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Kiely L, Conti J, Hay P. Anorexia nervosa through the lens of a severe and enduring experience: 'lost in a big world'. J Eat Disord 2024; 12:12. [PMID: 38254163 PMCID: PMC10804804 DOI: 10.1186/s40337-023-00953-2] [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: 09/04/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe and enduring anorexia nervosa (SE-AN), is a serious and persistent illness, despite 'state of the art' treatment. Criteria have been theoretically proposed, but not tested, and may not adequately capture illness complexity, which potentially inhibits treatment refinements. The clinical reality of death as an outcome for some people who experience SE-AN (1 in 20) and broadening access to voluntary assisted dying, further complicates the field, which is undeveloped regarding more fundamental concepts such as nosology, treatment, recovery definitions and alternative conceptualisations of SE-AN. The present paper is in response to this and aims to build upon qualitative literature to enhance phenomenological understandings of fatal SE-AN. METHOD A published book, being the legacy of a 32-year-old professional artist offers a rich account of a life lived with AN, for 18 years with continuous treatment. A polysemous narrative via the interrelationship between the languages of the artist's words and visual art is translated via interpretative phenomenological analysis (IPA), offering rich insight into the SE-AN experience. FINDINGS The process of analysis induced three superordinate themes (1) Disappearing Self (2) Dialectical Dilemma (3) Death and Dying: Finding Meaning. Two cross cutting themes traversed these themes: (a) Colour and (b) Shifting Hope, where the former produced a visual representation via the 'SE-AN Kaleidoscope'. Collectively the themes produce a concept of SE-AN, grounded in the data and depicted visually through the artist's paintings. CONCLUSIONS The picture of SE-AN revealed in the analysis extends upon conceptualisations of SE-AN, highlighting key processes which are thus far under explored. These factors are implicated in illness persistence eliciting opportunities for further research testing including diagnostic considerations and treatment directions. In SE-AN, distorted body image extends to a global distortion in the perception of self. Additional criteria for the severe and enduring stages of illness related to (1) self and identity processes (2) measures of 'global impoverishment' across life domains are proposed for consideration in the future testing of putative defining features of SE-AN.
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Affiliation(s)
- Laura Kiely
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia.
| | - Janet Conti
- School of Psychology, Translational Health Research Institute, Western Sydney University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Mental Health Services, Camden and Campbelltown Hospitals, SWSLHD, Campbeltown, NSW, 2560, Australia
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2
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Dorahy MJ, Yogeeswaran K, Middleton W. Dissociation-Induced Shame in Those with a Dissociative Disorder: Assessing the Impact of Relationship context using Vignettes. J Trauma Dissociation 2023; 24:674-691. [PMID: 36994492 DOI: 10.1080/15299732.2023.2195402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
Some evidence in non-clinical groups suggests that the relationship context in which dissociation is experienced might moderate its association with shame. The current study used vignettes detailing either dissociative symptoms or the expression of sadness occurring in three different relationship contexts: with a friend, an acquaintance, or when alone. Ratings of emotional (e.g. shame, anxiety) and behavioral (e.g. leave, talk) reactions were made on single-item measures, and shame feelings were further assessed with the State Shame Scale. Participants were in treatment for either dissociative identity disorder (n = 31) or other specified dissociative disorder (n = 3; N = 34). Feelings of shame were elevated in the acquaintance condition compared to when with a close friend or alone regardless of whether dissociation or sadness was experienced. In the acquaintance context, participants exposed to dissociation or sadness reported feeling annoyed at themselves, having a greater desire to leave, and a lesser desire to talk compared to when these experiences happened with a close friend or alone. Results suggest those with a dissociative disorder appraise themselves as more vulnerable to shame if experiencing dissociation or sadness when with an acquaintance, potentially because the risk of not being understood and rejected is heightened.
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Affiliation(s)
- Martin J Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
| | - Kumar Yogeeswaran
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Warwick Middleton
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
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3
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Dong Z, Zhou J, Conti A, Westwood SJ, Fu X, Liu Q, Yuan Y, Huang X, Qiu C, Zhang X, Tang W. Association between alexithymia and non-suicidal self-injury in psychiatric patients: the mediating role of self-esteem and the moderating role of emotional intelligence. J Psychiatr Res 2023; 162:57-64. [PMID: 37088044 DOI: 10.1016/j.jpsychires.2023.04.006] [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: 10/05/2022] [Revised: 03/09/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Raffagnato's theory claims that if people have no words to express their emotions (alexithymia), they express themselves by venting or through non-suicidal self-injury (NSSI). However, these associations have not been confirmed in psychiatric patients. This study explored the relationship between alexithymia and NSSI in psychiatric patients and the potential underlying psychological mechanisms. METHODS This retrospective study involved face-to-face interviews with 449 outpatients consecutively recruited from West China Hospital. Alexithymia, self-esteem, NSSI, and emotional intelligence (EI) were measured. The moderating role of EI and the mediating role of self-esteem between alexithymia and NSSI were also explored. Logistic regressions were used to examine whether sociodemographic, clinical variables and alexithymia were independently associated with NSSI. RESULTS The DSM-5 NSSI disorder and alexithymia prevalences were found to be 32.5% and 45.2%. When the other covariables were controlled for, the alexithymic patients were found to be at increased odds (OR 2.76) of engaging in NSSI behaviors. These results confirmed the strong associations between alexithymia, low self-esteem, and NSSI risk. Lower EI was found to be related to the connections between alexithymia and NSSI. Except for the lower risk in anxiety patients, the risk of NSSI was similar for patients with other mental disorders, CONCLUSION: This study revealed the psychological mechanisms through which alexithymia increases the risk of NSSI. Therefore, to reduce NSSI risk, screening for alexithymia should be emphasized. Self-esteem as a targeted psychological intervention could also assist in mitigating the process from alexithymia to NSSI behaviors, and EI training for psychiatric patients could weaken the relationship between alexithymia and NSSI.
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Affiliation(s)
- Zaiquan Dong
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhou
- Department of Psychosomatic Medicine, Leshan People's Hospital, Leshan, Sichuan, China
| | - Aldo Conti
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuel J Westwood
- Department of Psychology, School of Social Science, University of Westminster, London, UK
| | - Xia Fu
- Out-patient Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Liu
- Out-patient Department of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanling Yuan
- Department of Pharmacy of West China Hospital, Sichuan University, Chengdu, China
| | - Xia Huang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohui Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wanjie Tang
- Mental Health Centre, West China Hospital, Sichuan University, Chengdu, China; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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4
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Christoffersen H, Skårderud HR, Vrabel K, Weider S. Self-compassion as a mechanism of change in patients with eating disorders and childhood trauma receiving CFT-E; a study of within-person processes. NORDIC PSYCHOLOGY 2023. [DOI: 10.1080/19012276.2023.2192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Hedvig Christoffersen
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - Hanna Røed Skårderud
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - KariAnne Vrabel
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Siri Weider
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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5
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Barberis N, Calaresi D, Cannavò M, Verrastro V. Trait emotional intelligence and quality of life in women with polycystic ovary syndrome: Dysmorphic concerns and general distress as mediators. Compr Psychiatry 2023; 122:152373. [PMID: 36739836 DOI: 10.1016/j.comppsych.2023.152373] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women. It is characterised by a variety of symptoms that can seriously impair one's health-related quality of life (HRQoL). Dysmorphic concerns and general distress appear to be related to the development of HRQoL issues, whilst trait emotional intelligence (trait EI) has been significantly linked to better adaptability to chronic conditions. The present study sought to test the hypothesis that an association between trait EI and HRQoL in individuals with PCOS would be mediated by dysmorphic concerns and to examine their relationship with general distress (depression, anxiety, and stress). METHODS Questionnaires were administered to 478 individuals with PCOS to analyse trait EI, dysmorphic concerns, general distress, and HRQoL. RESULTS The results indicated that trait EI was negatively associated with dysmorphic concerns and general distress; dysmorphic concerns were positively related to general distress; dysmorphic concerns and general distress were negatively related to HRQoL; and dysmorphic concerns and general distress had a mediating role in the relationship between trait EI and HRQoL. CONCLUSION The results suggest that individuals with PCOS may have a lower HRQoL and high levels of trait EI may represent a protective factor against poor HRQoL. The implications for clinical practice are discussed.
