1
|
Saure E, Laasonen M, Kylliäinen A, Hämäläinen S, Lepistö-Paisley T, Raevuori A. Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa. J Clin Psychol 2024; 80:1901-1916. [PMID: 38712729 DOI: 10.1002/jclp.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE In anorexia nervosa (AN), the traits of autism spectrum disorder (ASD) are associated with poor outcomes. However, the subtle nature of these characteristics remains poorly understood. We investigated the in-depth patterns of ASD traits using Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) in women with AN. METHODS Of 28 women with ICD-10 AN, 16 (age 19-30 years) participated in the ADOS-2, a video-recorded, semistructured diagnostic assessment for social communication and interaction and restricted, repetitive behaviors and interests related to ASD. None of the participants had previously been diagnosed with ASD. Other measurements included the Eating Disorder Examination Questionnaire and the Wechsler Abbreviated Scale of Intelligence-IV. RESULTS Five individuals (18% of all, 31% of those assessed) scored above the cutoff for autism in ADOS-2. They had challenges in social communication and interaction, manifesting as sustained difficulties in social relationships and deficits in conversation skills. Few described being frequently misunderstood by others, including in the eating disorder treatment settings. Three individuals showed prominent restricted and repetitive behaviors such as ritual seeking, eating-related routines, sensory sensitivity related to food texture and selective eating, and intense interest in specific topics. The mean duration of AN in women above the cutoff was twice as long compared with those below (12.3 vs. 6.2 years). DISCUSSION The ASD-related characteristics and behavior appear to contribute to the manifestation and duration of AN in a subgroup of women. Among these women, the traits of ASD appear to be mixed with eating disorder symptoms, which should be taken into account in the treatment.
Collapse
Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Anneli Kylliäinen
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sini Hämäläinen
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| |
Collapse
|
2
|
Gagliardini G, Pandolfi G, Colli A. Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients. J Nerv Ment Dis 2024; 212:370-377. [PMID: 38704653 DOI: 10.1097/nmd.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z -scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.
Collapse
|
3
|
Carfagno M, Barone E, Arsenio E, Bello R, Marone L, Volpicelli A, Cascino G, Monteleone AM. Mediation role of interpersonal problems between insecure attachment and eating disorder psychopathology. Eat Weight Disord 2024; 29:43. [PMID: 38904743 PMCID: PMC11192810 DOI: 10.1007/s40519-024-01673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/16/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE Although insecure attachment and interpersonal problems have been acknowledged as risk and maintaining factors of eating disorders (EDs), the mediating role of interpersonal problems between attachment style and ED psychopathology has been poorly explored. The purpose of this study was to investigate the mediating role of interpersonal problems between insecure attachment and ED psychopathology. METHODS One-hundred-nine women with anorexia nervosa and 157 women with bulimia nervosa filled in the Eating Disorder Inventory-2 (EDI-2) and the Experiences in Close Relationships (ECR) revised scale to assess ED core symptoms and attachment styles, respectively. Interpersonal difficulties were evaluated by the Inventory of Interpersonal Problems (IIP-32). A mediator's path model was conducted with anxious and avoidant attachment subscores as independent variables, ED core symptoms as dependent variables and interpersonal difficulties as mediators. The diagnosis was entered in the model as a confounding factor. RESULTS The socially inhibited/avoidant interpersonal dimension was a mediator between avoidant attachment and the drive to thinness as well as between avoidant attachment and body dissatisfaction. An indirect connection was found between attachment-related anxiety and bulimic symptoms through the mediation of intrusive/needy score. CONCLUSIONS Social avoidance and intrusiveness mediate the relationships between avoidant and anxious attachment styles and ED psychopathology. These interpersonal problems may represent specific targets for psychotherapeutic treatments in individuals with EDs and insecure attachment. LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
Collapse
Affiliation(s)
- Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eugenia Barone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eleonora Arsenio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Bello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luigi Marone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Volpicelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | |
Collapse
|
4
|
Gilsbach S, Borzikowsy C, Herpertz-Dahlmann B. Lost in between-the transition process from a child and adolescent eating disorder service to adult mental health services in the German health care system. EUROPEAN EATING DISORDERS REVIEW 2024; 32:547-556. [PMID: 38303544 DOI: 10.1002/erv.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. METHOD We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3 years. Thirty-two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. RESULTS Only approximately one-third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. CONCLUSION Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process.
Collapse
Affiliation(s)
- Susanne Gilsbach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| | - Christoph Borzikowsy
- Fachhochschule für Verwaltung und Dienstleistung (FHVD), Campus Altenholz Rehmkamp, Altenholz, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| |
Collapse
|
5
|
Zhang J, Cui S, Xu Y, Cui T, Barnhart WR, Ji F, Nagata JM, He J. Introducing Diagnostic Classification Modeling as an Unsupervised Method for Screening Probable Eating Disorders. Assessment 2024:10731911241247483. [PMID: 38676565 DOI: 10.1177/10731911241247483] [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: 04/29/2024]
Abstract
Screening for eating disorders (EDs) is an essential part of the prevention and intervention of EDs. Traditional screening methods mostly rely on predefined cutoff scores which have limitations of generalizability and may produce biased results when the cutoff scores are used in populations where the instruments or cutoff scores have not been validated. Compared to the traditional cutoff score approach, the diagnostic classification modeling (DCM) approach can provide psychometric and classification information simultaneously and has been used for diagnosing mental disorders. In the present study, we introduce DCM as an innovative and alternative approach to screening individuals at risk of EDs. To illustrate the practical utility of DCM, we provide two examples: one involving the application of DCM to examine probable ED status from the 12-item Short form of the Eating Disorder Examination-Questionnaire (EDE-QS) to screen probable thinness-oriented EDs and the Muscularity-Oriented Eating Test (MOET) to screen probable muscularity-oriented EDs.
