejection and overall interpersonal sensitivity. Based on the assessment of the suicide risk, six participants in the main group were deemed high-risk; they also displayed increased fear of rejection, dependence on the assessments of others, and overall interpersonal sensitivity. All girls in the suicide risk subgroup had non-suicidal self-injuries. CONCLUSION The results of our study broaden our understanding of the risk factors of suicidal and self-injurious behavior in adolescent girls with EDs and reveal the characteristics of the type of weight control behavior used by this group in comparison with adolescent girls in the general population. Girls with EDs who were considered at the risk of committing suicide demonstrated high interpersonal sensitivity, which provides a rationale for further studying the general interpersonal mechanisms that underlie the pathogenesis of EDs, as well as that of self-injurious and suicidal behavior.
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Affiliation(s)
- Natalia A. Polskaya
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
- Moscow State University of Psychology & Education
| | - Anna Y. Basova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
- Pirogov Russian National Research Medical University
| | | | - Daria K. Yakubovskaya
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
| | | | - Anna A. Abramova
- Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva
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de Moraes CEF, Donnelly B, Appolinario JC, Hay P. Obtaining long-term recovery: advances in optimizing treatment outcomes in patients with binge-eating disorder. Expert Rev Neurother 2023; 23:1097-1111. [PMID: 37916419 DOI: 10.1080/14737175.2023.2273392] [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: 05/30/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated. AREAS COVERED This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including 'assessment' OR 'treatment' OR 'diagnosis' OR 'mechanisms' AND 'binge eating' OR 'binge-eating disorder' for manuscripts published between January 2013 and April 2023. EXPERT OPINION Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.
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Affiliation(s)
- Carlos Eduardo Ferreira de Moraes
- Obesity and Eating Disorders Group (GOTA), Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Brooke Donnelly
- Clinical Psychology Unit, School of Psychology, University of Sydney, Camperdown, Australia
| | - Jose Carlos Appolinario
- Obesity and Eating Disorders Group (GOTA), Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Mental Health Services, South West Sydney Local Health District (SWSLHD), Campbelltown, Australia
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21
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Murray SB, Alba C, Duval CJ, Nagata JM, Cabeen RP, Lee DJ, Toga AW, Siegel SJ, Jann K. Aberrant functional connectivity between reward and inhibitory control networks in pre-adolescent binge eating disorder. Psychol Med 2023; 53:3869-3878. [PMID: 35301976 DOI: 10.1017/s0033291722000514] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Behavioral features of binge eating disorder (BED) suggest abnormalities in reward and inhibitory control. Studies of adult populations suggest functional abnormalities in reward and inhibitory control networks. Despite behavioral markers often developing in children, the neurobiology of pediatric BED remains unstudied. METHODS 58 pre-adolescent children (aged 9-10-years) with BED (mBMI = 25.05; s.d. = 5.40) and 66 age, BMI and developmentally matched control children (mBMI = 25.78; s.d. = 0.33) were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in resting-state functional MRI functional connectivity (FC) within and between reward and inhibitory control networks. A seed-based approach was employed to assess nodes in the reward [orbitofrontal cortex (OFC), nucleus accumbens, amygdala] and inhibitory control [dorsolateral prefrontal cortex, anterior cingulate cortex (ACC)] networks via hypothesis-driven seed-to-seed analyses, and secondary seed-to-voxel analyses. RESULTS Findings revealed reduced FC between the dlPFC and amygdala, and between the ACC and OFC in pre-adolescent children with BED, relative to controls. These findings indicating aberrant connectivity between nodes of inhibitory control and reward networks were corroborated by the whole-brain FC analyses. CONCLUSIONS Early-onset BED may be characterized by diffuse abnormalities in the functional synergy between reward and cognitive control networks, without perturbations within reward and inhibitory control networks, respectively. The decreased capacity to regulate a reward-driven pursuit of hedonic foods, which is characteristic of BED, may in part, rest on this dysconnectivity between reward and inhibitory control networks.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Celina Alba
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Christina J Duval
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Ryan P Cabeen
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Darrin J Lee
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
- USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Steven J Siegel
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kay Jann
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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22
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Shepherd CB, Boswell RG, Genet J, Oliver-Pyatt W, Stockert C, Brumm R, Riebl S, Crowe E. Outcomes for binge eating disorder in a remote weight-inclusive treatment program: a case report. J Eat Disord 2023; 11:80. [PMID: 37218018 DOI: 10.1186/s40337-023-00804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There are no known published reports on outcomes for medically and psychiatrically compromised patients with binge eating disorder (BED) treated remotely in higher level of care settings. This case report presents outcomes of an intentionally remote weight-inclusive partial hospitalization and intensive outpatient program based on Health at Every Size® and intuitive eating principles. CASE PRESENTATION The patient presented with an extensive trauma background and long history of disturbed eating and body image. She was diagnosed with BED along with several comorbidities, most notably major depressive disorder with suicidality and non-insulin dependent diabetes mellitus. She completed a total of 186 days in the comprehensive, multidisciplinary treatment program encompassing individual and group therapy, as well as other supportive services such as meal support and in vivo exposure sessions. Upon discharge, her BED was in remission, her major depressive disorder was in partial remission, and she no longer exhibited signs of suicidality. Overall, she showed decreases in eating disorder, depressive, and anxiety symptoms as well as increases in quality of life and intuitive eating throughout treatment, which were largely maintained after one year. CONCLUSIONS This case highlights the potential of remote treatment as an option for individuals with BED, especially in cases where access to higher levels of care might be limited. These findings exemplify how a weight-inclusive approach can be effectively applied when working with this population.
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Affiliation(s)
- Caitlin B Shepherd
- Within Health, Coconut Grove, FL, USA.