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Affiliation(s)
- Nadia Barberis
- Dipartimento di Scienze della Salute, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, IT, Italy.
| | - Danilo Calaresi
- Dipartimento di Scienze della Salute, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, IT, Italy.
| | - Marco Cannavò
- Dipartimento di Scienze della Salute, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, IT, Italy.
| | - Valeria Verrastro
- Dipartimento di Scienze della Salute, Università degli Studi Magna Graecia di Catanzaro, Catanzaro, IT, Italy.
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6
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Rudy JA, McKernan S, Kouri N, D'Andrea W. A meta-analysis of the association between shame and dissociation. J Trauma Stress 2022; 35:1318-1333. [PMID: 35749645 DOI: 10.1002/jts.22854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022]
Abstract
Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa.
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Affiliation(s)
- Justine A Rudy
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Scott McKernan
- Department of Psychology, The New School for Social Research, New York, New York, USA
| | - Nicole Kouri
- Department of Clinical Psychology, Wayne State University, Detroit, Michigan, USA
| | - Wendy D'Andrea
- Department of Psychology, The New School for Social Research, New York, New York, USA
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7
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Zancu SA, Dafinoiu I, Enea V. Alexithymia, body image and disordered eating in fashion models and student athletes. Eat Weight Disord 2022; 27:709-716. [PMID: 34021902 DOI: 10.1007/s40519-021-01207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Fashion models and athletes are considered at risk for eating disorders, but research has produced mixed findings and little insight into psychological risk factors. Body-focused performance is common to both occupations, but emotional risk factors like alexithymia and body-image particularities have not been compared between them. This study aimed to: (1) examine the levels of alexithymia and affective states among female fashion models and athletes as body-performing occupations, and a control group, and (2) compare multidimensional body image and disordered eating among these groups. METHODS Data from 351 females aged 16-30 were compared among three samples: fashion models (n = 88), student athletes (n = 84) and control students (n = 179), who completed measures for alexithymia, affective states, multidimensional body image, and disordered eating. RESULTS Fashion models had significantly lower alexithymia compared with the other groups, and lower negative affect than controls. Positive affect was significantly lower among controls than the other groups. Body image comparisons revealed significantly higher fitness evaluation and orientation in fashion models and athletes compared to controls. Fashion models had significantly higher appearance orientation than the other groups. Student athletes had significantly higher appearance evaluation than controls and higher fitness evaluation than fashion models. Disordered eating did not differ among groups. CONCLUSION Lower alexithymia among fashion models is discussed in the context of emotional labor and artistic public performance. The findings suggest that body-focused performance may have emotional benefits and may drive higher body-image investment and satisfaction. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Simona Alexandra Zancu
- Department of Psychology, Alexandru Ioan Cuza University of Iaşi, 3 Toma Cozma Street, Iasi, România.
| | - Ion Dafinoiu
- Department of Psychology, Alexandru Ioan Cuza University of Iaşi, 3 Toma Cozma Street, Iasi, România
| | - Violeta Enea
- Department of Psychology, Alexandru Ioan Cuza University of Iaşi, 3 Toma Cozma Street, Iasi, România.
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8
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Reuber M, Roberts NA, Levita L, Gray C, Myers L. Shame in patients with psychogenic nonepileptic seizure: A narrative review. Seizure 2021; 94:165-175. [PMID: 34844847 DOI: 10.1016/j.seizure.2021.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/02/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022] Open
Abstract
Psychogenic Nonepileptic Seizures (PNES) have been linked to dysregulated emotions and arousal. However, the question which emotions may be most relevant has received much less attention. In this multidisciplinary narrative review, we argue that the self-conscious emotion of shame is likely to be of particular importance for PNES. We summarize current concepts of the development of shame processing and its relationship with other emotional states. We demonstrate the potential of acute shame to cause a sudden disruption of normal cognitive function and trigger powerful behavioral, cognitive, physiological and secondary emotional responses which closely resemble key components of PNES. These responses may lead to the development of shame avoidance strategies which can become disabling in themselves. We discuss how excessive shame proneness and shame dysregulation are linked to several psychopathologies often associated with PNES (including depression and PTSD) and how they may predispose to, precipitate and perpetuate PNES disorders, not least by interacting with stigma. We consider current knowledge of the neurobiological underpinnings of shame and PNES. We explore how shame could be the link between PNES and a heterogeneous range of possible etiological factors, and how it may link historical aversive experiences with individual PNES events occurring much later and without apparent external trigger. We argue that, in view of the potential direct links between shame and PNES, the well-documented associations of shame with common comorbidities of this seizure disorder and the well-characterized relationship between chronic shame and stigma, there is a compelling case to pay greater attention to shame in relation to PNES. Its role in the treatment of patients with PNES is discussed in a separate, linked review incorporating case vignettes to highlight the complex interactions of different but interlinked shame-related issues in individual patients.
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Affiliation(s)
- M Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom.
| | - Nicole A Roberts
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
| | - Liat Levita
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Cordelia Gray
- Specialist Psychotherapist, Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, University of Sheffield, Sheffield, UK
| | - Lorna Myers
- Director, Northeast Regional Epilepsy Group, New York, United States
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9
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The Prevalence of Adverse Childhood Experiences, Body Shame, and Revision Request Rate in 218 Plastic Surgery Patients: What Drives Postoperative Dissatisfaction? Plast Reconstr Surg 2021; 148:1233-1246. [PMID: 34644275 DOI: 10.1097/prs.0000000000008567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND What drives patients who are unhappy despite good results? Adverse childhood experiences are common, can impair adult health, and can cause body shame. Neither adverse childhood experiences nor body shame has been studied in surgical patients. The authors report adverse childhood experience prevalences in a plastic surgical population and investigate associations from adverse childhood experiences to body shame and to postoperative dissatisfaction. METHODS Two hundred eighteen consecutive patients (86 percent aesthetic and 14 percent reconstructive) completed the Adverse Childhood Experiences Survey and the Experience of Shame Scale. A one-sample test of proportions, logistic regression, and mediation analysis assessed outcomes. RESULTS Compared to the Kaiser/Centers for Disease Control and Prevention medical population, our patients had higher overall adverse childhood experience prevalences (79.8 percent versus 64 percent), emotional abuse (41 percent versus 11 percent), emotional neglect (38 percent versus 15 percent), family substance abuse (36 percent versus 27 percent), and family mental illness (29 percent versus 19 percent, all p < 0.001). Fifty-two percent of our patients had body shame. Adverse Childhood Experiences score predicted body shame (OR, 1.22; p = 0.003). Compared to unshamed patients, body shame was associated with more adverse childhood experiences (85 percent versus 72 percent), higher median Adverse Childhood Experiences score (3.5 versus 2), more cosmetic operations (three versus zero), more health problems (three versus two), higher antidepressant use (39 percent versus 19 percent), substance abuse history (16 percent versus 5 percent), and demands for additional pain medication (18 percent versus 5 percent). Body shame predicted requests for surgical revision (49 percent versus 17 percent; OR, 4.61; all p ≤ 0.0001). CONCLUSIONS Adverse childhood experience were common in our patients. Adverse Childhood Experiences score predicted body shame, which predicted revision requests. If body shame preceded and drove surgery, revision requests were likely. Patients desiring revisions had recognizable characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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10
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Nechita DM, Bud S, David D. Shame and eating disorders symptoms: A meta-analysis. Int J Eat Disord 2021; 54:1899-1945. [PMID: 34302369 DOI: 10.1002/eat.23583] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Numerous empirical studies and theoretical models posit that shame is a common experience among individuals across the eating disorder spectrum. In this study we aim to investigate the association between shame and eating disorders symptoms using a meta-analytical approach. METHOD In this meta-analysis, we synthesized findings from 195 studies to examine the proposed association between shame and eating disorders symptoms. We looked at the associations with both general eating disorders symptoms and with specific eating disorders symptoms (i.e., anorexic, bulimic, and binge-eating symptoms). Moderation analyses testing for the effect of type of shame, type of eating symptoms, clinical status, quality of the study, age, and gender were conducted. RESULTS Shame was significantly associated with a medium to large effect size with all types of eating disorders symptoms (rs between .40 and .52). Body shame (r = .55) and shame around eating (r = .59) were more strongly related with eating disorders pathology. Type of eating disorders symptoms did not moderate the relationship between shame and disturbed eating. DISCUSSION Overall, the magnitude of the effect size of the association between shame and eating disorders symptoms is a medium to large one. Body shame and shame around eating seem to be the types of shame most closely tied with eating disorders symptoms, suggesting that directly targeting them in interventions might be highly beneficial. Findings highlight current gaps in the literature (e.g., mostly correlational studies, low quality studies) with implications for future research.
