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Cogodi E, Ranieri J, Martelli A, Di Giacomo D. Emotional Dysregulation in Anorexia Nervosa: Scoping Review of Psychological Treatments. Healthcare (Basel) 2024; 12:1388. [PMID: 39057531 PMCID: PMC11276072 DOI: 10.3390/healthcare12141388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Eating disorders are complex psychiatric disorders characterized by compensatory and restrictive behavior and a preoccupation with one's body. Eating and purging behaviors are considered dysfunctional emotional regulation strategies. Therefore, psychological treatment is essential. The most common psychological interventions are dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), family therapy (FBT), multi-family group therapy (MFTG) and mentalization-based treatment (MBT). The aim of this study was to summarize the current evidence on the impact of psychological treatments on emotional regulation difficulties and psychological symptoms in patients with eating disorders, especially anorexia nervosa. A search was conducted on PubMed and Web of Science using the terms "anorexia nervosa" and "emotion dysregulation". Of the 278 initial articles, we included 15 publications. The results indicate that the acquisition of coping strategies, through DBT, leads to an improvement in anxiety and alexithymia. DBT, CBT and MBT lead to a reduction in the use of dysfunctional emotional regulation strategies too. Eating disorders involve both physical and mental health; therefore, it is desirable for future research to focus on the mutual synergy between the mental and physical components by evaluating various factors, such as biomarkers and the most appropriate therapeutic approach, with respect to the treatment setting.
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Affiliation(s)
- Enrica Cogodi
- Postgraduate in Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy; (E.C.); (J.R.)
| | - Jessica Ranieri
- Postgraduate in Clinical Psychology, University of L’Aquila, 67100 L’Aquila, Italy; (E.C.); (J.R.)
- Life, Health and Environmental Sciences Department, University of L’Aquila, 67100 L’Aquila, Italy
| | - Alessandra Martelli
- Faculty of Biosciences and Agri-Food and Environmental Technologies, University of Teramo, 64100 Teramo, Italy;
| | - Dina Di Giacomo
- Life, Health and Environmental Sciences Department, University of L’Aquila, 67100 L’Aquila, Italy
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2
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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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3
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Mikhail ME, Burt SA, Neale MC, Keel PK, Katzman DK, Klump KL. Changes in affect longitudinally mediate associations between emotion regulation strategy use and disordered eating. Int J Eat Disord 2024; 57:1181-1191. [PMID: 38332591 PMCID: PMC11093708 DOI: 10.1002/eat.24162] [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: 11/18/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Trait-level emotion regulation (ER) difficulties are associated with eating disorders (EDs) transdiagnostically. However, little research has examined whether within-person fluctuations in ER longitudinally predict ED behaviors in daily life or the mechanisms of ER effects. Investigating daily ER could help us better understand why people experience ED behaviors at a given time. We examined whether day-to-day changes in adaptive (e.g., cognitive reappraisal) and maladaptive (e.g., rumination) ER longitudinally predicted core ED behaviors (binge eating, purging, dieting) and whether changes in affect mediated effects. METHOD Female participants (N = 688) ages 15-30 from the Michigan State University Twin Registry reported their adaptive and maladaptive ER use, negative affect (NA), positive affect (PA), binge eating, purging, and dieting on 49 consecutive days. Using structural equation modeling, we examined whether within-person fluctuations in ER predicted same- and next-day ED behaviors and whether changes in affect mediated longitudinal ER effects. RESULTS Greater maladaptive ER predicted increased likelihood of same-day binge eating and next-day binge eating and purging. The association between maladaptive ER and next-day binge eating and purging was mediated by increased next-day NA. In contrast, dieting was more closely related to changes in PA. Adaptive ER did not predict reduced likelihood of any ED behavior. CONCLUSIONS Maladaptive ER may longitudinally increase risk for binge eating and purging by amplifying NA. Interventions focused on decreasing maladaptive ER and subsequent NA might help disrupt binge eating-purging cycles. Conversely, results add to evidence that PA fluctuations may play a unique role in maintaining restrictive behaviors. PUBLIC SIGNIFICANCE Little is known about how daily changes in emotion regulation may impact disordered eating. We found that maladaptive emotion regulation (e.g., rumination) was associated with a higher likelihood of binge eating and purging on the next day because it predicted increased next-day negative affect. In contrast, dieting was more closely tied to fluctuations in positive affect. Targeting daily emotion regulation and affective processes may help disrupt cycles of disordered eating.
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Affiliation(s)
| | | | - Michael C. Neale
- Departments of Psychiatry, Human Genetics, and Psychology, Virginia Commonwealth University, USA
| | | | | | - Kelly L. Klump
- Department of Psychology, Michigan State University, USA
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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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Smith S, Sutandar K, Woodside B. Premature termination of inpatient eating disorder treatment: Does timing matter? J Eat Disord 2023; 11:210. [PMID: 38012804 PMCID: PMC10680217 DOI: 10.1186/s40337-023-00934-5] [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: 02/21/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Premature termination of treatment is a serious problem in the treatment of eating disorders. Prior research attempting to differentiate patients who are able to complete treatment from those who terminate early has yielded mixed results. One proposed explanation for this is a failure to examine the time course of treatment termination. This study was designed to explore associations between baseline patient characteristics and timing of treatment termination. METHODS Participants were 124 eating disorder patients admitted voluntarily to the inpatient program at Toronto General Hospital between 2009 and 2015. At admission, all patients completed measures of eating disorder symptoms, eating disorder cognitions, depressive symptoms and emotional dysregulation. Body weight was measured weekly. Data analyses were completed using one-way ANOVAs and Chi Square tests. RESULTS Results showed significant associations between timing of treatment termination and eating disorder diagnosis, severity of eating disorder cognitions and severity of depressive symptoms. Post-hoc analyses revealed that patients who left treatment early had more severe depressive symptoms, eating disorder cognitions related to eating and difficulties engaging in goal directed behaviors when emotionally dysregulated. CONCLUSIONS Patients who terminated inpatient treatment early in their admissions differ from patients who terminated later and those who completed treatment. These differences have potential clinical implications for the clinical management of patients with severe eating disorders requiring inpatient admission. Trial registration This paper is not associated with a clinical trial.