- Department of Psychology, Smith College, Northampton, MA, USA.
| | - Rebecca G Boswell
- Princeton Center for Eating Disorders, Penn Medicine, Plainsboro, NJ, USA
- Department of Psychology, Princeton University, Princeton, NJ, USA
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Arnold S, Correll CU, Jaite C. Frequency and correlates of lifetime suicidal ideation and suicide attempts among consecutively hospitalized youth with anorexia nervosa and bulimia nervosa: results from a retrospective chart review. Borderline Personal Disord Emot Dysregul 2023; 10:10. [PMID: 36998054 PMCID: PMC10064676 DOI: 10.1186/s40479-023-00216-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/25/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Youth with eating disorders (EDs) face an increased risk of a premature suicide death. Precursors of completed suicide are suicidal ideation and suicide attempts, which need to be well understood to prevent suicide. However, epidemiological data on the lifetime prevalence and clinical correlates of suicidal ideation and suicide attempts (i.e., "suicidality") are lacking for the vulnerable group of inpatient ED youth. METHODS This retrospective chart review was conducted at a psychiatric child and adolescent inpatient department, covering a 25-year period. Consecutively hospitalized youth with an ICD-10 diagnosis of anorexia nervosa (AN), restricting type (AN-R), binge-purging type (AN-BP), and bulimia nervosa (BN) were included. Data extraction and coding were standardized with trained raters extracting information from patient records according to a procedural manual and using a piloted data extraction template. The lifetime prevalence of suicidal ideation and suicide attempts was calculated for each ED subgroup, and clinical correlates of suicidality were analyzed via multivariable regression analyses. RESULTS In the sample of 382 inpatients aged 9-18 years (median age = 15.6, females = 97.1%; AN-R: n = 242, BN: n = 84, AN-BP: n = 56), 30.6% of patients had lifetime suicidal ideation (BN:52.4% ≈ AN-BP:44.6% > AN-R:19.8%, χ2(2,382) = 37.2, p < 0.001, Φ = 0.31), and 3.4% of patients reported a history of suicide attempts (AN-BP:8.9% ≈ BN:4.8% > AN-R:1.7%, χ2(2,382) = 7.9, p = 0.019, Φ = 0.14). Independent clinical correlates of suicidality were i) for AN-R a higher number of psychiatric comorbidities (OR = 3.02 [1.90, 4.81], p < 0.001), and body weight < 1st BMI percentile at hospital admission (OR = 1.25 [1.07,1.47], p = 0.005) (r2 = 0.20); ii) for AN-BP patients a higher number of psychiatric comorbidities (OR = 3.68 [1.50, 9.04], p = 0.004) and history of childhood abuse (OR = 0.16 [0.03, 0.96], p = 0.045) (r2 = 0.36), and iii) for BN patients a higher prevalence of non-suicidal self-injury (NSSI)(OR = 3.06 [1.37, 6.83], p = 0.006) (r2 = 0.13). CONCLUSIONS About half of youth inpatients with AN-BP and BN had lifetime suicidal ideation, and one-tenth of patients with AN-BP had attempted suicide. Treatment programs need to address specific clinical correlates of suicidality, namely, low body weight, psychiatric comorbidities, history of childhood abuse, and NSSI. TRIAL REGISTRATION This study was not a clinical trial but a retrospective chart review based on routinely assessed clinical parameters. The study includes data from human participants; however: (1) no intervention and no prospective assignment to interventions were performed, and (2) no evaluation of intervention in participants was accomplished.
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Affiliation(s)
- Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitaetsmedizin Berlin, corporate member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany
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25
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Mehler PS, Anderson K, Bauschka M, Cost J, Farooq A. Emergency room presentations of people with anorexia nervosa. J Eat Disord 2023; 11:16. [PMID: 36759897 PMCID: PMC9909152 DOI: 10.1186/s40337-023-00742-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
People with anorexia nervosa (AN) tend to shy away from engaging in typical primary care provider relationships in order to avoid detection. Therefore, they may seek care for their medical concerns through a local emergency department (ED). Inherently, AN is associated with a litany of medical complications, which become more prevalent as the severity of their eating disorder increases. Notwithstanding the typical young age at the onset of AN, no body system is immune to these medical complications. Thus, ED providers may need to pursue a medical diagnosis in order to explain presenting symptoms in people with AN. In addition to the medical issues, AN is also a serious mental illness with high mortality rates, including deaths by suicide. Therefore, ED providers also need to be familiar with relevant mental health issues for these people.
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Affiliation(s)
- Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA. .,University of Colorado School of Medicine, Denver, CO, USA.
| | - Kristin Anderson
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Maryrose Bauschka
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeana Cost
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,Eating Recovery Center, Denver, CO, USA
| | - Asma Farooq
- ACUTE Center for Eating Disorders at Denver Health, Denver, CO, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
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Crone C, Fochtmann LJ, Attia E, Boland R, Escobar J, Fornari V, Golden N, Guarda A, Jackson-Triche M, Manzo L, Mascolo M, Pierce K, Riddle M, Seritan A, Uniacke B, Zucker N, Yager J, Craig TJ, Hong SH, Medicus J. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders. Am J Psychiatry 2023; 180:167-171. [PMID: 36722117 DOI: 10.1176/appi.ajp.23180001] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Silva-Breen H, Schneider J, Tinoco A, Matheson EL, LaVoi NM. Development and preliminary validation of the Coach Self-Efficacy Body Image Scale (CSEBIS). Body Image 2022; 43:408-419. [PMID: 36345079 DOI: 10.1016/j.bodyim.2022.10.008] [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: 05/17/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022]
Abstract
Body image concerns are a commonly cited reason for sport drop out. Researchers have begun to explore the influence of coaches on athletes' body image. However, no measure exists to accurately and easily assess interventions or predict coaches' body image supportive behaviors. Using Self-Efficacy Theory as a conceptual framework, the Coach Self-Efficacy Body Image Scale (CSEBIS) was developed. Content validity was judged by a panel of experts (N = 3) and through interviews with coaches (N = 4) across various sports and experience levels. Following initial item iteration, the CSEBIS was assessed with 682 coaches for reliability and validity. The 27 items across four subscales (knowledge, recognition, engagement, disengagement) showed good reliability (internal consistency, test-retest reliability, inter-item and item-total correlations), validity (convergent and discriminant validity, differentiation between known groups), factor structure, and model invariance across gender. Developing and initially validating the CSEBIS contributes to the existing literature by providing researchers with a novel scale to measure coaches' confidence in identifying and addressing body image concerns among their athletes. Following further testing, this instrument may be used to assess the effectiveness of body image education and intervention efforts in sport, and the impact of coaches' attitudes and behaviors on athletes' body image.