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Affiliation(s)
- Diana-Mirela Nechita
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Samuel Bud
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania.,Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.,International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
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11
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Vaught AS, Piazza V, Raines AM. Prevalence of eating disorders and comorbid psychopathology in a US sample of treatment-seeking veterans. Int J Eat Disord 2021; 54:2009-2014. [PMID: 34338326 DOI: 10.1002/eat.23591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) are a well-studied public health issue in the general population. Less is known, however, about the prevalence of such conditions and levels of comorbid psychopathology among military and veteran populations. The current study sought to describe the probable prevalence of EDs and levels of comorbid psychopathology using a racially diverse treatment-seeking sample of US veteran men and women. METHOD Veterans (N =254) presenting for routine clinical care completed self-report questionnaires assessing EDs, posttraumatic stress disorder, depression, and shame. RESULTS Thirty-one percent of the sample met probable criteria for either bulimia nervosa (BN), binge-eating disorder, or purging disorder. Although overall ED prevalence estimates were similar across men and women, estimates of BN were higher among Black veterans compared to White veterans or veterans who identified as a race other than Black or White. Further, mean levels of psychopathology were significantly higher in veterans with a probable ED compared to those without. DISCUSSION This study extends previous research and highlights the importance of establishing dedicated ED screening programs within the Veterans Health Administration.
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Affiliation(s)
- Amanda S Vaught
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
| | - Vivian Piazza
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,Atlas Psychiatry, New Orleans, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
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12
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Karaca Dinç P, Oktay S, Durak Batıgün A. Mediation role of alexithymia, sensory processing sensitivity and emotional-mental processes between childhood trauma and adult psychopathology: a self-report study. BMC Psychiatry 2021; 21:508. [PMID: 34654396 PMCID: PMC8520293 DOI: 10.1186/s12888-021-03532-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is overwhelming evidence for a strong association between childhood trauma and adult psychopathology. This study aimed to investigate the mediation roles of alexithymia, sensory processing sensitivity, and emotional-mental processes in the relationship between childhood traumas and adult psychopathology. METHODS The sample consisted of 337 people (78.9% female, 21.1% male) aged between 20 and 64 years. Participants filled the scales online via a Google form. Reading Mind in the Eyes (EYES), Sensory Processing Sensitivity Scale (SPS), Toronto Alexithymia Scale (TAS-26), Childhood Trauma Questionnaire (CTQ), and the Brief Symptom Inventory (BSI) were used. PROCESS (Model 4) macro was used to examine the mediating role of sensory processing sensitivity, alexithymia, and the EYES test results in the relationship between childhood trauma and psychopathology. RESULTS The results of mediation analysis demonstrated that sensory processing sensitivity and alexithymia mediated the relationship between childhood trauma and adult psychopathology. However, the EYES test (mentalization) did not mediate in this relationship. CONCLUSION This study shows that childhood traumas may relate to more psychological symptoms in individuals with high sensory processing sensitivity and alexithymia. Our study may contribute to the understanding of what may lead to a person's vulnerability to experiencing psychological symptoms after childhood trauma. It may be crucial that future treatment and intervention programs should include sensory sensitivity and alexithymia. Sensory processing sensitivity and alexithymia can be examined in the treatment of psychological problems of individuals who have experienced childhood trauma.
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Affiliation(s)
- Pelin Karaca Dinç
- Ankara University, Ankara, Turkey
- Department of Psychology, Faculty of Languages History and Geography, University of Ankara University, No:45-45/A 06100, Sıhhiye, Ankara, Turkey
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13
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Meneguzzo P, Garolla A, Bonello E, Todisco P. Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother 2021; 29:718-724. [PMID: 34432335 PMCID: PMC9291290 DOI: 10.1002/cpp.2665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive–behavioural therapy and a flexible and personalized component implemented by third‐wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re‐evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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14
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Troisi A, Nanni RC, Giunta A, Manfreda V, Del Duca E, Criscuolo S, Bianchi L, Esposito M. Cutaneous body image in psoriasis: The role of attachment style and alexithymia. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractThe aim of this study was to estimate the contribution of adult attachment style and alexithymia to cutaneous body image in patients with psoriasis while controlling for the confounding effects of disease severity and depressive symptoms. Participants were 107 consecutive patients (60% women) with a diagnosis of plaque-type psoriasis. Cutaneous body dissatisfaction was measured with the Cutaneous Body Image Scale (CBIS) and disease severity with the Psoriasis Area and Severity Index (PASI). Depressive symptoms, attachment style and alexithymia were assessed with the Beck Depression Inventory (BDI), the Attachment Style Questionnaire (ASQ) and the Toronto Alexithymia Scale (TAS-20), respectively. Hierarchical regression analysis showed that, independently from the severity of skin disease and depressive symptoms, patients with an insecure-avoidant attachment style and higher levels of alexithymia reported greater cutaneous body dissatisfaction. Because of the cross-sectional design, the causal relationship between avoidant attachment, alexithymia and cutaneous body image cannot be determined. There was no control group. Clinical assessment of patients with psoriasis should include attachment style and alexithymia among the psychological variables related to cutaneous body dissatisfaction.
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15
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Constantian MB. Commentary on: Using Nasal Self-Esteem to Predict Revision in Cosmetic Rhinoplasty. Aesthet Surg J 2021; 41:657-660. [PMID: 33231626 DOI: 10.1093/asj/sjaa268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark B Constantian
- Department of Surgery (Plastic Surgery), St Joseph Hospital, Nashua, NH, USA
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16
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Braun TD, Uebelacker LA, Ward M, Holzhauer CG, McCallister K, Abrantes A. "We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma. Complement Ther Med 2021; 59:102729. [PMID: 33965560 DOI: 10.1016/j.ctim.2021.102729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST. DESIGN Collective case series (N = 7). SETTING New England Vet Center. INTERVENTIONS Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. MAIN OUTCOME MEASURES Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). RESULTS Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. CONCLUSIONS TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.