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Affiliation(s)
- Sarah Smith
- Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kalam Sutandar
- Department of Psychiatry, University of Toronto, 25 Sheppard Ave West, Suite 300, Toronto, ON, M2N 6S6, Canada
| | - Blake Woodside
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
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Eichin KN, Georgii C, Schnepper R, Voderholzer U, Blechert J. Emotional food-cue-reactivity in anorexia nervosa and bulimia nervosa: An electroencephalography study. Int J Eat Disord 2023; 56:2096-2106. [PMID: 37565581 PMCID: PMC10946739 DOI: 10.1002/eat.24028] [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: 11/17/2022] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Food-cue-reactivity entails neural and experiential responses to the sight and smell of attractive foods. Negative emotions can modulate such cue-reactivity and this might be central to the balance between restrictive versus bulimic symptomatology in Anorexia Nervosa (AN) and Bulimia Nervosa (BN). METHOD Pleasantness ratings and electrocortical responses to food images were measured in patients with AN (n = 35), BN (n = 32) and matched healthy controls (HC, n = 35) in a neutral state and after idiosyncratic negative emotion induction while electroencephalography (EEG) was recorded. The EEG data were analyzed using a mass testing approach. RESULTS Individuals with AN showed reduced pleasantness for foods compared to objects alongside elevated widespread occipito-central food-object discrimination between 170 and 535 ms, indicative of strong neural cue-reactivity. Food-object discrimination was further increased in the negative emotional condition between 690 and 1200 ms over centroparietal regions. Neither of these effects was seen in individuals with BN. DISCUSSION Emotion modulated food-cue-reactivity in AN might reflect a decreased appetitive response in negative mood. Such specific (emotion-)regulatory strategies require more theoretical work and clinical attention. The absence of any marked effects in BN suggests that emotional cue-reactivity might be less prominent in this group or quite specific to certain emotional contexts or food types. PUBLIC SIGNIFICANCE Negative affectivity is a risk factor for the development of eating disorders and individuals with eating disorders experience problems with emotion regulation. To better understand the effects of negative emotions, the present study investigated how they affected neural correlates of food perception in anorexia nervosa and bulimia nervosa.
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Affiliation(s)
- Katharina Naomi Eichin
- Department of Psychology and Centre for Cognitive NeuroscienceUniversity of SalzburgSalzburgAustria
- Department of PsychologyJohannes Kepler UniversityLinzAustria
| | - Claudio Georgii
- Department of Psychology and Centre for Cognitive NeuroscienceUniversity of SalzburgSalzburgAustria
| | - Rebekka Schnepper
- Department of Psychology and Centre for Cognitive NeuroscienceUniversity of SalzburgSalzburgAustria
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | | | - Jens Blechert
- Department of Psychology and Centre for Cognitive NeuroscienceUniversity of SalzburgSalzburgAustria
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Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [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: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
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8
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Puttevils L, De Bruecker M, Allaert J, Sanchez-Lopez A, De Schryver N, Vervaet M, Baeken C, Vanderhasselt MA. Attentional bias to food during free and instructed viewing in anorexia nervosa: An eye tracking study. J Psychiatr Res 2023; 164:468-476. [PMID: 37437319 DOI: 10.1016/j.jpsychires.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
Previous research has shown that patients with anorexia nervosa (AN) show an attentional bias to food. However, due to different conceptualizations of attentional bias and the use of various paradigms, results are inconclusive and more precise insights into the exact nature of this attentional bias are needed. Therefore, an eye-tracking paradigm with food (low and high caloric) and non-food (objects) pictures was used to investigate biases in AN patients (n = 25) compared to healthy controls (n = 22). Several indices of visual attention were examined, both during free (initial orientation, fixation frequency, fixation time) and explicitly instructed (engagement, disengagement) viewing. Our results during the free viewing phase indicated that AN patients (as compared to healthy matched controls) looked less frequently and spent less time fixating on food stimuli, compared to the comparison group. No differences between both groups (n = 47) in initial orientation could be observed. Interestingly, during the instructed viewing phase, no differences between the patient and the comparison group were observed in engagement or disengagement to food stimuli. These results suggest an (initial) attentional avoidance of food in AN patients when closely investigating spontaneous attentional processes, while this could not be observed during gaze behaviour when receiving clear instructions. Hence, future research should look into how attentional bias during spontaneous gaze patterns could serve as a potential marker of AN, and how targeting this bias could be applied in treatment interventions.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium.
| | - Marie De Bruecker
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium
| | - Jens Allaert
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | | | - Nele De Schryver
- Department of Psychiatry, Center for Eating Disorders, Ghent University Hospital, K12F, C. Heymanslaan 10, 9000, Ghent, Belgium
| | | | - Chris Baeken
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Psychiatry, University Hospital (UZ Brussel), Brussels, Belgium
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) Lab, Ghent University, Ghent, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
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Rossi AA, Panzeri A, Mannarini S. The Italian Version of the Difficulties in Emotion Regulation Scale – Short Form (IT-DERS-SF): A Two-step Validation Study. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-10006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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10
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Mohorić T, Pokrajac-Bulian A, Anić P, Kukić M, Mohović P. Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36406848 PMCID: PMC9644388 DOI: 10.1007/s12144-022-03824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022]
Abstract
Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.
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Affiliation(s)
- Tamara Mohorić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Alessandra Pokrajac-Bulian
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Petra Anić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Miljana Kukić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Patrizia Mohović
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
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Wayda-Zalewska M, Grzegorzewski P, Kot E, Skimina E, Santangelo PS, Kucharska K. Emotion Dynamics and Emotion Regulation in Anorexia Nervosa: A Systematic Review of Ecological Momentary Assessment Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13659. [PMID: 36294238 PMCID: PMC9603728 DOI: 10.3390/ijerph192013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Altered emotion dynamics and emotion regulation (ER) have been indicated in theoretical descriptions of abnormal emotional functioning, which contributes to the development and maintenance of anorexia nervosa (AN). Ecological momentary assessment (EMA) has recently become popular in research on eating disorders. It is a source of new insights into the psychopathology of AN as it enables intensive long-term tracking of everyday experiences and behaviours of individuals through repeated self-reports. The following systematic review aims to synthesize research on the use of EMA when evaluating emotion dynamics and ER in AN. Specific studies were identified with the use of MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed in reference lists of the relevant publications. As a result, 27 publications were identified and included in the systematic review. The findings from the reviewed studies point to various disturbed components of emotion dynamics as well as to unique associations of maladaptive ER strategies with specific abnormalities in emotion dynamics in AN. Limitations of the studies were discussed as well. An outlook for further research in the field was provided in the last section of the paper.
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Affiliation(s)
| | - Piotr Grzegorzewski
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | - Emilia Kot
- Faculty of Psychology, University of Warsaw, 00183 Warsaw, Poland
| | - Ewa Skimina
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | | | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
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12
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Rodrigues TF, Ramos R, Vaz AR, Brandão IM, Fernandez-Aranda F, Machado PPP. The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation. EUROPEAN EATING DISORDERS REVIEW 2022; 30:760-771. [PMID: 35501947 DOI: 10.1002/erv.2914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/09/2022] [Accepted: 04/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Difficulties in emotion regulation are thought to play a transdiagnostic role across eating disorders (ED). In the current study, we explored with a path analysis the mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation. METHOD Participants were 103 female outpatients recruited at a Portuguese ED hospital unit, diagnosed with an ED, aged 14-60 years old (M = 28.0, SD = 10.5), body mass index (BMI) ranging from 11.72 to 39.44 (M = 20.1, SD = 5.4). RESULTS The path analysis resulted in a model with an adequate fit to the data (SRMR = 0.05; RMSEA = 0.07 [0.00, 0.12], PCLOSE = 0.269; TLI = 0.97; IFI = 0.99; GFI = 0.95). A final model in which the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation was mediated by self-criticism, experiential avoidance and negative urgency, accounted for a variance of 71% for strategies, 57% for non-acceptance, 62% for impulses, 56% for goals and 20% for clarity. CONCLUSION Results suggest that self-criticism, experiential avoidance and negative urgency, combined, are relevant in the relationship between ED-related symptoms and difficulties in emotion regulation. ED treatment and emotion regulation skills may be enhanced through the inclusion of specific components that target self-criticism, experiential avoidance and negative urgency, as they become prominent during the therapeutic process.