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Affiliation(s)
- Hannah Silva-Breen
- The Tucker Center for Research on Girls & Women in Sport, University of Minnesota, 1900 University Avenue SE, Minneapolis, MN 55455, United States
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom.
| | - Aline Tinoco
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - Emily L Matheson
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, United Kingdom
| | - Nicole M LaVoi
- The Tucker Center for Research on Girls & Women in Sport, University of Minnesota, 1900 University Avenue SE, Minneapolis, MN 55455, United States
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Abstract
PURPOSE OF REVIEW Public policy efforts for prevention of and intervention upon eating disorders is severely limited in the United States due to the paucity of population-based data. This review article summarizes findings regarding eating disorders based on the National Epidemiological Studies on Alcohol and Related Conditions, Third Wave. The studies reviewed provide the most recent epidemiological indicators of anorexia nervosa, bulimia nervosa, and binge-eating disorder (BED) in the United States and demonstrate the utility of population-based data for validating the generalizability of findings from clinical samples. RECENT FINDINGS Anorexia nervosa, bulimia nervosa, and BED are widely distributed across sociodemographic characteristics, with substantially elevated risks for a variety of serious psychiatric, medical, and functional impairments, including heighted suicidality over the lifespan. Sexual minorities and individuals with adverse childhood experiences may be particularly vulnerable. Yet, many adults with eating disorders do not seek help, particularly professional help. National Epidemiological Studies on Alcohol and Related Conditions, Third Wave studies also validated some important clinical observations (e.g., overvaluation of shape/weight and physical inactivity in BED, more severe anorexia nervosa with onset prior to 14 years old). SUMMARY More rigorous population-based studies are needed to further advocate for appropriate resources and policies for eating disorders in the United States.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management and Behavior
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Valenciano-Mendoza E, Fernández-Aranda F, Granero R, Vintró-Alcaraz C, Mora-Maltas B, Valero-Solís S, Sánchez I, Toro JJD, Gómez-Peña M, Moragas L, Jiménez-Murcia S. Common and differential risk factors behind suicidal behavior in patients with impulsivity-related disorders: The case of bulimic spectrum eating disorders and gambling disorder. J Behav Addict 2022; 11:963-978. [PMID: 36287739 PMCID: PMC9881661 DOI: 10.1556/2006.2022.00072] [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: 11/18/2021] [Revised: 05/23/2022] [Accepted: 09/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Mental disorders with high levels of impulsivity such as bulimic spectrum eating disorders (BSED) and gambling disorder (GD) are associated with high risk of suicidal behavior. The aim of the present study was to identify the common and differential vulnerability factors behind suicide attempts in a sample of patients with BSED compared to patients with GD. METHODS A total of 6,077 adults who sought treatment and met criteria either for BSED (n = 2,391) or GD (n = 3,686) were assessed at a specialized hospital unit. Personality traits, psychopathological symptomatology, lifetime history of suicide attempts and socio-demographic variables were evaluated. RESULTS The prevalence of suicide attempts was higher for BSED patients (26.2%) compared to GD patients (7.1%) being anorexia nervosa (Binge/Purge type) and bulimia nervosa the most affected subtypes. In the predictive model, the transdiagnostic vulnerability factors with the highest contribution to the risk of suicidal behavior both in BSED and GD were unemployment, early age of onset of the disorder, worse psychopathological state, and self-transcendence personality trait. However, specific risk factors for suicidal acts were identified in each disorder: longer duration of the disorder, lower education levels and reward dependence were exclusively associated with BSED while female gender, older age, and higher harm avoidance were associated with GD. DISCUSSION Patients with GD and BSED share certain vulnerability factors although certain factors are exclusive to each disorder. CONCLUSIONS Interventions need to pay special attention to both common and specific vulnerability factors to mitigate the risk of suicidal acts in these disorders.
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Affiliation(s)
- Eduardo Valenciano-Mendoza
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Bernat Mora-Maltas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Valero-Solís
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
| | - Jessica Jimenez-de Toro
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain,Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain,Corresponding author. E-mail:
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The Relationship Between Age at Incarceration and Lifetime Suicide Attempt Among a Nationally Representative Sample of U.S. Adults. Community Ment Health J 2022; 58:1403-1415. [PMID: 35247109 DOI: 10.1007/s10597-022-00952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/05/2022] [Indexed: 11/03/2022]
Abstract
To examine the association between age at incarceration and lifetime suicide attempt (SA), and whether it differs by gender. Lifetime prevalence of SA was compared between respondents with no incarceration, juvenile, and adult incarceration who completed the 2012-2013 National Survey of Alcohol and Related Conditions-III (N = 36,107). We compared the odds of SA, adjusting for sociodemographic characteristics, psychiatric disorders, and childhood adverse experiences, and stratified the results by gender. Adjusted odds ratio (AOR) of SA relative to no incarceration history was 1.66 (95% Confidence Interval [CI] 1.32-2.07) for adult incarceration and 2.00 (95% CI 1.49-2.70) for juvenile incarceration. AOR of SA relative to no incarceration history was 2.14 (95% CI 1.56-2.93) for adult and 2.15 (95% CI 1.38-3.35) for juvenile incarceration in women; it was 1.73 (95% CI 1.14-2.60) in juvenile incarceration relative to no incarceration history in men. A history of incarceration may increase SA, particularly among juvenile and women offenders.