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Affiliation(s)
- Tosca D Braun
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States(1); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
| | - Mariana Ward
- Memorial Sloan Kettering, Sloan Kettering Institute, 1275 York Ave., New York, NY, 10065, United States.
| | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave., North Worcester, MA, 01655, United States.
| | - Kelly McCallister
- West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States.
| | - Ana Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
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17
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Dincer B, Yıldırım Ayaz E, Oğuz A. Changes in Sexual Functions and Alexithymia Levels of Patients with Type 2 Diabetes During the COVID-19 Pandemic. SEXUALITY AND DISABILITY 2021; 39:461-478. [PMID: 33967358 PMCID: PMC8093367 DOI: 10.1007/s11195-021-09693-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/08/2023]
Abstract
This study was conducted to determine the changes in sexual functioning and alexithymia levels in patients with type 2 diabetes during the COVID-19 pandemic. This descriptive, cross-sectional study was conducted with 162 patients with type 2 diabetes. Data were collected using the Information Form, Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale. For 83.3% of the participants, there was a decrease in sexual functioning after diabetes, 69.8% after the COVID-19 pandemic, and 67.2% due to both conditions. The majority of the patients stated the reasons for experiencing sexual problems related to not seeing sexuality as a priority (77.1%), and stress/anxiety experienced during the COVID-19 pandemic (67.9%). Moreover, patients' alexithymia, anxiety, and depression levels were found to be high during the pandemic, when the study was conducted. A positive correlation was identified between alexithymia and anxiety and depression. Further, multiple regression results indicated that about 50% of alexithymia levels could be explained by anxiety and depression levels. The anxiety, depression, and alexithymia scores of those who had decreased sexual functioning before and during the pandemic period were statistically significantly higher than those who did not have any change (p < 0.01). During the COVID-19 pandemic when the study was conducted, high levels of alexithymia, anxiety, and depression were observed in participants, and it was found that their sexual functioning was negatively affected. Healthcare professionals should evaluate their patients in extraordinary situations such as epidemics and pandemics in terms of sexual functioning as well as other vital functions.
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Affiliation(s)
- Berna Dincer
- Department of Medical Nursing, Faculty of Health Sciences, Istanbul Medeniyet University, Şehit Hakan Kurban Street, No 44, 34862 Kartal, İstanbul, Turkey
| | - Elif Yıldırım Ayaz
- Sultan Abdülhamid Han Training and Research Hospital, Internal Medicine Clinic, Sağlık Bilimleri University, Istanbul, Turkey
| | - Aytekin Oğuz
- Istanbul Medeniyet University Training and Research Hospital, Internal Medicine Clinic, Istanbul, Turkey
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18
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Budiarto Y, Helmi AF. Shame and Self-Esteem: A Meta-Analysis. EUROPES JOURNAL OF PSYCHOLOGY 2021; 17:131-145. [PMID: 35136434 PMCID: PMC8768475 DOI: 10.5964/ejop.2115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 07/20/2020] [Indexed: 12/30/2022]
Abstract
Scholars agree that shame has many effects related to psychological functioning declines, and one among others is the fluctuation of self-esteem. However, the association between shame and self-esteem requires further studies. Heterogeneity studies due to different measurements, various sample characteristics, and potential missing research findings may result in uncertain conclusions. This study aimed to explore the relationship between shame and self-esteem by meta-analysis to come up with evidence of heterogeneity and publication bias of the study. Eighteen studies from the initial 235 articles involving the term shame and self-esteem were studied using the random-effects model. A total of 578 samples were included in the study. The overall effect size estimate between shame and self-esteem (r = -.64) indicates that shame correlates negatively with self-esteem and is large effect size. The result showed that heterogeneity study was found (I² = 95.093%). The Meta-regression showed that age moderated the relationship between shame and self-esteem (p = .002), while clinical sample characteristics (p = .232) and study quality (p = .184) did not affect the overall effect size.
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Affiliation(s)
- Yohanes Budiarto
- Faculty of Psychology, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Faculty of Psychology, Universitas Tarumanagara, Jakarta, Indonesia
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19
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Childhood maltreatment and adulthood proneness to shame and guilt: The mediating role of maladaptive schemas. MOTIVATION AND EMOTION 2021. [DOI: 10.1007/s11031-021-09866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Zhang CH, Li G, Fan ZY, Tang XJ, Zhang F. Psychological Capital Mediating the Relationship Between Childhood Trauma and Alexithymia in Chinese Medical Students: A Cross-Sectional Study. Psychol Res Behav Manag 2020; 13:1343-1352. [PMID: 33408537 PMCID: PMC7781113 DOI: 10.2147/prbm.s288647] [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: 10/25/2020] [Accepted: 12/12/2020] [Indexed: 01/20/2023] Open
Abstract
Purpose A much higher prevalence of alexithymia has been found in medical students compared with the general population. This study aimed to test the potential mediating effect of psychological capital on the relationship between childhood trauma and alexithymia in Chinese medical students, thereby providing clues for future interventions aimed at dealing with alexithymia in this population. Methods Convenience cluster sampling was used to recruit 1200 medical students in Chongqing, China. This cross-sectional study utilised the Childhood Trauma Questionnaire Short Form, the Toronto Alexithymia Scale, and the Psychological Capital Questionnaire. A structural equation model with maximum likelihood was used to study the mediating effect presented in the aim, and the significance of the mediating effect was examined by the bootstrap method. Multiple-group invariance analyses were also conducted to confirm the stability of the model. Results A total of 1018 were identified to have valid responses with a rate of 84.83%. 38.4% were males, 61.6% were females. The prevalence of alexithymia was 16.5%. Results of structural equation model showed that childhood trauma was positively related to alexithymia, with a standard path coefficient of 0.219 (C.R.=6.644, P<0.001). The partial mediating effect of psychological capital was 0.060 (P<0.001), accounting for 21.51% of the total effect of childhood trauma on alexithymia. Results of bootstrap method showed that the lower and upper bounds of the 95% confidence interval did not contain 0, and the multiple-group invariance analyses showed that the p values of the changes in the degrees of freedom and chi-square value were greater than 0.05, thus confirming the stability of the model. Conclusion Childhood trauma was a direct predictor of alexithymia among Chinese medical students, and the relationship between these two was partially mediated by psychological capital. Therefore, interventions aimed at enhancing psychological capital in this population may be effective at diminishing alexithymia.
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Affiliation(s)
- Chang-Hong Zhang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Ge Li
- The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing 401331, People's Republic of China
| | - Zhao-Ya Fan
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Xiao-Jun Tang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Fan Zhang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, People's Republic of China
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21
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Dilger AE, Sykes JM. Unhappy Patients Can Turn into Angry Patients: How to Deal with Both. Facial Plast Surg Clin North Am 2020; 28:461-468. [PMID: 33010864 DOI: 10.1016/j.fsc.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient satisfaction is the ultimate measure of success in cosmetic facial plastic surgery. A successful outcome depends on patient selection, technical performance, and postoperative care. Patient perception can be influenced by physician-patient interactions. Surgical training focuses on diagnosis-identifying variations in physical condition and treatment. Although these skills are essential to a well-trained and successful facial plastic surgeon, the importance of proper patient selection, management of expectations, and empathetic communication in cosmetic surgery are often overlooked in education and cannot be understated. This article outlines the contributing factors to difficult physician-patient relationships and strategies for mitigating these situations.