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Affiliation(s)
- Tânia F Rodrigues
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Rita Ramos
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Ana Rita Vaz
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Marques Brandão
- Psychiatry Department, Faculty of Medicine, Hospital of S. João, University of Porto, Porto, Portugal
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Paulo P P Machado
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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13
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Sanchez I, Lucas I, Munguía L, Camacho‐Barcia L, Giménez M, Sánchez‐González J, Granero R, Solé‐Morata N, Gearhard A, Diéguez C, Jiménez‐Murcia S, Fernández‐Aranda F. Food addiction in anorexia nervosa: Implications for the understanding of crossover diagnosis. EUROPEAN EATING DISORDERS REVIEW 2022; 30:278-288. [PMID: 35306714 PMCID: PMC9314799 DOI: 10.1002/erv.2897] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/14/2022]
Abstract
Objective Food addiction (FA) construct was introduced to reflect abnormal eating patterns that resemble behavioural ones found in substance use disorders. FA has been barely explored in anorexia nervosa (AN). This study evaluated FA occurrence and associated factors in a sample of patients with AN, distinguishing between restrictive and binge–purging subtypes and focussing on the influence of FA in the crossover diagnosis between them. Method A sample of 116 patients with AN admitted for treatment seeking at an Bellvitge Hospital Eating Disorders Unit were included (72 restrictive [AN‐R]; 44 binge‐purge AN [AN‐BP]), and eating‐related, personality and psychopathological variables were assessed. Most participants were women (92.2%), mean age 27.1 years old (SD = 10.5). Results FA was more prevalent in patients with AN‐BP compared to the AN‐R group (75.0% and 54.2%, respectively). The patients with AN‐R FA+, presented more similar ED symptomatology, general psychopathology and personality traits, with the AN‐BP patients, than with the AN‐R FA‐. Conclusions Patients with AN‐R FA+, exhibit more similarities with the AN‐BP subgroup than with the AN‐R FA‐. Thus, it is possible to hypothesise that the presence of FA might be an indicator of the possible crossover from AN‐R to AN‐BP. Patients with anorexia nervosa – restrictive subtype (AN‐R) and patients with anorexia nervosa – bulimic‐purgative subtype (AN‐BP) present a prevalence of food addiction (FA) of 54% and 75%, respectively. Patients with AN‐R FA+ have more clinical and personality similarities with AN‐BP than with AN‐R FA−. The presence of FA could be associated with the possible crossover from AN‐R to AN‐BP.
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Affiliation(s)
- Isabel Sanchez
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
| | - Ignacio Lucas
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
| | - Lucero Munguía
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
| | - Lucia Camacho‐Barcia
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
| | - Mónica Giménez
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
| | - Jessica Sánchez‐González
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
| | - Roser Granero
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
- Department of Psychobiology and Methodology Autonomous University of Barcelona Barcelona Spain
| | - Neus Solé‐Morata
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
| | - Ashley Gearhard
- Department of Psychology University of Michigan Ann Arbor Michigan USA
| | - Carlos Diéguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Department of Physiology CIMUS University of Santiago de Compostela‐Instituto de Investigación Sanitaria Santiago de Compostela Spain
| | - Susana Jiménez‐Murcia
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
- Department of Clinical Sciences School of Medicine and Health Sciences University of Barcelona Barcelona Spain
| | - Fernando Fernández‐Aranda
- Department of Psychiatry University Hospital of Bellvitge Barcelona Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn) Instituto de Salud Carlos III Madrid Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group Neurosciences Programme Bellvitge Biomedical Research Institute (IDIBELL) Barcelona Spain
- Department of Clinical Sciences School of Medicine and Health Sciences University of Barcelona Barcelona Spain
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14
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Martenstyn JA, Jeacocke NA, Pittman J, Touyz S, Maguire S. Treatment Considerations for Compulsive Exercise in High-Performance Athletes with an Eating Disorder. SPORTS MEDICINE - OPEN 2022; 8:30. [PMID: 35239063 PMCID: PMC8894522 DOI: 10.1186/s40798-022-00425-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/13/2022] [Indexed: 01/11/2023]
Abstract
Compulsive exercise is linked with poorer treatment outcomes in people with eating disorder (EDs). High-performance athletes represent a growing and complex subcomponent of the broader ED population, and emergent evidence indicates that different conceptualisations of compulsive exercise are needed in this population. Existing randomised controlled trials in ED populations have demonstrated small treatment effects on compulsive exercise compared with control groups; however, athletes were sparsely sampled across these studies. Thus, the extent to which current treatments for compulsive exercise in EDs are also effective in high-performance athletes is unknown. For this opinion paper, we sought representation from high-performance sports leadership, someone with lived experience of both an ED and high-performance athletics, and ED clinical experts. We discuss the utility of recommending exercise abstinence in ED treatment with athletes, as well as a number of other treatment strategies with some evidence in other contexts for further consideration and research in this population. These include using mindfulness-based interventions as an adjunct to cognitive-behavioural therapies, using wearable technologies and self-reported fatigue to inform training decisions, and incorporating greater exercise variation into training programs. We also offer practical considerations for clinicians seeking to apply foundational elements of cognitive-behavioural interventions (e.g., exposure and response prevention, cognitive restructuring, behavioural experiments) into an ED treatment program for a high-performance athlete. Future research is needed to examine characteristics of pathological compulsive exercise in athletes and whether available treatments are both feasible and effective in the treatment of compulsive exercise in athletes with an ED.