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, 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 English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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Lydecker JA, Grilo CM, Hamilton A, Barnes RD. Digital self-harm is associated with disordered eating behaviors in adults. Eat Weight Disord 2022; 27:2129-2136. [PMID: 35066861 PMCID: PMC9288535 DOI: 10.1007/s40519-021-01355-6] [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: 08/19/2020] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Eating-disorder psychopathology is associated with self-harm behaviors. With much time spent and many social interactions taking place online, self-cyberbullying has emerged as a new form of self-harm that is digital. The current study examined digital self-harm in adults and its associations with eating-disorder psychopathology and behaviors. METHODS Participants were adults (N = 1794) who completed an online cross-sectional survey. Participants reported whether they had ever posted mean things about themselves online, whether they had ever anonymously bullied themselves online and completed measures of eating-disorder psychopathology and disordered eating behaviors. RESULTS Digital self-harm was reported by adults across demographic characteristics and across the lifespan, although there were some significant differences in demographic characteristics associated with reported digital self-harm. Participants who engaged in digital self-harm were younger than those denying digital self-harm. Eating-disorder psychopathology and disordered eating behaviors were significantly higher among individuals reporting digital self-harm compared with age-matched controls. CONCLUSIONS This was the first study to examine digital self-harm among adults and the first study to examine associations of digital self-harm with eating-disorder psychopathology and disordered eating behaviors. Importantly, digital self-harm is reported by adults and therefore is not limited to youth. Our findings that digital self-harm is associated with disordered eating suggests that digital self-harm is a clinically significant topic that needs further research to inform clinical practice and clinical research. LEVEL OF EVIDENCE Level III, Evidence obtained from well-designed cohort or case-controlled analytic studies.
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Affiliation(s)
- Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Antonia Hamilton
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Rachel D Barnes
- Department of Psychiatry, Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.,Health Psychology, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Forrest LN, Grilo CM. Change in eating-disorder psychopathology network structure in patients with binge-eating disorder: Findings from treatment trial with 12-month follow-up. J Consult Clin Psychol 2022; 90:491-502. [PMID: 35482651 PMCID: PMC9247034 DOI: 10.1037/ccp0000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective treatments exist for binge-eating disorder (BED), although roughly 50% of patients fail to attain binge-eating abstinence. Evidence on how to refine treatments is lacking. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for the identification of the most strongly connected symptoms, which could inform intervention targets. This study assessed how BED symptom centrality changed with behaviorally based weight-loss treatments (BBWLTs). METHODS Participants were 191 adult patients (71% female, 79% White) with BED with comorbid obesity participating in a randomized controlled trial testing 6-month BBWLTs for BED. Independent assessments of BED symptoms were performed at pretreatment, posttreatment, and 12 months after treatment. Strength centrality indicated how strongly and frequently symptoms were associated with each other in the network. Significant changes in centrality between timepoints were determined using permutation tests. RESULTS At pretreatment, overvaluation of shape/weight and preoccupation with shape/weight and food/eating had the highest strength centrality. At posttreatment and 12-month follow-up, dissatisfaction with shape/weight had the highest centrality, which significantly increased from pretreatment. CONCLUSIONS The relations among symptoms of BED are not static and change over time with treatment. BBWLTs do not appear to reduce connectivity of overvaluation of shape/weight (the most central BED symptom prior to treatment), but instead increase connectivity of dissatisfaction with shape/weight with other symptoms following treatment. The observed network structure of symptoms following BBWLTs resembles network analyses of people without eating disorders. Findings highlight the importance of understanding how treatments impact symptom relationships, not just symptom intensities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Lauren N. Forrest
- Penn State College of Medicine, Department of Psychiatry and Behavioral Health, Hershey, PA. USA
| | - Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT. USA
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Convertino AD, Blashill AJ. Psychiatric comorbidity of eating disorders in children between the ages of 9 and 10. J Child Psychol Psychiatry 2022; 63:519-526. [PMID: 34225382 DOI: 10.1111/jcpp.13484] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Eating disorders exhibit high comorbidity with other psychiatric disorders, most notably mood, substance use, and anxiety disorders. However, most studies examining psychiatric comorbidity are conducted in adolescents and adults. Therefore, the comorbidity among children living with eating disorders is unknown. The aim of this study was to characterize co-occurring psychiatric disorders with eating disorders in a US sample of children aged 9-10 years old utilizing the Adolescent Brain Cognitive Development study. METHODS The analytic sample included 11,718 children aged 9-10 years. Anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder subtype diagnoses were examined. Statistical analyses were conducted using complex sampling. Odds ratios and 95% confidence intervals were calculated comparing the likelihood of being diagnosed for a psychiatric disorder when having an eating disorder, as compared to children without an eating disorder, children diagnosed with major depressive disorder, and children diagnosed with posttraumatic stress disorder using binary logistic regression. RESULTS Co-occurring psychiatric disorders were substantially higher in children with eating disorders as compared to children without eating disorders, but not as compared to children diagnosed with major depressive disorder or posttraumatic stress disorder. The most common comorbidities for the eating disorder group were anxiety disorders (71.4%), attention deficit/hyperactivity disorder (47.9%), disruptive/impulse control disorders (45.0%), mood disorders (29.6%), and obsessive-compulsive disorder (28.8%), largely in line with previous research. CONCLUSIONS This study extends prior research finding high rates of comorbidity in eating disorders, specifically with anxiety, mood, and disruptive/impulse control disorders. Clinicians assessing for psychiatric disorders should be aware that eating disorders can occur in children 9 and 10 years old and are associated with severe comorbidity. Referrals for specialty mental health care should be considered.