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Affiliation(s)
- Amanda E Dilger
- Facial Plastic and Reconstructive Surgery, Beverly Hills, CA, USA; Roseville Facial Plastic Surgery, Roseville, CA, USA
| | - Jonathan M Sykes
- Facial Plastic Surgery, UC Davis Medical Center, Sacramento, CA, USA; Facial Plastic Surgery, Roxbury Institute, Beverly Hills, CA, USA.
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22
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Blythin SPM, Nicholson HL, Macintyre VG, Dickson JM, Fox JRE, Taylor PJ. Experiences of shame and guilt in anorexia and bulimia nervosa: A systematic review. Psychol Psychother 2020; 93:134-159. [PMID: 30182527 DOI: 10.1111/papt.12198] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 06/19/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Emotional states may play an important role in the development and maintenance of anorexia (AN) and bulimia nervosa (BN). This systematic review aimed to examine the evidence regarding the relationship that shame and guilt have with two eating disorders, AN and BN. METHODS Four major databases (Pubmed, PsychINFO, Web of Science, Medline) were searched (up until April 2018) for studies measuring guilt or shame in clinically diagnosed AN and BN groups. Included papers were evaluated for risk of bias. RESULTS Twenty-four papers met the inclusion criteria. Several methodological issues were noted within the reviewed studies, including a lack of longitudinal data and unaccounted confounding variables. Nonetheless, shame was typically more common in those with AN and BN than controls, was positively related to the severity of symptoms, and associated with the onset of eating disorder-related difficulties (e.g., binging or purging). Effect sizes were typically moderate to large. The role of guilt was less clear, with few studies and mixed results. DISCUSSION There is preliminary evidence that shame is implicated in the aetiology of AN and BN presentations, whilst there is currently insufficient evidence of such a role for guilt. It remains unclear whether shame is a risk factor for the development of AN and BN or a consequence of these difficulties. PRACTITIONER POINTS Elevated shame appears to be a feature of anorexia (AN) and bulimia nervosa (BN). Shame appears to fluctuate with the occurrence of eating disordered behaviours like binging, purging or restricted eating. Guilt is less consistently linked to AN and BN presentations. Interventions directed at shame may be helpful for these populations. A lack of longitudinal data means the temporal features of these relationships are still unclear.
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Affiliation(s)
| | | | - Vanessa G Macintyre
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Joanne M Dickson
- Institute of Psychology, Health and Society, University of Liverpool, UK.,Department of Psychology, School of Arts and Humanities, Edith Cowan University, Perth, Western Australia, Australia
| | - John R E Fox
- South Wales Clinical Psychology Training Programme, Cardiff University, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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23
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Cheok F, Proeve M. The Role of Perspective Taking and Alexithymia in Associations Between Shame, Guilt, and Social Anxiety. J Cogn Psychother 2019; 33:286-300. [PMID: 32746392 DOI: 10.1891/0889-8391.33.4.286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study expanded previous research concerning relationships between shame, guilt, and social anxiety by examining both internal and external shame and exploring the role of two cognitive constructs relating to emotion regulation, perspective taking, and alexithymia. Findings were consistent with the literature regarding positive associations between shame and social anxiety and no relationship between guilt and social anxiety. Perspective taking was positively related to guilt, while alexithymia was positively related to both shame types. Social anxiety was predicted by shame-proneness, external shame, and alexithymia. There were also small indirect effects for both types of shame on social anxiety through alexithymia. Further replication of relationships between shame, alexithymia, and social anxiety is needed. Alexithymia, with and without concurrent shame, has implications for therapeutic interventions for social anxiety as it may represent a barrier to implementing conventional therapies.
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Affiliation(s)
- Frida Cheok
- School of Psychology, University of Adelaide, South Australia, Australia
| | - Michael Proeve
- School of Psychology, University of Adelaide, South Australia, Australia
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24
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Currie CL, Copeland JL, Voss ML, Swanepoel LM, Ambeskovic M, Patel NB, Higa EK. Trauma-informed interventions versus control for cancer-risk behaviours among adults: rationale and design for a randomized trial. BMC Public Health 2019; 19:1403. [PMID: 31664968 PMCID: PMC6819450 DOI: 10.1186/s12889-019-7641-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023] Open
Abstract
Background Tobacco use, alcohol use, and sugar-sweetened beverage consumption are each associated with increased cancer-risk. Psychological trauma is a common experience and a key driver of these behaviours among adults. The primary aim of this study is to evaluate the effect of trauma-informed yoga, drumming, and psychoeducation compared to control on tobacco use, alcohol use, and sugar-sweetened beverage consumption among community-based adults. Secondary aims are to evaluate the effect of these interventions compared to control on psychological and physiological stress symptomology, social connection, and coping behaviour. Methods Recruitment for this single-blinded randomized trial began in April 2019 in the Faculty of Health Sciences at the University of Lethbridge. Adults who consumed tobacco, alcohol, or sugar-sweetened beverages in the past month and live in Lethbridge, Alberta are being recruited using ads placed in public spaces. Participants are randomly allocated to a 12-session group yoga class, 12-session group drumming class, a 12-session psychoeducation class, or control. Participants attend an appointment in-person to fill out an online questionnaire package, provide a saliva sample, and complete physical measures pre-intervention, and 1-month and 6-months post-intervention. Discussion This study provides a unique opportunity to compare the impacts of two trauma-informed body-based interventions to psychoeducation and control for cancer-risk behaviour among community-based adults. The findings can be used to develop trauma-informed group interventions to reduce cancer-risk behaviour in general populations. Results are expected in 2022. Trial registration This trial was registered with ClinicalTrials.govISRCTN15583681 on 22 August 2019 (retrospectively registered).
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Affiliation(s)
- Cheryl L Currie
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Jennifer L Copeland
- Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, Canada
| | - M Lauren Voss
- Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, Canada
| | - Lisa-Marie Swanepoel
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Mirela Ambeskovic
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, Canada
| | - Nimesh B Patel
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Erin K Higa
- Faculty of Health Sciences, University of Lethbridge, M3083 Markin Hall, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
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Conti C, Di Francesco G, Lanzara R, Severo M, Fumagalli L, Guagnano MT, Porcelli P. Alexithymia and binge eating in obese outpatients who are starting a weight‐loss program: A structural equation analysis. EUROPEAN EATING DISORDERS REVIEW 2019; 27:628-640. [DOI: 10.1002/erv.2696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Chiara Conti
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Giulia Di Francesco
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Roberta Lanzara
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
- Department of Dynamic and Clinical Psychology“Sapienza” University of Rome Rome Italy
| | - Melania Severo
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Luna Fumagalli
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
| | - Maria Teresa Guagnano
- Department of Medicine and AgingUniversity “G. d'Annunzio” Chieti‐Pescara Chieti Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial SciencesUniversity “G. d'Annunzio” of Chieti‐Pescara Chieti Italy
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Emirtekin E, Balta S, Sural İ, Kircaburun K, Griffiths MD, Billieux J. The role of childhood emotional maltreatment and body image dissatisfaction in problematic smartphone use among adolescents. Psychiatry Res 2019; 271:634-639. [PMID: 30791336 DOI: 10.1016/j.psychres.2018.12.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/07/2018] [Accepted: 12/09/2018] [Indexed: 12/22/2022]
Abstract
Growing empirical evidence has identified specific psychological and contextual risk factors associated with problematic smartphone use (PSU). However, the potential direct and indirect impact of childhood emotional maltreatment (CEM) on PSU remains largely unexplored, despite the established role of CEM in the onset of other excessive, problematic, and addictive behaviors. Consequently, the purpose of the present study was to test the direct and indirect relationships of emotional abuse and neglect (two facets of CEM) with PSU via specific mediational pathways including body image dissatisfaction (BID), social anxiety, and depression. The sample comprised 443 adolescents who completed a questionnaire that included assessment tools of aforementioned variables. Multiple mediation model results indicated that CEM was directly and indirectly associated with PSU via BID, depression, BID-related depression, and BID-related social anxiety. Results suggested that emotionally traumatic experiences were associated with PSU in adolescents and that this relationship may partially be explained by BID and psychosocial risk factors. The present study draws caution to the amplifying roles of CEM and BID on increased PSU. The results of the study have important clinical and public health implications, but additional research is needed before interventions can be developed and implemented on the basis of present results.