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Affiliation(s)
- Jordan A Martenstyn
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, NSW, Australia. .,InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | | | - Jana Pittman
- School of Medicine, Blacktown Hospital, Western Sydney University, Sydney, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, NSW Health, St Leonards, Sydney, NSW, Australia
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15
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Cassioli E, Rossi E, D'Anna G, Martelli M, Hazzard VM, Crosby RD, Wonderlich SA, Ricca V, Castellini G. A 1-year follow-up study of the longitudinal interplay between emotion dysregulation and childhood trauma in the treatment of anorexia nervosa. Int J Eat Disord 2022; 55:98-107. [PMID: 34862809 PMCID: PMC8787461 DOI: 10.1002/eat.23647] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The study aimed to investigate the complex relationship between eating disorder (ED) specific psychopathology, emotion dysregulation, and their longitudinal variations in patients with anorexia nervosa (AN) treated with a multidisciplinary approach including enhanced cognitive-behavior therapy (CBT-E), and to provide an integrated model which includes childhood trauma as a predictor of worse treatment outcomes. METHOD In total, 120 female patients with AN were evaluated at admission (T0), and 105 were re-evaluated after 1 year (T1) of treatment. At T0, patients underwent a clinical assessment and filled the Symptom Checklist 90-Revised (SCL90-R), the Eating Disorders Examination Questionnaire (EDE-Q), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). SCL-90-R, EDE-Q, and DERS were readministered at T1. Variations between T0 and T1 were evaluated, and the proposed model was investigated using bivariate latent change score analysis in a structural equation modeling (SEM) framework. RESULTS An overall significant clinical amelioration was observed after treatment. A unidirectional effect of DERS scores on EDE-Q variations was outlined by SEM: patients with higher baseline DERS scores achieved less EDE-Q improvements, and EDE-Q latent change score was significantly predicted by longitudinal variations of DERS-but not vice versa. Higher CTQ scores predicted reduced treatment efficacy for ED-specific psychopathology through the mediating effect of higher baseline DERS scores. DISCUSSION The present study sheds light on the mechanism by which early trauma compromises treatment outcome in patients with AN, underlining the crucial role of emotional dysregulation.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Michela Martelli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | | | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
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16
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Drinkwater D, Holttum S, Lavender T, Startup H, Oldershaw A. Seeing Through the Façade of Anorexia: A Grounded Theory of Emotional Change Processes Associated With Recovery From Anorexia Nervosa. Front Psychiatry 2022; 13:868586. [PMID: 35815041 PMCID: PMC9263079 DOI: 10.3389/fpsyt.2022.868586] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Difficulties in managing emotions have been implicated in the development and maintenance of anorexia nervosa (AN), and psychological treatment models seek to address this in putative targets of change. Yet the field of psychotherapy remains unclear and insufficiently evidenced about the process of change and how this is actually achieved, including in what steps and in what order within clinical treatment. This qualitative study sought to develop theory about the process of emotional change during recovery from anorexia. METHODS Semi-structured interviews were carried out with nine women currently engaged in psychological treatment for anorexia. Interviews included questions pertaining to participants' experience of anorexia, emotions, and emotion management. A constructivist version of grounded theory was employed. RESULTS The analysis produced 10 major categories, comprising over 60 focused codes. Categories were clustered together into three super categories, reflecting 3 distinct but interrelated phases of participants' journeys toward recovery. The phases were: (1) Coping in a world of uncertainty, (2) Seeing through the façade of anorexia, and (3) Recovery and growth. Whilst movement toward later positions often appeared to be contingent on earlier ones, the analysis suggests that this was not an entirely linear process and that participants moved between positions as they grappled with the process of change. Participants came to view behaviors associated with anorexia as emotion-management strategies that were not working and as a façade. As they moved toward recovery and growth, they became less confined by their need for safety, and to see emotions as meaningful and valuable. Becoming more connected to emotional experience and expression, coincided with positive shifts in their intra and interpersonal relationships. CONCLUSION These findings support the recent shift toward emotion-focused models of anorexia. They also highlight an important focus in supporting individuals with AN to connect with, and be guided by, emotional experiences in their relationships with themselves and the world around them. This new grounded theory offers a putative process of change that could be utilized to guide intervention development.
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Affiliation(s)
- Danielle Drinkwater
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, United Kingdom
| | - Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, United Kingdom
| | - Tony Lavender
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, United Kingdom
| | - Helen Startup
- Sussex Partnership Foundation Trust, Sussex Education Center, Hove, United Kingdom
| | - Anna Oldershaw
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, United Kingdom.,Kent All Age Eating Disorder Service, North East London NHS Foundation Trust (NELFT), Maidstone, United Kingdom
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17
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Giordani RCF, Silva FS. The ethereal bodies of pro-Ana blogs: emotional communities and spaces of sociability on the web. CIENCIA & SAUDE COLETIVA 2021; 26:5293-5301. [PMID: 34787220 DOI: 10.1590/1413-812320212611.3.34522019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
The study presented in this paper aimed at understanding how anorexic young women use virtual environments as spaces of sociability in order to construct a narrative about anorexia, anchor their experiences through emotional mutuality and validate discourses. To do so, an analysis of the content found in the commenting and posting sections of pro-anorexia blogs was carried out. Three thematic categories were identified: body, personal identity and sociability on the web. It was observed that blogs are virtual spaces of sociability and construction of identity groups. The representations and the experiences lived by the corporal materiality feed cyberspace and are the starting point for understanding a phenomenon particular to the contemporaneity, that is the virtual exchanges. In blogs, one can find body narratives that seek to give coherence to an individual and to his or her existence as well as narratives that aim at anchoring and legitimizing personal experiences and validating pro-anorexia attitudes. Social ties are strengthened within the group, which becomes an emotional community. The meanings of the spreading discourses allow us to infer that in these groups, the materiality of anorexic bodies emancipates itself from the social stigmas of a disease.
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18
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Henderson M, Bould H, Flouri E, Harrison A, Lewis G, Lewis G, Srinivasan R, Stafford J, Warne N, Solmi F. Association of Emotion Regulation Trajectories in Childhood With Anorexia Nervosa and Atypical Anorexia Nervosa in Early Adolescence. JAMA Psychiatry 2021; 78:1249-1257. [PMID: 34232251 PMCID: PMC8264752 DOI: 10.1001/jamapsychiatry.2021.1599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE People with anorexia nervosa often experience difficulties regulating their emotions. There is no longitudinal evidence as to whether these differences are already present in childhood or when they begin to emerge. OBJECTIVE To investigate the association between emotion regulation trajectories from 3 to 7 years of age and symptoms of anorexia nervosa and atypical anorexia nervosa in adolescence. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all children with complete exposure data in the Millennium Cohort Study, a UK general population birth cohort. Data were acquired from June 2001 to March 2016 and analyzed from June to November 2020. EXPOSURES Mothers reported on their children's emotion regulation skills at 3, 5, and 7 years of age using the Children's Social Behavior Questionnaire. Multilevel models were used to derive early childhood emotion regulation scores (ie, predicted intercept) and within-child changes in emotion regulation scores from 3 to 7 years of age (ie, predicted slope). MAIN OUTCOME AND MEASURES Symptoms consistent with a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa at 14 years of age, defined using a range of questions relative to body image, weight perception, and dieting behaviors (hereinafter referred to as broad anorexia nervosa). Univariable and multivariable logistic regression models tested the association between exposures and outcome. Regression models were adjusted for child and family sociodemographic and socioeconomic characteristics and mental health difficulties, prenatal and perinatal factors, child's cognitive development, and maternal attachment. RESULTS A total of 15 896 participants (85.7% of total sample; 51.0% boys; 84.5% White individuals) had complete data on the exposure and were included in the main analyses. Among those with complete exposure and outcome data (9912 of the analytical sample [62.4%]), 97 participants (1.0%; 86 [88.7%] girls and 85 [87.6%] White individuals) had symptoms consistent with a diagnosis of broad anorexia nervosa at 14 years of age. No evidence suggested that children with lower emotion regulation ability at 3 years of age had greater odds of later reporting symptoms of broad anorexia nervosa (odds ratio [OR], 1.21; 95% CI, 0.91-1.63). However, children whose emotion regulation skills did not improve over childhood and who had greater problems regulating emotions at 7 years of age had higher odds of having broad anorexia nervosa at 14 years of age (OR, 1.45; 95% CI, 1.16-1.83). CONCLUSIONS AND RELEVANCE These findings suggest that difficulties in developing age-appropriate emotion regulation skills in childhood are associated with experiencing broad anorexia nervosa in adolescence. Interventions to support the development of emotion regulation skills across childhood may help reduce the incidence of anorexia nervosa.