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Affiliation(s)
- Alexandra D Convertino
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Aaron J Blashill
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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Murray SB, Duval CJ, Balkchyan AA, Cabeen RP, Nagata JM, Toga AW, Siegel SJ, Jann K. Regional gray matter abnormalities in pre-adolescent binge eating disorder: A voxel-based morphometry study. Psychiatry Res 2022; 310:114473. [PMID: 35220054 DOI: 10.1016/j.psychres.2022.114473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 02/19/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with an array of multisystemic organ morbidity, broad psychiatric morbidity, and obesity. Despite behavioral markers often developing in early childhood, the neurobiological markers of early-onset BED remain understudied, and developmental pathophysiology remains poorly understood. METHODS 71 preadolescent children (aged 9-10-years) with BED and 74 age, BMI and developmentally matched control children were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development (ABCD) Study. We investigated group differences in gray matter density (GMD) via voxel-based morphometry (VBM). We additionally performed region of interest analyses, assessing the association between GMD in nodes of the reward (orbitofrontal cortex; OFC) and inhibitory control (dorsolateral prefrontal cortex; dlPFC) networks, and parent-reported behavioral inhibition and approach tendencies. RESULTS Diffuse elevations in cortical GMD were noted in those with BED, which spanned prefrontal, parietal, and temporal regions. No areas of reduced GMD were noted in those with BED. No alterations in subcortical GMD were noted. Brain-behavioral associations suggest a distinct and negative relationship between GMD in the OFC and dlPFC, respectively, and self-reported markers of hedonic behavioral approach tendencies. CONCLUSIONS Early-onset BED may be characterized by diffuse morphological abnormalities in gray matter density, suggesting alterations in cortical architecture which may reflect decreased synaptic pruning and arborization, or decreased myelinated fibers and therefore inter-regional afferents.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Translational Research in Eating Disorders Program, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States.
| | - Christina J Duval
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Translational Research in Eating Disorders Program, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Ane A Balkchyan
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States; Translational Research in Eating Disorders Program, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Ryan P Cabeen
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Steven J Siegel
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
| | - Kay Jann
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, United States
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Pruessner L, Hartmann S, Rubel JA, Lalk C, Barnow S, Timm C. Integrating a web-based intervention into routine care of binge-eating disorder: Study protocol for a randomized controlled trial. Internet Interv 2022; 28:100514. [PMID: 35281702 PMCID: PMC8907668 DOI: 10.1016/j.invent.2022.100514] [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: 12/06/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background Although binge eating disorder (BED) is the most common eating pathology and carries a high mental and physical burden, access to specialized treatment is limited due to patient-related barriers and insufficient healthcare resources. Integrating web-based self-help programs into clinical care for BED may address this treatment gap by making evidence-based eating disorder interventions more accessible. Methods A two-armed randomized controlled trial will be conducted to evaluate the effectiveness of a web-based self-help intervention for BED in routine care settings. Patients aged 18-65 years fulfilling the diagnostic criteria for BED (N = 152) will be randomly allocated to (1) an intervention group receiving a 12-week web-based self-help program or (2) a waitlist control group with delayed access to the intervention. The primary outcome will be the number of binge eating episodes. Secondary outcomes include global eating pathology, functional impairments, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. Measurements will be conducted at baseline (study entrance), 6 weeks after baseline (mid-treatment), and 12 weeks after baseline (post-treatment). To capture outcomes and treatment mechanisms in real-time, traditional self-reports will be combined with weekly symptom monitoring and ecological momentary assessment. Discussion Evaluating the effectiveness of web-based interventions is essential to overcome the treatment gap for patients with BED. When adequately integrated into standard care, these programs have the potential to alleviate the high burden of BED for individuals, their families, and society. Trial registration https://clinicaltrials.gov/ct2/show/NCT04876183, Identifier: NCT04876183 (registered on May 6th, 2021).
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Affiliation(s)
- Luise Pruessner
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Steffen Hartmann
- 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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Giel KE, Bulik CM, Fernandez-Aranda F, Hay P, Keski-Rahkonen A, Schag K, Schmidt U, Zipfel S. Binge eating disorder. Nat Rev Dis Primers 2022; 8:16. [PMID: 35301358 PMCID: PMC9793802 DOI: 10.1038/s41572-022-00344-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia
| | | | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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Lengvenyte A, Strumila R, Maimoun L, Seneque M, Olié E, Lefebvre P, Renard E, Courtet P, Guillaume S. A specific association between laxative misuse and suicidal behaviours in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord 2022; 27:307-315. [PMID: 33797033 DOI: 10.1007/s40519-021-01180-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Eating disorders (ED) are associated with an in increased risk of suicidal behaviours. Laxative abuse might alter the gut-brain axis signaling, that might be implicated in the pathophysiology of suicide. This study aims to determine the association between laxative misuse and suicide attempt (SA) and suicidal ideation (SI) in patients with ED. METHODS 277 patients with ED were recruited from an Eating Disorder Unit of Lapeyronie Academic Hospital, Montpellier, France. Sociodemographic and clinical data were collected. Chi-square and t test were used, with Bonferroni corrections where required. Multiple regression models assessed the relationships between laxative misuse, SA, and SI. RESULTS 62 (22.4%) patients reported lifetime laxative misuse. They were more likely to have a history of SA than non-misusers [43.83 vs 19.9%, p < 0.001, odds ratio (OR) 3.68]. In the multivariate model, adjusted for other confounders, lifetime laxative misuse remained associated with SA (adjusted OR 3.79, p = 0.041). In past 28 days, patients with SA history reported misusing laxatives for more days than patients without SA history (6 vs 1.5 days, p = 0.01, adjusted for vomiting and ED severity). Laxative use days during past 28 days was associated with current SI, adjusted for vomiting in the same period (p = 0.017). CONCLUSIONS Current and lifetime laxative misuse were associated with SA history and current SI in patients with ED, at least in part independently of other suicide-related factors. LEVEL OF EVIDENCE Level III cohort, cross-sectional study.
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Affiliation(s)
- Aiste Lengvenyte
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Robertas Strumila
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France.
