Mindfulness, rumination, and coping skills in young women with Eating Disorders: A comparative study with healthy controls

Can neuroimaging measures differentiate the disease course of anorexia nervosa? A systematic review

Anorexia nervosa (AN) entails many uncertainties regarding the clinical outcome, due to large heterogeneity in the disease course. AN is associated with global decrease in brain volumes and altered brain functioning during acute illness. However, it is unclear whether structural and functional brain alterations can predict clinical outcome. We aimed to systematically review the predictive value of volumetric and functional brain outcome measures of structural and functional brain magnetic resonance imaging (MRI) on the disease course of AN. Four databases (Embase, Medline, Psycinfo, and Cochrane Central Register) were systematically searched. A total of 15 studies (structural MRI: n = 6, functional MRI: n = 9) were reviewed. In total 464 unique AN patients, and 328 controls were included. Follow-up time ranged between 1 and 43 months. Structural neuroimaging studies showed that lower brain volumes of the cerebellum, subcortical grey matter, and cortical white matter at admission predicted a worse clinical outcome. A smaller increase of the anterior cingulate cortex volume in the early phase of the disease predicted a worse clinical outcome. Lower overall gyrification, and a higher clustering coefficient predicted a worse clinical outcome. Functional MRI studies showed that frontal, parietal and temporal activity during task-based algorithms predicted follow-up body mass index, although results were bidirectional possibly due to the large heterogeneity in methodological approaches. Neuroimaging measures may predict the clinical outcome of AN. However, there is a lack of replication studies. Future studies are needed to validate the prognostic utility of neuroimaging measures in AN patients, and should harmonize demographic, clinical and neuroimaging features in order to enhance comparability.

Reduced Anxiety Associated to Adaptive and Mindful Coping Strategies in General Practitioners Compared With Hospital Nurses in Response to COVID-19 Pandemic Primary Care Reorganization

COVID-19 pandemic imposed psychosocial stress increasing in frontline healthcare workers, who managed by responding with different coping strategies. General practitioners were targeted by an extraordinary increase in the demand for reception, diagnosis and treatment from all patients even if working in solo. In Italy, the emergency changed risk assumption and roles in between primary care, unraveling the emotional distress of general practitioners, who suffered not only for isolation, but also emotional threatens. In this correlational study we wanted to evaluate trait anxiety and stress as perceived by general practitioners working in individual ambulatory practice room, and by hospital ward nurses working in group, during a chronic phase (February-May 2021) of COVID-19 pandemic. Our hypothesis is that a different work social organization in clinic contest as for general practitioners compared with nurses could induce adaptive or non-adaptive coping to stress under emergency and mindful attitude could be crucial. A number of 37 general practitioners, and 36 nurses were taken from the sanitary district of ASL1 Avezzano-Sulmona-L'Aquila in Italy. For our analyses we used the Health Professions Stress and Coping Scale to assess the risk of burn-out, and detect the coping strategies. We also used the Cognitive and Affective Mindfulness Scale-Revised, investigating whether clinicians used an eventual mindful attitude to prevent anxiety and responding with adaptive coping strategies. General practitioners reported high levels of anxiety, associated to an increased use of emotional distress. Mindful attitude was protective for anxiety in both general practitioners and nurses. As anxiety increased, it was coped by increasing the demand for social support. This coping strategy correlated with emotional distress and when enhanced, it corresponded to avoidance of the problem. Mindful attitude addressed general practitioners to adaptive coping strategies as the solution of the problem. On the other side, nurses accepted the problem but addressed it to others, by avoiding solving it themselves as beyond their role and organizational responsibility. In conclusion, mindful attitude can prevent dysfunctional reactive behaviors among clinicians at the forefront of emergency and reduce emotional distress for isolation as suffered by general practitioners.

Eating Disorders and Intimate Partner Violence: The Influence of Fear of Loneliness and Social Withdrawal

Eating disorders are vulnerability factors that increase the likelihood of intimate partner violence. However, the mechanisms underlying this relationship are unclear. Although eating disorders have been associated with increased perception and fear of loneliness, they have also been associated with increased social withdrawal resulting from decreased enjoyment of social situations and poorer social functioning. The purpose of the present study was to examine the mediating role of fear of loneliness in the relationship between the behavioural characteristics of eating disorders and intimate partner violence, as well as to explore the moderating role of social withdrawal in the relationship between fear of loneliness and intimate partner violence. The sample comprised 683 participants (78% female and 22% male) with a mean age of 21.14 years (SD = 2.72). The psychometric scales used were Eating Disorders Inventory (EDI 2), Emotional Dependency Questionnaire (EDQ), Coping Strategies Inventory (CSI) and the Violence Received, Exercised and Perceived in Youth and Adolescent Dating Relationships Scale (VREPS). The hypothesised model was tested by path analysis using maximum likelihood. The path analysis of the hypothesised model showed that inefficacy, fear of maturity, and impulsivity were the behavioural characteristics of eating disorders predominantly related to fear of loneliness. Fear of loneliness had no direct significant effect on any of the received violence variables. However, interaction effects indicated that there was a moderately significant effect of fear of loneliness on physical, psychological, and social violence received as a function of levels of social withdrawal. These findings show the need to take into account and work on fear of loneliness and social withdrawal among individuals with an eating disorder to decrease the likelihood of establishing violent intimate partner relationships. Improving interpersonal functioning and social support is key to recovery from eating disorders.

Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination

The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: “eating disorder/anorexia/bulimia/binge eating disorder” AND “worry/rumination/brooding/repetitive thinking”. A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for “presence/absence ED diagnosis” and “subtype of ED symptom”. ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.

Coping strategies and stress-induced natural killer cell redistribution in women with eating disorders

BACKGROUND

Patients with eating disorders (ED) are very sensitive and responsive to psychosocial stress. Stress response includes changes in immune cell distribution and may be modulated by the capability to cope with stressors. Thus, the present study sought to analyze the association between coping strategies and immune response (natural killer [NK] cell redistribution following psychosocial stress) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) and healthy controls (HC).

METHOD

Twenty-four AN patients, 29 BN patients, and 58 HC were studied. A multidimensional assessment tool, the COPE Inventory, was used to assess coping strategies. The number of NK cells was quantified in peripheral blood before and after the application of the Trier Social Stress Test (TSST). Potentially mediating variables, such as weight status, severity of eating pathology, depression, anxiety, and impulsivity were controlled.

RESULTS

The three groups differed in intensity and direction of cell redistribution: The TSST was followed in BN patients by a significant decrease in the number of NK cells, whereas HC displayed a moderate decrease and AN a clear increase. Specific correlations between coping strategies and NK cell mobilization were found, especially in BN patients (positive for "planning" and negative for "substance abuse").

CONCLUSION

Recognition and subsequent modification of the dysfunctional coping strategies used by patients with ED could contribute to improving their immune status, strengthening their resilience and increasing their ability to overcome the disease.