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Affiliation(s)
- Mariella Henderson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom,Gloucestershire Health and Care NHS (National Health Service) Foundation Trust, Gloucester, United Kingdom
| | - Eirini Flouri
- Institute of Education, University College London, London, United Kingdom
| | - Amy Harrison
- Institute of Education, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ramya Srinivasan
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jean Stafford
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Francesca Solmi
- Division of Psychiatry, University College London, London, United Kingdom
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19
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Peláez-Fernández MA, Romero-Mesa J, Extremera N. From Deficits in Emotional Intelligence to Eating Disorder Symptoms: A Sequential Path Analysis Approach Through Self-Esteem and Anxiety. Front Psychol 2021; 12:713070. [PMID: 34484070 PMCID: PMC8416284 DOI: 10.3389/fpsyg.2021.713070] [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: 05/21/2021] [Accepted: 07/23/2021] [Indexed: 12/03/2022] Open
Abstract
Past studies have reported emotional intelligence (EI) as a relevant factor in development and maintenance of eating disorders (ED), as well as in increasing self-esteem and reducing anxiety. Similarly, research has showed that anxiety and self-esteem are positively and negatively associated to ED criteria, respectively. However, no prior studies have yet tested the multiple intervening roles of both self-esteem and anxiety as potential mediators of the association between EI and ED symptomatology. The present study aims to bridge these gaps by testing a sequential path model. Specifically, we examine the potential sequential mediation effects of self-esteem-anxiety on the link between EI and ED. A sample composed of 516 Spanish undergraduate students and community adults completed measures of EI, self-esteem, anxiety, and ED symptomatology. The results show that high levels of EI were positively associated with self-esteem and negatively associated with anxiety and ED symptoms. Anxiety was positively associated to ED symptoms, while self-esteem levels were negatively linked to ED symptoms. Moreover, path analyses showed that self-esteem and anxiety fully mediated the relationship between EI and ED symptoms in sequence. These findings suggest that EI plays a key role in reducing symptomatology of ED through increased self-esteem and reduced anxiety symptoms, providing novel evidence regarding psychological mechanisms through which EI contributes to a reduction of ED symptomatology. Implications for assessing and improving these psychological resources in ED preventive programs are discussed.
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Affiliation(s)
- María Angeles Peláez-Fernández
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Juana Romero-Mesa
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
| | - Natalio Extremera
- Department of Social Psychology, Social Work, Social Anthropology, and East Asian Studies, Faculty of Psychology, University of Málaga, Málaga, Spain
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20
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Castro TF, Miller K, Araújo MX, Brandão I, Torres S. Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:955-968. [PMID: 34472158 DOI: 10.1002/erv.2858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This 15 years longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term recovery from anorexia nervosa (AN), and its link to anxiety and depression. METHOD Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, emotion regulation difficulties (ER; only assessed in recovery phase), and completed an experimental task to analyse emotional experience. RESULTS In spite of significant improvement in alexithymia, anxiety, and depression with AN recovery, some emotion functioning difficulties did not normalize. The occurrence of comorbid anxiety and depression explained the reduced ability to identify, understand, and accept emotions in long-term recovery (relative to controls), but not the increased global difficulty in using ER strategies, which revealed a more stable nature of deficit. With recovery, negative emotions linked to situations addressing food and body weight are felt more intensely. CONCLUSIONS Managing emotions, especially the negative ones, remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behaviour can serve as an affect regulatory function, increasing the risk of relapse. Emotional education is an important avenue in protecting long-term AN relapse.
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Affiliation(s)
- Telma Fontão Castro
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Kylee Miller
- Department of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Xavier Araújo
- Department of Psychology and Education, University Portucalense, Porto, Portugal.,Department of Psychology, Centro Hospitalar S. João, Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar S. João, Porto, Portugal
| | - Sandra Torres
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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21
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Kappou K, Ntougia M, Kourtesi A, Panagouli E, Vlachopapadopoulou E, Michalacos S, Gonidakis F, Mastorakos G, Psaltopoulou T, Tsolia M, Bacopoulou F, Sergentanis TN, Tsitsika A. Neuroimaging Findings in Adolescents and Young Adults with Anorexia Nervosa: A Systematic Review. CHILDREN-BASEL 2021; 8:children8020137. [PMID: 33673193 PMCID: PMC7918703 DOI: 10.3390/children8020137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
Background: Anorexia nervosa (AN) is a serious, multifactorial mental disorder affecting predominantly young females. This systematic review examines neuroimaging findings in adolescents and young adults up to 24 years old, in order to explore alterations associated with disease pathophysiology. Methods: Eligible studies on structural and functional brain neuroimaging were sought systematically in PubMed, CENTRAL and EMBASE databases up to 5 October 2020. Results: Thirty-three studies were included, investigating a total of 587 patients with a current diagnosis of AN and 663 healthy controls (HC). Global and regional grey matter (GM) volume reduction as well as white matter (WM) microstructure alterations were detected. The mainly affected regions were the prefrontal, parietal and temporal cortex, hippocampus, amygdala, insula, thalamus and cerebellum as well as various WM tracts such as corona radiata and superior longitudinal fasciculus (SLF). Regarding functional imaging, alterations were pointed out in large-scale brain networks, such as default mode network (DMN), executive control network (ECN) and salience network (SN). Most findings appear to reverse after weight restoration. Specific limitations of neuroimaging studies in still developing individuals are also discussed. Conclusions: Structural and functional alterations are present in the early course of the disease, most of them being partially or totally reversible. Nonetheless, neuroimaging findings have been open to many biological interpretations. Thus, more studies are needed to clarify their clinical significance.
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Affiliation(s)
- Kalliopi Kappou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Myrto Ntougia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Aikaterini Kourtesi
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Eleni Panagouli
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Elpis Vlachopapadopoulou
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Stefanos Michalacos
- Department of Endocrinology-Growth and Development, “P. & A. Kyriakou” Children’s Hospital, 115 27 Athens, Greece; (E.V.); (S.M.)
| | - Fragiskos Gonidakis
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 115 28 Athens, Greece;
| | - Georgios Mastorakos
- Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece;
| | - Theodora Psaltopoulou
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Maria Tsolia
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair Adolescent Health Care, First Department of Pediatrics, “Agia Sophia” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Theodoros N. Sergentanis
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Department of Clinical Therapeutics, “Alexandra” Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Artemis Tsitsika
- MSc “Strategies of Developmental and Adolescent Health”, 2nd Department of Pediatrics, “P. & A. Kyriakou” Children’s Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (K.K.); (M.N.); (A.K.); (E.P.); (T.P.); (M.T.); (T.N.S.)