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France.
- Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania.
| | - Laurent Maimoun
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295, Montpellier, France
| | - Maude Seneque
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes, and Nutrition, CHRU Montpellier, Montpellier, France
| | - Eric Renard
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- UMR CNRS 5203, INSERM U1191, Institute of Functional Genomics, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Sebastien Guillaume
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
- Department of Urgent and Post Urgent Psychiatry, CHU Montpellier, 371 Av. du Doyen Gaston Giraud, 34090, Montpellier, France
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Mueller NE, Duffy ME, Stewart RA, Joiner TE, Cougle JR. Quality over quantity? The role of social contact frequency and closeness in suicidal ideation and attempt. J Affect Disord 2022; 298:248-255. [PMID: 34728279 DOI: 10.1016/j.jad.2021.10.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/23/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Social support has been identified as a protective factor against suicidal thoughts and behaviors. Research has not conclusively identified the component of social support most implicated in suicidal thoughts and behaviors: (1) frequency of social contact or (2) closeness of relationships. This study examined the relationships between these facets of social support and suicidal thoughts and behaviors in two nationally representative samples, as well as subsamples with social anxiety disorder (SAD). METHODS Study 1 variables for lifetime and past-year suicide ideation and attempt, social contact frequency, and closeness were calculated and examined within the National Comorbidity Survey-Replication (NCS-R). Study 2 examined the independent contributions of social contact frequency and closeness to only lifetime suicide attempt in the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). RESULTS In the NCS-R, lower social closeness but not contact frequency was uniquely associated with suicidal ideation and attempt in the general sample and those with SAD. In the NESARC-III, both components of social support were associated with lifetime suicide attempt in the general sample, while only social closeness was uniquely associated with suicide attempt in the SAD subsample. LIMITATIONS This study utilized cross-sectional data and was limited in the validity and specificity of the variables assessed. DISCUSSION Lower social closeness was more strongly associated with suicidality than social contact frequency and merits attention as a potential target for suicide-related interventions. Social closeness may be especially relevant in populations experiencing high rates of suicidal thoughts and behaviors and decreased social support.
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Affiliation(s)
- Nora E Mueller
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA
| | - Mary E Duffy
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA
| | - Rochelle A Stewart
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, PO Box 3064301, Tallahassee, FL 32306, USA.
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Carrard I, Bucher Della Torre S. A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project. PLoS One 2021; 16:e0259796. [PMID: 34780528 PMCID: PMC8592424 DOI: 10.1371/journal.pone.0259796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Because of the serious consequences of eating disorders on young women’s lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18–25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants’ satisfaction with the interventions, group discussion at the end of the intervention, and with participants’ rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.
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Affiliation(s)
- Isabelle Carrard
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- * E-mail:
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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Abstract
PURPOSE OF REVIEW Binge eating disorder (BED) is a new diagnosis in the Fifth Edition of the Diagnostic and Statistic Manual of Mental Disorders (DSM-5) and the Eleventh Revision of the International Classification of Diseases (ICD-11). RECENT FINDINGS DSM-5 BED is currently estimated to affect 1.5% of women and 0.3% of men worldwide; a lifetime diagnosis of DSM-5 BED is reported by 0.6-1.8% of women and 0.3-0.7% of men. In adolescence, BED is even more prevalent, but often transient. Many adults with BED report longstanding symptoms; less than half are recognized in healthcare. Commonly co-occurring conditions include obesity, type 2 diabetes, and hypertension. In a nationally representative US-based study, up to 23% of individuals with BED had attempted suicide, and virtually all (94%) reported lifetime mental health symptoms: 70% mood disorders, 68% substance use disorders, 59% anxiety disorders, 49% borderline personality disorder, and 32% posttraumatic stress disorder. Data on mortality are scarce, but the standardized mortality ratio of BED is estimated to be 1.5-1.8. Various minority statuses, deprivation, violence, trauma, and major mental illness may increase the risk of BED. SUMMARY BED is often invisible and overlooked, perhaps due to societal biases. For this reason, prevention, detection, and management of BED are closely linked with social justice and equity.
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Abstract
BACKGROUND The nature and significance of impulse-control difficulties in binge-eating disorder (BED) are uncertain. Most emerging research has focused on food-specific rather than general impulsivity. The current study examines the clinical presentation of patients with BED categorized with and without clinical levels of general impulsivity. METHOD A total of 343 consecutive treatment-seeking patients with BED were categorized as having BED with general impulsivity (GI+; N = 73) or BED without general impulsivity (GI-: N = 270) based on structured diagnostic and clinical interviews. The groups were compared on demographic, developmental, and psychological features, and on rates of psychiatric and personality comorbidity. RESULTS Individuals with BED and general impulsivity (GI+) reported greater severity of eating-disorder psychopathology, greater depressive symptoms, and greater rates of comorbidity than those without general impulsivity (GI-). CONCLUSIONS A subtype of individuals with BED and general impulsivity may signal a more severe presentation of BED characterized by heightened and broader psychopathology. Future work should investigate whether these impulse-control difficulties relate to treatment outcomes.
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Bulik CM, Bertoia ML, Lu M, Seeger JD, Spalding WM. Suicidality risk among adults with binge-eating disorder. Suicide Life Threat Behav 2021; 51:897-906. [PMID: 34080227 PMCID: PMC8597150 DOI: 10.1111/sltb.12768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate relative suicidality risk associated with binge-eating disorder (BED). METHODS Retrospective study of patients identified as having BED (N = 1042) and a matched general population cohort (N = 10,420) from the Optum electronic health record database between January 2009 and September 2015. Patients had ≥1 outpatient encounter with a provider who recognized BED during the 12-month baseline preceding entry date. Incidence and relative risk of suicidality were assessed. RESULTS Incidence per 1000 person-years (95% CI) of suicidal ideation and suicide attempts, respectively, was 31.1 (23.1, 41.0) and 12.7 (7.9, 19.4) in the BED cohort and 5.8 (4.7, 7.1) and 1.4 (0.9, 2.2) in the comparator cohort. Risk of suicidal ideation and suicide attempts was greater in the BED cohort (HR [95% CIs], 6.43 [4.42, 9.37]) than in the comparator cohort (HR [95% CI], 9.47 [4.99, 17.98]) during follow-up. After adjusting for psychiatric comorbidities, associations of suicidal ideation and suicide attempts with BED remained elevated in patients with BED having histories of suicidality. CONCLUSIONS Findings suggest that history of suicidality may result in an increased risk of suicidal ideation and suicide attempts in patients with BED relative to the general population. Psychiatric comorbidity burden may explain the elevated risk of these conditions in BED.