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Affiliation(s)
- Emrah Emirtekin
- The Centre for Open and Distance Learning, Yaşar University, İzmir, Turkey
| | - Sabah Balta
- School of Applied Sciences, Yaşar University, İzmir, Turkey
| | - İrfan Sural
- Computer and Instructional Technologies Department, Osmangazi University, Eskişehir, Turkey
| | - Kagan Kircaburun
- Computer and Instructional Technologies Department, Duzce University, Duzce, Turkey.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, United Kingdom
| | - Joel Billieux
- Addictive and Compulsive Behaviours Lab, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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27
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Imperatori C, Innamorati M, Lamis DA, Farina B, Fabbricatore M, Contardi A. Body uneasiness is associated with food addiction symptoms: A cross-sectional study. EUROPEAN EATING DISORDERS REVIEW 2018; 26:638-644. [DOI: 10.1002/erv.2640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/19/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | - Marco Innamorati
- Department of Human Sciences; European University of Rome; Rome Italy
| | - Dorian A. Lamis
- Department of Psychiatry and Behavioral Sciences; Emory University School of Medicine; Atlanta Georgia
| | - Benedetto Farina
- Department of Human Sciences; European University of Rome; Rome Italy
| | | | - Anna Contardi
- Department of Human Sciences; European University of Rome; Rome Italy
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Scarpina F, Melzi L, Castelnuovo G, Mauro A, Marzoli SB, Molinari E. Explicit and Implicit Components of the Emotional Processing in Non-organic Vision Loss: Behavioral Evidence About the Role of Fear in Functional Blindness. Front Psychol 2018; 9:494. [PMID: 29692751 PMCID: PMC5903191 DOI: 10.3389/fpsyg.2018.00494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 03/23/2018] [Indexed: 12/04/2022] Open
Abstract
Non-organic vision loss (NOVL), a functional partial or global vision loss, might be considered a manifestation of conversion disorder. The few previous studies focused on investigating the relationship between cerebral activity and subjective symptoms in NOVL; however, the emotional processing is still neglected. In the present case-controls study, we investigated the capability of two individuals diagnosed with NOVL to recognize implicitly the emotions of fear and anger; this was assessed through a facial emotion recognition task based on the redundant target effect. In addition, the level of alexithymia was measured by asking them to judge explicitly their ability to identify and describe emotions. Both individuals showed selective difficulties in recognizing the emotion of fear when their performance was contrasted with a matched control sample; they also mislabeled other emotional stimuli, judging them as fearful, when they were not. However, they did not report alexithymia when measured using a standard questionnaire. This preliminary investigation reports a mismatch between the implicit (i.e., the behavior in the experimental paradigm) and the explicit (i.e., the subjective evaluation of one’s own emotional capability) components of the emotional processing in NOVL. Moreover, fear seems to represent a critical emotion in this condition, as has been reported in other psychiatric disorders. However, possible difficulties in the emotional processing of fear would emerge only when they are inferred from an implicit behavior, instead of a subjective evaluation of one’s own emotional processing capability.
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Affiliation(s)
- Federica Scarpina
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Lisa Melzi
- Neuro-Ophthalmology Service and Electrophysiology Laboratory, Department of Ophthalmology, Scientific Institute Capitanio Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alessandro Mauro
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy.,Division of Neurology and Neuro-Rehabilitation, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefania B Marzoli
- Neuro-Ophthalmology Service and Electrophysiology Laboratory, Department of Ophthalmology, Scientific Institute Capitanio Hospital, Istituto Auxologico Italiano, Milan, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Ospedale San Giuseppe, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
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Palmisano GL, Innamorati M, Susca G, Traetta D, Sarracino D, Vanderlinden J. Childhood Traumatic Experiences and Dissociative Phenomena in Eating Disorders: Level and Association with the Severity of Binge Eating Symptoms. J Trauma Dissociation 2018; 19:88-107. [PMID: 28281939 DOI: 10.1080/15299732.2017.1304490] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of the current study is to evaluate the presence of childhood trauma, psychoform, and somatoform dissociation in eating disorders (ED). Eighty-six ED outpatients participated in this study, 20 of them were diagnosed with restrictive anorexia (AN-R), 10 of them with anorexia nervosa binge-purging subtypes (AN-B), 25 with bulimia nervosa (BN), and 31 with binge eating disorder (BED). They were matched by sex and age with a control group consisting of 86 healthy subjects (HC). Traumatic experiences were assessed by means of the Childhood Trauma Questionnaire (CTQ), psychological, and somatoform dissociation, respectively, by means of the Dissociative Experience Scale (DES-II) and Somatoform Dissociation Questionnaire (SDQ-20), and binge eating symptoms by means of Binge Eating Scale (BES). ED subjects showed higher levels of childhood trauma, and both psychoform and somatoform dissociation compared to HC subjects. ED patients showed higher levels of childhood trauma compared to the HC group. No significant differences were shown between ED subgroups with respect to all forms of childhood trauma. BN and AN-B subgroups showed higher levels of both psychological and somatoform dissociation. Dissociation and childhood trauma predicted the severity of binge eating symptoms. Our results confirm previous studies in the same field.
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Affiliation(s)
| | - Marco Innamorati
- b Department of Science and Technology of Education , University of Rome "Tor Vergata" , Roma , Italy
| | - Giovanna Susca
- a Department of Psychology , University of Bari "Aldo Moro" , Bari , Italy
| | - Denise Traetta
- c Eating Disorder Center "Salvatore Cotugno" , Department of Psychiatry, "Azienda Unità Sanitaria Locale-4" , Bari , Italy
| | - Diego Sarracino
- d Department of Psychology , University of Milan "Bicocca" , Milano , Italy
| | - Johan Vanderlinden
- e Eating Disorder Unit of the University Psychiatric Center K.U. Leuven , Kortenberg , Belgium
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Trauma in relation to psychological characteristics in women with eating disorders. CURRENT ISSUES IN PERSONALITY PSYCHOLOGY 2017. [DOI: 10.5114/cipp.2017.67047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The aim of the article was to present the results of the author’s own study that sought relationships between having experienced psychological trauma and the psychological characteristics of people with eating disorders. The basic research question was the following: To what degree are the traumatic events experienced by females with various types of eating disorders related to these females’ psychological characteristics? <br />
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<b>Participants and procedure</b><br />
The sample comprised 120 females with eating disorders: 30 females aged between 20 and 26 diagnosed with bulimia nervosa, 31 females diagnosed with binge-eating disorder and 59 females aged between 20 and 26 diagnosed with anorexia nervosa. The research was carried out in the years 2007-2012 in outpatient clinics treating neuroses and eating disorders and mental health outpatient clinics in Poland. The study employed a clinical and psychometric (i.e., questionnaires for measuring psychological characteristics) approach.<br />
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<b>Results</b><br />
Statistical analysis confirmed the existence of significant differences between the females with eating disorders who have experienced relational trauma(s) in their lives (particularly in their childhood and adolescence) and those who did not reveal such experience. The females with anorexia and bulimia who have also experienced psychological, physical or sexual violence revealed a significantly different, higher level of bulimic thinking and tendencies for excessively uncontrolled, impulsive behaviors towards food and nutrition (i.e., vomit-provoking and other forms of body purgation, e.g. using purgative drugs and others) than did females with no relational trauma experience.<br />
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<b>Conclusions</b><br />
The frequency of relational trauma occurrence was significantly higher for females with bulimia and bulimic anorexia. For females with restrictive anorexia and binge-eating disorder, no significantly frequent occurrence of trauma was observed. <br />
Diagnosing the occurrence of relational trauma in patients’ histories is a key element that should be involved in the process of psychotherapy for people with eating disorders.