- Correspondence: ; Tel./Fax: +30-210-771-0824
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Brown TA, Cusack A, Berner LA, Anderson L, Nakamura T, Gomez L, Trim J, Chen JY, Kaye WH. Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders. Behav Ther 2020; 51:401-412. [PMID: 32402256 PMCID: PMC7225176 DOI: 10.1016/j.beth.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
Abstract
Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.
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Affiliation(s)
- Tiffany A. Brown
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Anne Cusack
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Laura A. Berner
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Leslie Anderson
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Tiffany Nakamura
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Lauren Gomez
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Julie Trim
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Joanna Y. Chen
- Department of Psychology, Drexel University; 3201 Chestnut St, Philadelphia, PA 19104
| | - Walter H. Kaye
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
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23
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Cardi V, Albano G, Salerno L, Lo Coco G, Ambwani S, Schmidt U, Macdonald P, Treasure J. The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence. Front Psychol 2020; 11:707. [PMID: 32373032 PMCID: PMC7178255 DOI: 10.3389/fpsyg.2020.00707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023] Open
Abstract
The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02336841.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gaia Albano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | | | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pamela Macdonald
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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24
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Mallorquí-Bagué N, Lozano-Madrid M, Testa G, Vintró-Alcaraz C, Sánchez I, Riesco N, César Perales J, Francisco Navas J, Martínez-Zalacaín I, Megías A, Granero R, Veciana De Las Heras M, Chami R, Jiménez-Murcia S, Fernández-Formoso JA, Treasure J, Fernández-Aranda F. Clinical and Neurophysiological Correlates of Emotion and Food Craving Regulation in Patients with Anorexia Nervosa. J Clin Med 2020; 9:jcm9040960. [PMID: 32244331 PMCID: PMC7230937 DOI: 10.3390/jcm9040960] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/24/2023] Open
Abstract
Background: Difficulties in emotion regulation and craving regulation have been linked to eating symptomatology in patients with anorexia nervosa (AN), contributing to the maintenance of their eating disorder. Methods: To investigate clinical and electrophysiological correlates of these processes, 20 patients with AN and 20 healthy controls (HC) completed a computerized task during EEG recording, where they were instructed to down-regulate negative emotions or food craving. Participants also completed self-report measures of emotional regulation and food addiction. The P300 and Late Positive Potential (LPP) ERPs were analysed. Results: LPP amplitudes were significantly smaller during down-regulation of food craving among both groups. Independent of task condition, individuals with AN showed smaller P300 amplitudes compared to HC. Among HC, the self-reported use of re-appraisal strategies positively correlated with LPP amplitudes during emotional regulation task, while suppressive strategies negatively correlated with LPP amplitudes. The AN group, in comparison to the HC group, exhibited greater food addiction, greater use of maladaptive strategies, and emotional dysregulation. Conclusions: Despite the enhanced self-reported psychopathology among AN, both groups indicated neurophysiological evidence of food craving regulation as evidenced by blunted LPP amplitudes in the relevant task condition. Further research is required to delineate the mechanisms associated with reduced overall P300 amplitudes among individuals with AN.
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Affiliation(s)
- Nuria Mallorquí-Bagué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Addictive Behavior Unit, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, 08001 Barcelona, Spain
- Correspondence: (N.M.-B.); (F.F.-A.)
| | - María Lozano-Madrid
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Giulia Testa
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Cristina Vintró-Alcaraz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
| | - José César Perales
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Centre, University of Granada, 18071 Granada, Spain; (J.C.P.); (A.M.)
| | - Juan Francisco Navas
- Department of Basic Psychology, Autonomous University of Madrid, 28049 Madrid, Spain;
- Universitat Oberta de Catalunya, 08018 Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - Alberto Megías
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Centre, University of Granada, 18071 Granada, Spain; (J.C.P.); (A.M.)
| | - Roser Granero
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08035 Barcelona, Spain
| | | | - Rayane Chami
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (R.C.); (J.T.)
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
| | - José Antonio Fernández-Formoso
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
| | - Janet Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, London SE5 8AF, UK; (R.C.); (J.T.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, 08907 Barcelona, Spain; (M.L.-M.); (G.T.); (C.V.-A.); (I.S.); (N.R.); (I.M.-Z.); (S.J.-M.)
- CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, 28029 Madrid, Spain; (R.G.); (J.A.F.-F.)
- Clinical Sciences Department, School of Medicine, University of Barcelona, 08907 Barcelona, Spain
- Correspondence: (N.M.-B.); (F.F.-A.)
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25
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Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis. J Clin Psychol Med Settings 2019; 28:40-52. [DOI: 10.1007/s10880-019-09685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1351-1358. [PMID: 29101588 DOI: 10.1007/s10802-017-0365-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.
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27
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Simon JJ, Stopyra MA, Friederich HC. Neural Processing of Disorder-Related Stimuli in Patients with Anorexia Nervosa: A Narrative Review of Brain Imaging Studies. J Clin Med 2019; 8:jcm8071047. [PMID: 31323803 PMCID: PMC6678397 DOI: 10.3390/jcm8071047] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 12/25/2022] Open
Abstract
Abnormalities and alterations in brain function are commonly associated with the etiology and maintenance of anorexia nervosa (AN). Different symptom categories of AN have been correlated with distinct neurobiological patterns in previous studies. The aim of this literature review is to provide a narrative overview of the investigations into neural correlates of disorder-specific stimuli in patients with AN. Although findings vary across studies, a summary of neuroimaging results according to stimulus category allows us to account for methodological differences in experimental paradigms. Based on the available evidence, the following conclusions can be made: (a) the neural processing of visual food cues is characterized by increased top-down control, which enables restrictive eating, (b) increased emotional and reward processing during gustatory stimulation triggers disorder-specific thought patterns, (c) hunger ceases to motivate food foraging but instead reinforces disorder-related behaviors, (d) body image processing is related to increased emotional and hedonic reactions, (e) emotional stimuli provoke increased saliency associated with decreased top-down control and (f) neural hypersensitivity during interoceptive processing reinforces avoidance behavior. Taken together, studies that investigated symptom-specific neural processing have contributed to a better understanding of the underlying mechanisms of AN.