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Affiliation(s)
- Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina School of MedicineChapel HillNCUSA,Department of NutritionGillings School of Global Public HealthUniversity of North CarolinaChapel HillNCUSA,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | | | - Mei Lu
- Takeda Pharmaceuticals USALexingtonMAUSA
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Hunt RA, Levinson CA. Self-Reported Interoceptive Sensibility Does Not Moderate the Relationship Between Eating Disorder Symptoms and Suicidal Thoughts and Behaviors. Behav Ther 2021; 52:1137-1144. [PMID: 34452668 DOI: 10.1016/j.beth.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/19/2022]
Abstract
Past research has demonstrated a strong relationship between eating disorders (EDs) and suicidality (i.e., suicidal thoughts, plans, and attempts), and preliminary work within the framework of the interpersonal psychological theory of suicide (Joiner, 2007) suggests that potentially painful ED behaviors (binge eating, purging, fasting, excessive exercise) may contribute to increased risk of suicide through heightened pain tolerance and increased capability of suicide. However, additional explanations are needed for why only some individuals with EDs actually engage in suicidal behaviors (i.e., attempt suicide), whereas others do not. A growing body of literature suggests that interoceptive deficits (a disconnection from one's own bodily sensations and emotions; IDs) might be a factor linking eating disorders and suicide. To better understand this relationship, the current study tests the moderating effects of self-reported IDs on the relations between ED behaviors and suicidality and past suicide attempts in a transdiagnostic ED sample (N = 181). We hypothesized that ED behaviors would directly relate to suicidality, but that IDs would moderate the relationship between ED behaviors and past suicide attempts, such that those high in IDs would demonstrate a stronger relationship between ED behaviors and suicide attempts. Contrary to our hypothesis, IDs did not moderate the relationship; instead, fasting and purging had significant and strong main effects on suicidality and past suicide attempts without moderation effects. Results suggest that fasting and purging may be important ED behaviors to consider in the relationship between EDs and suicidality. Future directions include further examining the relationship between IDs, suicidality, and EDs using measures of IDs that better encompass physical (as opposed to emotional) aspects of IDs.
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Freins à l’abord des troubles du comportement alimentaire en médecine générale. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Carr MM, Wiedemann AA, Macdonald-Gagnon G, Potenza MN. Impulsivity and compulsivity in binge eating disorder: A systematic review of behavioral studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110318. [PMID: 33794320 PMCID: PMC8222068 DOI: 10.1016/j.pnpbp.2021.110318] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 01/15/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Binge eating disorder (BED) often includes impulsive and compulsive behaviors related to eating behavior and food. Impulsivity and compulsivity generally may contribute to the etiology and maintenance of multiple psychiatric disorders including BED. This review aimed to identify and synthesize available behavioral studies of impulsivity and compulsivity among individuals with BED. METHOD A systematic search was performed focusing on BED and specific facets of impulsivity (rapid response and choice) and compulsivity (set-shifting, cognitive flexibility, and/or habit learning). All case-control studies comparing adults with either full-threshold or subthreshold BED to individuals with normal weight, overweight/obesity, or other eating disorders (e.g., bulimia nervosa) were included. RESULTS Thirty-two studies representing 29 unique samples met inclusion criteria. Increased choice impulsivity was observed among individuals with BED relative to individuals with normal weight. There were mixed findings and/or a lack of available evidence regarding rapid response impulsivity and compulsivity. The presence of between-group differences was not dependent on sample characteristics (e.g., full or sub threshold BED diagnosis, or treatment-seeking status). Heterogeneity relating to covariates, task methodologies, and power limited conclusions. CONCLUSIONS Literature supports a postive association between choice impulsivity and BED. More research is needed to determine if individuals with BED demonstrate elevated levels of either rapid response impulsivity or types of compulsivity. Careful selection of covariates and consideration of task methodologies and power would aid future research.
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Affiliation(s)
- Meagan M Carr
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT 06511, United States of America
| | - Ashley A Wiedemann
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT 06511, United States of America
| | - Grace Macdonald-Gagnon
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT 06511, United States of America
| | - Marc N Potenza
- Department of Psychiatry, Yale School of Medicine, 300 George St., New Haven, CT 06511, United States of America; Connecticut Mental Health Center, 34 Park St., New Haven, CT 06511, United States of America; Connecticut Council on Problem Gambling, 100 Great Meadow Rd, Wethersfield, CT 06109, United States of America; Child Study Center, Yale School of Medicine, 230 S Frontage Rd., New Haven, CT 06519, United States of America; Department of Neuroscience, Yale University, One Church Street, New Haven, CT 06510, United States of America.