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Amianto F, Northoff G, Abbate Daga G, Fassino S, Tasca GA. Is Anorexia Nervosa a Disorder of the Self? A Psychological Approach. Front Psychol 2016; 7:849. [PMID: 27378967 PMCID: PMC4906654 DOI: 10.3389/fpsyg.2016.00849] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/20/2016] [Indexed: 01/26/2023] Open
Abstract
The debate concerning the pathogenesis and the maintaining factors of eating disorders, anorexia nervosa in particular, is ongoing especially since therapeutic interventions do not result in satisfactory and enduring rates of remission. This paper presents a model for the pathogenesis of eating disorders, based on the hypothesis of a deficiency in the development of the self. We present the theory in light of new evidence concerning the role of attachment insecurity in the development and maintenance of eating disorders. In particular, we define the self in eating disorders in a comprehensive way by taking into account recent evidence from experimental psychology and neurobiology. The paper considers the development of the self in terms of its synchronic (i.e., experienced in the moment) and diachronic (i.e., experienced as continuous over time) aspects. Both synchronic and diachronic aspects of the self are relevant to the expression of eating disorder symptoms. Further, the maturation of the self is interwoven with the development of attachment functioning from infancy to adolescence. This interplay between these developmental processes of the self and of attachment could be crucial in understanding the pathogenesis of eating disorders. The final part of the paper suggests a neurobiological link between the theory of the self in the eating disorders and the spatiotemporal functioning of the brain. Disturbances in spatiotemporal functioning may represent the neurobiological pathway by which deficiencies in the self is related to attachment functions in individuals with eating disorders.
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Affiliation(s)
- Federico Amianto
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa ON, Canada
| | - Giovanni Abbate Daga
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Secondo Fassino
- Regional Expert Centre for Eating Disorders, Neurosciences Department, Psychiatry Section, University of Turin Turin, Italy
| | - Giorgio A Tasca
- Psychology, The Ottawa Hospital, University of Ottawa, Ottawa ON, Canada
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Schimmenti A. Dissociative experiences and dissociative minds: Exploring a nomological network of dissociative functioning. J Trauma Dissociation 2016; 17:338-61. [PMID: 26507547 DOI: 10.1080/15299732.2015.1108948] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In this study, the psychometric properties of the Dissociative Experiences Scale-II (DES-II) were tested in a sample of Italian adults, and a nomological network of dissociative functioning based on current psychodynamic research was examined. A total of 794 participants (55% females) ranging in age from 18 to 64 completed the DES-II and other measures of theory of mind, alexithymia, attachment style, and empathy. The Italian translation of the DES-II showed high internal consistency, adequate item-to-scale homogeneity, and good split-half reliability. A single-factor solution including the 8 items of pathological dissociation (DES-T) adequately fit the data. Participants who reported higher levels of dissociative experiences showed significantly lower scores on theory of mind and empathy than other participants. They also showed significantly higher scores on alexithymia, preoccupied attachment, and fearful attachment. Results of the study support the view that people who suffer from severe dissociative experiences may also have difficulties mentalizing and regulating affects and that they may feel uncomfortable in close relationships because they have a negative view of the self. This can inform clinical work with dissociative individuals, who could benefit from therapies that consider their potential problems with mentalization, empathy, affect regulation, and attachment.
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Affiliation(s)
- Adriano Schimmenti
- a Faculty of Human and Social Sciences , Kore University of Enna , Enna , Italy
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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Why some patients are unhappy: part 1. Relationship of preoperative nasal deformity to number of operations and a history of abuse or neglect. Plast Reconstr Surg 2014; 134:823-835. [PMID: 25357039 DOI: 10.1097/prs.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma (neglect or abuse) can create body shame (different from body dissatisfaction), driving some patients to seek aesthetic surgery. We hypothesized that a trauma history would be related to the severity of the original deformity and the drive to undergo repeated operations. METHODS Descriptive statistics were computed for 100 secondary rhinoplasty patients, 50 of whom originally had dorsal humps, 21 of whom had straight, functional noses, and 29 of whom had subjectively normal noses but underwent multiple rhinoplasties. This latter group fulfills criteria for body dysmorphic disorder. RESULTS Compared with patients with hump noses, patients with normal primary noses were 2.9 times more likely to be demanding 2.5 times more likely to be depressed, had undergone 3.0 times more rhinoplasties and other aesthetic operations, and were 3.8 times more likely to have confirmed trauma histories. Patients who had undergone more than three operations were 92.7 percent women; 85 percent originally had straight noses and had undergone an average of 7.56 rhinoplasties and 5.78 aesthetic operations; 85.4 percent had histories of abuse or neglect. CONCLUSIONS Secondary rhinoplasty patients with normal preoperative noses, who fulfill the criteria for body dysmorphic disorder, had significantly higher prevalences of depression, demanding conduct, previous rhinoplasties and other aesthetic operations, and confirmed trauma histories than patients who originally had dorsal deformities or straight noses with functional symptoms. To the authors' knowledge, this is the first report of such associations. A history of childhood trauma may impact adult patient behavior and therefore the surgical experience.
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Constantian MB, Lin CP. Why some patients are unhappy: part 2. Relationship of nasal shape and trauma history to surgical success. Plast Reconstr Surg 2014; 134:836-851. [PMID: 25357040 DOI: 10.1097/prs.0000000000000552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A previous report indicated that secondary rhinoplasty patients with normal preoperative noses displayed significantly higher prevalences of depression, demanding behavior, previous aesthetic operations, and confirmed trauma (abuse/neglect) histories than patients who originally had dorsal deformities or straight noses with functional symptoms. The authors hypothesized that abuse or neglect might also influence patient satisfaction and suggest screening criteria. METHODS One hundred secondary rhinoplasty patients stratified by their original nasal shapes were examined by bivariate analysis to determine the characteristics associated with surgical satisfaction. Mediation analysis established intervening factors between total surgery number and patients' perceived success. Random forests identified important patient attributes that predicted surgical success; logistic regression confirmed these effects. RESULTS Satisfied patients originally had dorsal humps, three or fewer previous operations, were not demanding or depressed, were not looking for perfect noses, and had no trauma histories. Dissatisfied patients originally had subjectively normal noses, more than three operations, were depressed, had demanding personalities, and had trauma histories. Patients who had undergone the most operations were most likely to request more surgery and least likely to be satisfied. A trauma (abuse/neglect) history was the most significant mediator between patient satisfaction and number of operations and the most prominent factor driving surgery in patients with milder deformities. CONCLUSIONS Potentially causative links exist between trauma (abuse/neglect), body image disorders, and obsessive plastic surgery. Body dysmorphic disorder may be a model of the disordered adaptation to abuse or neglect, a variant of posttraumatic stress disorder. Our satisfied and dissatisfied patients shared common characteristics and therefore may be identifiable preoperatively.