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Affiliation(s)
- Joe J Simon
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany.
| | - Marion A Stopyra
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
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28
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Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
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29
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Sfärlea A, Dehning S, Keller LK, Schulte-Körne G. Alexithymia predicts maladaptive but not adaptive emotion regulation strategies in adolescent girls with anorexia nervosa or depression. J Eat Disord 2019; 7:41. [PMID: 31798880 PMCID: PMC6883686 DOI: 10.1186/s40337-019-0271-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/30/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Among adolescent girls, anorexia nervosa (AN) and major depression (MD) are common and often comorbid mental health problems. Both disorders are characterised by difficulties in recognising and verbalising (alexithymia) as well as regulating one's emotions, but research in adolescent patients is scarce and little is known about the relation between alexithymia and difficulties in emotion regulation. The aims of this study were to investigate alexithymia and emotion regulation skills in adolescents with AN, adolescents with MD, and healthy adolescents, and to determine whether alexithymia functions as a predictor for emotion regulation skills. METHODS Emotion regulation strategies, alexithymia, and depressive symptoms were assessed by questionnaire measures in 12-18 year old girls with AN (n = 26), girls with MD (n = 25), and healthy girls (n = 35). Groups were compared with respect to the these variables and multiple regression analyses were calculated separately for adaptive and maladaptive emotion regulation strategies in order to examine if alexithymia predicted emotion regulation over and above age and depressive symptoms. RESULTS Girls with AN or MD both reported using adaptive emotion regulation strategies less frequently and maladaptive emotion regulation skills more frequently as well as higher levels of alexithymia compared to healthy girls. Alexithymia positively predicted maladaptive emotion regulation strategies, while depressive symptoms negatively predicted adaptive emotion regulation strategies. CONCLUSIONS The results suggest that different mechanisms may underlie the lack of adaptive and the surplus of maladaptive emotion regulation strategies in adolescent psychiatric patients.
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Affiliation(s)
- Anca Sfärlea
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336 Munich, Germany
| | - Sandra Dehning
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336 Munich, Germany
| | - Lena Katharina Keller
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336 Munich, Germany.,2Faculty of Medicine, Institute of Medical Psychology, LMU, Munich, Germany
| | - Gerd Schulte-Körne
- 1Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Pettenkoferstr. 8a, 80336 Munich, Germany
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30
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Nyman-Carlsson E, Birgegård A, Engström I, Gustafsson SA, Nevonen L. Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 27:76-85. [PMID: 30094893 DOI: 10.1002/erv.2630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome. METHODS Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology. RESULTS In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms. CONCLUSIONS Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.
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Affiliation(s)
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden
| | - Ingemar Engström
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lauri Nevonen
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Praktikertjänst Psychiatry AB, Stockholm, Sweden
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31
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Monell E, Clinton D, Birgegård A. Emotion dysregulation and eating disorders-Associations with diagnostic presentation and key symptoms. Int J Eat Disord 2018; 51:921-930. [PMID: 30030942 DOI: 10.1002/eat.22925] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 06/12/2018] [Accepted: 06/17/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Emotion dysregulation seems involved in the development, maintenance, and outcome of eating disorders (EDs). The present study aimed to differentiate patients with EDs from a comparison group on emotion dysregulation, and to examine emotion dysregulation in relation to ED diagnostic presentation and ED symptoms. METHOD Participants, patients with EDs (N = 999) and a student comparison group (N = 252), completed the Difficulties in Emotion Regulation Scale and the Eating Disorder Examination Questionnaire. Patients were compared to the comparison group and compared by diagnosis regarding emotion dysregulation, and unique associations between emotion dysregulation aspects and ED symptoms were examined. RESULTS Patients reported greater general emotion dysregulation than the comparison group, especially poorer emotional awareness and clarity. There were very few diagnostic differences. In both patients and the comparison group, limited access to emotion regulation strategies was associated with cognitive ED symptoms, and presence of binge eating in the comparison group. In patients, poor emotional awareness and emotional non-acceptance were additionally associated with cognitive symptoms, and difficulties in impulse control and emotional non-acceptance were associated with binge eating. DISCUSSION Emotion dysregulation is an important transdiagnostic characteristic of ED. Results suggest interventions that enhance emotional awareness and acceptance, as well as emotion regulation skills training, in both ED treatment and prevention.
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Affiliation(s)
- Elin Monell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Centre for Research & Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - David Clinton
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Institute for Eating Disorders, Oslo, Norway
| | - Andreas Birgegård
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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32
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Weinbach N, Sher H, Bohon C. Differences in Emotion Regulation Difficulties Across Types of Eating Disorders During Adolescence. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018. [PMID: 29101588 DOI: 10.1007/s10802-017-0365-7.differences] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Emotion regulation appears to play a key role in eating disorders. However, prior attempts to associate specific emotion regulation abilities with specific types of eating disorders resulted in inconsistent findings. Moreover, far less is known about emotion regulation in eating disorders during adolescence, a critical period of emotional development. The current study addresses this gap, comparing emotion regulation characteristics between adolescents with restrictive types of eating disorders and those with binge eating or purging types of eating disorders. Ninety-eight adolescents with eating disorders (49 with restrictive and 49 with binge eating/purging eating disorders) completed a set of questionnaires including the Difficulties in Emotion Regulation Scale (DERS). The results revealed that binge eating/purging types of eating disorders were associated with greater difficulties in a variety of emotion regulation dimensions including impulse control, goal-directed behavior and access to effective emotion regulation strategies. Awareness and clarity of emotions were also worse in the binge eating/purging types of eating disorders, but this difference did not remain when comorbid psychopathology measures were controlled for. Moreover, the emotion regulation profile of adolescents with anorexia nervosa-binging/purging type was more similar to that of adolescents with bulimia nervosa than to that of adolescents with anorexia nervosa-restrictive type. While both restrictive and binge eating/purging eating disorders have been associated with emotion regulation difficulties, the current study shows that the presence of binge eating or purging episodes is linked with greater severity of emotion regulation deficits among adolescents with eating disorders.
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Affiliation(s)
- Noam Weinbach
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA.
| | - Helene Sher
- Eating Disorder Unit, Child and Adolescent Psychiatry, Soroka Medical Center, Beer-Sheva, Israel
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA
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Herbrich L, Kappel V, van Noort BM, Winter S. Differences in set-shifting and central coherence across anorexia nervosa subtypes in children and adolescents. EUROPEAN EATING DISORDERS REVIEW 2018; 26:499-507. [PMID: 29797742 DOI: 10.1002/erv.2605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Regarding executive functioning in anorexia nervosa (AN), little is known about differences between the restricting (AN-R) and binge eating/purging (AN-BP) subtypes. Especially for adolescents, there is sparse data. Hence, the current aim is to investigate differences in set-shifting, central coherence, and self-reported executive functioning across adolescent AN subtypes. METHODS Ninety AN-R, 21 AN-BP, and 63 controls completed an extensive assessment battery including neuropsychological tests for executive functioning and the self-report questionnaire Behavior Rating Inventory of Executive Functioning. RESULTS Patients with AN-R and AN-BP did not differ on neuropsychological measures, and both performed similarly to controls. Behavior Rating Inventory of Executive Functioning scores fell within the normal range with AN subtypes showing mostly comparable ratings. AN-BP patients scored higher on 2 composite indices and the "shift" subscale compared with AN-R. CONCLUSIONS The results suggest similar cognitive functioning in adolescent AN subtypes as well as healthy controls. However, more research is needed to draw more general conclusions.