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47
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Mental Pain in Eating Disorders: An Exploratory Controlled Study. J Clin Med 2021; 10:jcm10163584. [PMID: 34441880 PMCID: PMC8397208 DOI: 10.3390/jcm10163584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 12/12/2022] Open
Abstract
Mental pain (MP) is a transdiagnostic feature characterized by depression, suicidal ideation, emotion dysregulation, and associated with worse levels of distress. The study explores the presence and the discriminating role of MP in EDs in detecting patients with higher depressive and ED-related symptoms. Seventy-one ED patients and 90 matched controls completed a Clinical Assessment Scale for MP (CASMP) and the Mental Pain Questionnaire (MPQ). ED patients also completed the Beck Depression Inventory-II (BDI-II), Clinical Interview for Depression (CID-20), and Eating Attitudes Test (EAT-40). ED patients exhibited significantly greater severity and higher number of cases of MP than controls. Moreover, MP resulted the most important cluster predictor followed by BDI-II, CID-20, and EAT-40 in discriminating between patients with different ED and depression severity in a two-step cluster analysis encompassing 87.3% (n = 62) of the total ED sample. Significant positive associations have been found between MP and bulimic symptoms, cognitive and somatic-affective depressive symptoms, suicidal tendencies, and anxiety-related symptoms. In particular, those presenting MP reported significantly higher levels of depressive and anxiety-related symptoms than those without. MP represents a clinical aspect that can help to detect more severe cases of EDs and to better understand the complex interplay between ED and mood symptomatology.
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Masheb RM, Ramsey CM, Marsh AG, Decker SE, Maguen S, Brandt CA, Haskell SG. DSM-5 eating disorder prevalence, gender differences, and mental health associations in United States military veterans. Int J Eat Disord 2021; 54:1171-1180. [PMID: 33665848 DOI: 10.1002/eat.23501] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Little is known about prevalence estimates of new and revised DSM-5 eating disorders diagnoses in general, and especially among high-risk, underserved and diverse eating disorder populations. The aim of the current study was to determine prevalence, gender differences and correlates of DSM-5 eating disorders in veterans. METHOD Iraq and Afghanistan war era veterans (N = 1,121, 51.2% women) completed the Eating Disorder Diagnostic Scale-5 and validated measures of eating pathology and mental health between July 2014 and September 2019. RESULTS Overall more women than men (32.8% vs. 18.8%, p < .001) reported symptoms consistent with a DSM-5 eating disorder. Prevalence estimates (women vs. men) for the specific diagnoses were: Anorexia Nervosa (AN; 0.0% vs. 0.0%), Bulimia Nervosa (BN; 6.1% vs. 3.5%), Binge-Eating Disorder (BED; 4.4% vs. 2.9%), Atypical AN (AAN; 13.6% vs. 4.9%), Subclinical BN (0.0% vs. 0.2%), Subclinical BED (1.4% vs. 0.6%), Purging Disorder (2.1% vs. 0.7%), and Night Eating Syndrome (NES; 5.2% vs. 6.0%). Women were more likely to have BN or AAN, and there was no difference for BED or NES among genders. The eating disorder group had a higher mean BMI, and significantly greater eating pathology and mental health symptoms than the non-eating disorder group. DISCUSSION Approximately one-third of women, and one-fifth of men, reported symptoms consistent with a DSM-5 eating disorder diagnosis. These high prevalence estimates across genders, and associated mental health concerns, suggest an urgent need to better understand and address eating disorders in military and veteran populations.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Christine M Ramsey
- Yale School of Medicine, New Haven, Connecticut, USA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Alison G Marsh
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Suzanne E Decker
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Shira Maguen
- University of California San Francisco Medical School, San Francisco, CA, USA.,San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
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Eating Disorders and Suicidal Behaviors in Adolescents with Major Depression: Insights from the US Hospitals. Behav Sci (Basel) 2021; 11:bs11050078. [PMID: 34069446 PMCID: PMC8159103 DOI: 10.3390/bs11050078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the odds of association between suicidal ideation and/or attempt with comorbid eating disorders in adolescents with major depressive disorder (MDD). Methods: We conducted a cross-sectional study and included 122,020 adolescents with a primary diagnosis of MDD from the nationwide inpatient sample (NIS, 2012–2014). They were sub-grouped by a comorbid diagnosis of eating disorders (N = 1675). We calculated the adjusted odds ratio (aOR) using a logistic regression model with demographic confounders for associations of eating disorders with suicidal ideation and attempt. Results: Suicidal ideations were seen in a higher proportion of adolescents with eating disorders (46.3% vs. 14.2% in those without eating disorders). On the contrary, a low proportion of adolescents with eating disorders had suicidal attempts (0.9% vs. 39.4% in those without eating disorders). Overall, eating disorders were associated with higher odds for suicidal ideations (aOR 5.36, 95% CI 4.82–5.97) compared to those without eating disorders, but with lower odds of suicidal attempt (aOR 0.02, 95% CI 0.01–0.03). Conclusions: Adolescents with MDD and comorbid eating disorders had five-times increased odds of suicidal ideations but lower odds of a suicide attempt. Self-harm/injurious behaviors are early signs of suicidal ideations in these patients. A collaborative care model is required for the screening, early diagnosis, and management of adolescents with eating disorders to improve their quality of life.
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Kinderlehrer DA. Anorexia Nervosa Caused by Polymicrobial Tick-Borne Infections: A Case Study. Int Med Case Rep J 2021; 14:279-287. [PMID: 34007219 PMCID: PMC8121620 DOI: 10.2147/imcrj.s311516] [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: 03/17/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022] Open
Abstract
The etiology of anorexia nervosa (AN) is multifactorial, and infections may play a contributory and possibly a prominent role. A case is presented which is indicative of a causal association between tick-borne infections and AN. This adolescent female was diagnosed with AN at an eating disorder clinic after excessive food restriction and an irrational fear of weight gain necessitating nasogastric tube feeding. Her history was consistent with systemic infections and she tested serologically positive to Borrelia burgdorferi, Babesia microti, and Mycoplasma pneumoniae; in addition, her clinical presentation was consistent with a Bartonella infection. After treatment with oral and intravenous antimicrobials, she stopped food restriction and no longer had body image concerns. Physicians should be aware of the possibility that tick-borne infections could underly a diagnosis of AN. The role of tick-borne infections in the etiology of AN warrants further study.
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