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Affiliation(s)
- Mark B Constantian
- Nashua, N.H.; and Madison, Wis. From the Department of Surgery (Plastic Surgery), St. Joseph Hospital; and the Division of Plastic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison
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Harrison A, Mountford VA, Tchanturia K. Social anhedonia and work and social functioning in the acute and recovered phases of eating disorders. Psychiatry Res 2014; 218:187-94. [PMID: 24755042 DOI: 10.1016/j.psychres.2014.04.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/07/2014] [Accepted: 04/02/2014] [Indexed: 02/07/2023]
Abstract
Interpersonal difficulties are proposed to maintain eating disorders (EDs). This study explored whether social anhedonia (SA) was an additional social emotional maintenance factor which might also explain work/social problems in EDs. Additionally, the study explored SA and work and social adjustment in recovered participants. Women with anorexia nervosa (AN; n=105), bulimia nervosa (BN; n=46), recovered from AN (RAN; n=30) and non-ED controls (n=136) completed the Work and Social Adjustment Scale (WSAS) and the Revised Social Anhedonia Scale. ED participants reported greater SA and WSAS scores than non-ED controls; the RAN group reported an intermediate profile. AN participants had poorer work/social adjustment than BN participants. SA was associated with longer illness duration. SA, current severity (BMI) and lifetime severity (lowest adult BMI) significantly predicted work/social difficulties. Recovered participants scoring in the clinical range for SA experienced significantly greater work/social difficulties than recovered participants scoring outside the clinical range for SA. EDs are associated with clinical levels of SA and poor work/social functioning which reduce in recovery. SA may maintain the interpersonal functioning difficulties.
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Affiliation(s)
- Amy Harrison
- King׳s College London, Institute of Psychiatry, Addiction Sciences Building, 4 Windsor Walk, London SE5 8AF, UK; Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
| | - Victoria A Mountford
- Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Kate Tchanturia
- Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK; King׳s College London, Institute of Psychiatry, PO59, De Crespigny Park, London SE5 8AF, London, UK; Clinical Psychology, Illia State University, Kakutsa Cholokashvili Avenue 3/5, Tbilisi 0162, Georgia
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Craparo G, Ardino V, Gori A, Caretti V. The Relationships between Early Trauma, Dissociation, and Alexithymia in Alcohol Addiction. Psychiatry Investig 2014; 11:330-5. [PMID: 25110508 PMCID: PMC4124194 DOI: 10.4306/pi.2014.11.3.330] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/12/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Addiction is often considered a dissociative behavior that is related to alexithymia and developmental trauma. The study aims were to explore the relationships between early trauma, alexithymia, and dissociation. METHODS A total of 117 (males=60; females=57) alcohol-addicted individuals and 117 healthy individuals (males=60; females=57) were administered a series of self-report questionnaires that assess traumatic experiences, alexithymia, and pathological dissociation. RESULTS Correlation analyses indicated significant correlations between alexithymia, dissociation, and trauma and a significant difference between the target and control groups, with higher alexithymia and dissociation scores in the target group. CONCLUSION These findings suggest that trauma, alexithymia, and dissociation are predictors of alcohol addiction.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, University of Enna Kore, Enna, Italy
| | - Vittoria Ardino
- PSSRU Unit Department of Social Policy, London School of Economics and Political Sciences, London, United Kingdom
| | - Alessio Gori
- Department of Psychology, University of Florence, Florence, Italy
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Craparo G, Gori A, Petruccelli I, Cannella V, Simonelli C. Intimate partner violence: relationships between alexithymia, depression, attachment styles, and coping strategies of battered women. J Sex Med 2014; 11:1484-94. [PMID: 24621112 DOI: 10.1111/jsm.12505] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of the most common forms of violence against women is the intimate partner violence (IPV). This term includes physical, sexual, and emotional abuse and controlling behaviors by an intimate partner. AIM This exploratory study investigates the relationship between alexithymia, adult attachment styles, depression, and coping strategies in a group of female victims of IPV and a control group. METHODS Participants were 80 female victims of IPV with an age range from 18 years to 54 years (mean 31.62; standard deviation 9.81). The control group included 80 women with no history of IPV with an age range from 19 years to 37 years (mean 25.05; standard deviation 3.67). MAIN OUTCOME MEASURES We administered the following self-report questionnaires: (i) 20-Item Toronto Alexithymia Scale (TAS-20); (ii) Coping Orientation Problems Experienced; (iii) Beck Depression Inventory (BDI)-II; and (iv) Attachment Style Questionnaire (ASQ). RESULTS Compared with control group, the IPV group showed higher mean scores on TAS-20 (52.9 vs. 41.1, P < 0.001) and BDI-II (19.50 vs. 9.95, P < 0.001). In both groups, we found significant correlations between BDI-II and TAS-20 total scores (P < 0.001) and between BDI-II and the following dimensions of ASQ: confidence (P < 0.001), discomfort with closeness (P = 0.002), relationships as secondary (P < 0.001), need for approval (P < 0.001), and preoccupation with relationships (P < 0.001). Differently from the control group, in the IPV group, social support correlated significantly and positively (P < 0.001) with the dimension preoccupation with relationships on ASQ, but not with the secure attachment style. CONCLUSIONS In comparison to the control group, alexithymia, depressive symptoms, and an insecure attachment style were negatively correlated with the ability to cope with stress for women in the IPV group.
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Granieri A, Schimmenti A. Mind–body splitting and eating disorders: a psychoanalytic perspective. PSYCHOANALYTIC PSYCHOTHERAPY 2014. [DOI: 10.1080/02668734.2013.872172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Craparo G, Faraci P, Rotondo G, Gori A. The Impact of Event Scale - Revised: psychometric properties of the Italian version in a sample of flood victims. Neuropsychiatr Dis Treat 2013; 9:1427-32. [PMID: 24092980 PMCID: PMC3788700 DOI: 10.2147/ndt.s51793] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aims to verify the main psychometric properties of the Italian version of the Impact of Event Scale - Revised (IES-R) in a sample of flood victims. METHODS The sample was composed of 262 subjects involved in the natural disaster of 2009 in the city of Messina (Italy). All participants completed the IES-R and the Dissociative Experiences Scale-II (DES-II) in order to verify some aspects of convergent validity. RESULTS THE EXPLORATORY AND CONFIRMATORY FACTOR ANALYSIS, USED TO VERIFY THE CONSTRUCT VALIDITY OF THE MEASURE, SHOWED A CLEAR FACTOR STRUCTURE WITH THREE INDEPENDENT DIMENSIONS: intrusion, avoidance, and hyper-arousal. The goodness-of-fit indices (non-normed fit index [NNFI] = 0.99; comparative fit index [CFI] = 0.99; standardized root mean square residual [SRMR] = 0.04; and root mean square error of approximation [RMSEA] = 0.02) indicated a good adaptation of the model to the data. The IES-R scales showed satisfactory values of internal consistency (intrusion, α = 0.78; avoidance, α = 0.72; hyper-arousal, α = 0.83) and acceptable values of correlation with the DES-II. CONCLUSION These results suggest that this self-reported and easily administered instrument for assessing the dimensions of trauma has good psychometric properties and can be adopted usefully, both for research and for practice in Italy.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, University of Enna Kore, Italy
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