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Affiliation(s)
- Laura Herbrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Berlin, Germany
| | - Viola Kappel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Berlin, Germany
| | - Betteke Maria van Noort
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Berlin, Germany
| | - Sibylle Winter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Berlin, Germany
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Smithuis L, Kool-Goudzwaard N, de Man-van Ginkel JM, van Os-Medendorp H, Berends T, Dingemans A, Claes L, van Elburg AA, van Meijel B. Self-injurious behaviour in patients with anorexia nervosa: a quantitative study. J Eat Disord 2018; 6:26. [PMID: 30305903 PMCID: PMC6169009 DOI: 10.1186/s40337-018-0214-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/29/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136). METHODS A cross-sectional design using a self-report questionnaire. Mann-Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests. RESULTS Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts. CONCLUSIONS Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.
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Affiliation(s)
- Linda Smithuis
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands.,2Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Nienke Kool-Goudzwaard
- 2Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Intensive Treatment Centre, Fivoor, The Hague, The Netherlands
| | - Janneke M de Man-van Ginkel
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,5Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands.,6Department of Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tamara Berends
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - Alexandra Dingemans
- Rivierduinen Eating disorders Ursula, Rivierduinen, Leiden, The Netherlands.,9Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Laurence Claes
- 10Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,11Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annemarie A van Elburg
- Clinical Psychology, Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,13Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Berno van Meijel
- 14Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,15Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
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Seidel M, King JA, Ritschel F, Boehm I, Geisler D, Bernardoni F, Beck M, Pauligk S, Biemann R, Strobel A, Goschke T, Walter H, Roessner V, Ehrlich S. Processing and regulation of negative emotions in anorexia nervosa: An fMRI study. Neuroimage Clin 2017; 18:1-8. [PMID: 29321971 PMCID: PMC5756056 DOI: 10.1016/j.nicl.2017.12.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/23/2023]
Abstract
Theoretical models and recent advances in the treatment of anorexia nervosa (AN) have increasingly focused on the role of alterations in the processing and regulation of emotions. To date, however, our understanding of these changes is still limited and reports of emotional dysregulation in AN have been based largely on self-report data, and there is a relative lack of objective experimental evidence or neurobiological data. The current functional magnetic resonance imaging (fMRI) study investigated the hemodynamic correlates of passive viewing and voluntary downregulation of negative emotions by means of the reappraisal strategy detachment in AN patients. Detachment is regarded as adaptive regulation strategy associated with a reduction in emotion-related amygdala activity and increased recruitment of prefrontal brain regions associated with cognitive control processes. Emotion regulation efficacy was assessed via behavioral arousal ratings and fMRI activation elicited by an established experimental paradigm including negative images. Participants were instructed to either simply view emotional pictures or detach themselves from feelings triggered by the stimuli. The sample consisted of 36 predominantly adolescent female AN patients and a pairwise age-matched healthy control group. Behavioral and neuroimaging data analyses indicated a reduction of arousal and amygdala activity during the regulation condition for both patients and controls. However, compared with controls, individuals with AN showed increased activation in the amygdala as well as in the right dorsolateral prefrontal cortex (dlPFC) during the passive viewing of aversive compared with neutral pictures. These results extend previous findings indicative of altered processing of salient emotional stimuli in AN, but do not point to a general deficit in the voluntary regulation of negative emotions. Increased dlPFC activation in AN during passive viewing of negative stimuli is in line with the hypothesis that the disorder may be characterized by excessive self-control. Taken together, the data seem to suggest that reappraisal via detachment may be an effective strategy to reduce negative arousal for individuals with AN.
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Affiliation(s)
- Maria Seidel
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A King
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Franziska Ritschel
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ilka Boehm
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Daniel Geisler
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Matthias Beck
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sophie Pauligk
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University, Magdeburg, Germany
| | - Alexander Strobel
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Thomas Goschke
- Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychology, Charité Berlin, Berlin, Germany
| | - Veit Roessner
- Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neuroscience, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Translational Developmental Neuroscience Section, Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
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Treasure J, Cardi V. Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture? EUROPEAN EATING DISORDERS REVIEW 2017; 25:139-147. [PMID: 28402069 DOI: 10.1002/erv.2511] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 12/13/2022]
Abstract
Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
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Ambrosecchia M, Ardizzi M, Russo E, Ditaranto F, Speciale M, Vinai P, Todisco P, Maestro S, Gallese V. Interoception and Autonomic Correlates during Social Interactions. Implications for Anorexia. Front Hum Neurosci 2017; 11:219. [PMID: 28567008 PMCID: PMC5434670 DOI: 10.3389/fnhum.2017.00219] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/18/2017] [Indexed: 01/01/2023] Open
Abstract
The aim of this study is to investigate the bodily-self in Restrictive Anorexia, focusing on two basic aspects related to the bodily self: autonomic strategies in social behavior, in which others' social desirability features, and social cues (e.g., gaze) are modulated, and interoception (i.e., the sensitivity to stimuli originating inside the body). Furthermore, since previous studies carried out on healthy individuals found that interoception seems to contribute to the autonomic regulation of social behavior, as measured by Respiratory Sinus Arrhythmia (RSA), we aimed to explore this link in anorexia patients, whose ability to perceive their bodily signal seems to be impaired. To this purpose, we compared a group of anorexia patients (ANg; restrictive type) with a group of Healthy Controls (HCg) for RSA responses during both a resting state and a social proxemics task, for their explicit judgments of comfort in social distances during a behavioral proxemics task, and for their Interoceptive Accuracy (IA). The results showed that ANg displayed significantly lower social disposition and a flattened autonomic reactivity during the proxemics task, irrespective of the presence of others' socially desirable features or social cues. Moreover, unlike HCg, the autonomic arousal of ANg did not guide behavioral judgments of social distances. Finally, IA was strictly related to social disposition in both groups, but with opposite trends in ANg. We conclude that autonomic imbalance and its altered relationship with interoception might have a crucial role in anorexia disturbances.
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Affiliation(s)
- Marianna Ambrosecchia
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Martina Ardizzi
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
| | - Elisa Russo
- Casa di Cura, Villa MargheritaVicenza, Italy
| | - Francesca Ditaranto
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | | | | | | | - Sandra Maestro
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Stella MarisPisa, Italy
| | - Vittorio Gallese
- Department of Medicine and Surgery, Unit of Neuroscience, University of ParmaParma, Italy
- Institute of Philosophy, School of Advanced Study, University of LondonLondon, UK
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Haynos AF, Berg KC, Cao L, Crosby RD, Lavender JM, Utzinger LM, Wonderlich SA, Engel SG, Mitchell JE, Le Grange D, Peterson CB, Crow SJ. Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 126:495-505. [PMID: 27893231 DOI: 10.1037/abn0000202] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype. (PsycINFO Database Record
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry, University of Minnesota Medical Center
| | - Kelly C Berg
- Department of Psychiatry, University of Minnesota Medical Center
| | - Li Cao
- Neuropsychiatric Research Institute
| | | | | | - Linsey M Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical Center
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical Center
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