Collapse
Affiliation(s)
| | - Shuqi Cui
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Yinuo Xu
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | | | | | - Feng Ji
- University of Toronto, Ontario, Canada
| | - Jason M Nagata
- University of California, San Francisco, California, USA
| | - Jinbo He
- The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| |
Collapse
|
6
|
Patarinski AGG, Smith GT, Davis HA. Eating disorder-related functional impairment predicts greater depressive symptoms across one semester of college. Eat Behav 2024; 53:101873. [PMID: 38579503 PMCID: PMC11144091 DOI: 10.1016/j.eatbeh.2024.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
Eating disorder (ED) behaviors and depression are associated with numerous negative outcomes, including lower quality of life and functional impairment. College women are at elevated risk for both. Prior research indicates ED behaviors, including binge eating, self-induced vomiting, and fasting, predict increases in future depressive symptoms. However, symptom heterogeneity in EDs is common, and all disordered eating, or its associated distress, cannot be captured by the endorsement of behaviors. Impairment that results from ED behaviors may be a comparable, or stronger, predictor of depressive symptoms. We sought to characterize the longitudinal relationship between ED-related functional impairment, ED behaviors, and depressive symptoms. College-aged women [N = 304; 72 % white, mean (SD) age = 18.45 (0.88)] completed an online survey in August (baseline), and then three months later in November (follow-up). Baseline ED-related functional impairment, but not baseline ED behaviors, significantly predicted depressive symptoms at follow-up, controlling for baseline depressive symptoms, negative affect, and body mass index. Findings indicate ED-related functional impairment is a risk factor for increases in depressive symptoms across one semester of college, irrespective of ED behavior engagement, weight status, and dispositional negative affect. Intervening upon ED-related functional impairment may reduce or prevent future depressive symptoms among college-aged women.
Collapse
Affiliation(s)
- Anna Gabrielle G Patarinski
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregory T Smith
- Department of Psychology, University of Kentucky, Lexington, KY, United States
| | - Heather A Davis
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States.
| |
Collapse
|
7
|
Luo Y, Pluta D, Brodrick BB, Palka JM, McCoy J, Lohrenz T, Gu X, Vannucci M, Montague PR, McAdams CJ. Diminished Adaptation, Satisfaction, and Neural Responses to Advantageous Social Signals in Anorexia Nervosa and Bulimia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024; 9:305-313. [PMID: 37951540 PMCID: PMC10939989 DOI: 10.1016/j.bpsc.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Development and recurrence of 2 eating disorders (EDs), anorexia nervosa and bulimia nervosa, are frequently associated with environmental stressors. Neurobehavioral responses to social learning signals were evaluated in both EDs. METHODS Women with anorexia nervosa (n = 25), women with bulimia nervosa (n = 30), or healthy comparison women (n = 38) played a neuroeconomic game in which the norm shifted, generating social learning signals (norm prediction errors [NPEs]) during a functional magnetic resonance imaging scan. A Bayesian logistic regression model examined how the probability of offer acceptance depended on cohort, block, and NPEs. Rejection rates, emotion ratings, and neural responses to NPEs were compared across groups. RESULTS Relative to the comparison group, both ED cohorts showed less adaptation (p = .028, ηp2 = 0.060), and advantageous signals (positive NPEs) led to higher rejection rates (p = .014, ηp2 = 0.077) and less positive emotion ratings (p = .004, ηp2 = 0.111). Advantageous signals increased neural activations in the orbitofrontal cortex for the comparison group but not for women with anorexia nervosa (p = .018, d = 0.655) or bulimia nervosa (p = .043, d = 0.527). More severe ED symptoms were associated with decreased activation of dorsomedial prefrontal cortex for advantageous signals. CONCLUSIONS Diminished neural processing of advantageous social signals and impaired norm adaptation were observed in both anorexia nervosa and bulimia nervosa, while no differences were found for disadvantageous social signals. Development of neurocognitive interventions to increase responsivity to advantageous social signals could augment current treatments, potentially leading to improved clinical outcomes for EDs.
Collapse
Affiliation(s)
- Yi Luo
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Dustin Pluta
- Department of Statistics, Rice University, Houston, Texas
| | - Brooks B Brodrick
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jayme M Palka
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Jordan McCoy
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas
| | - Terry Lohrenz
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Center for Computational Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - P Read Montague
- Fralin Biomedical Research Institute, Virginia Tech, Roanoke, Virginia; Department of Physics, Virginia Tech, Blacksburg, Virginia; Virginia Tech-Wake Forest School of Biomedical Engineering and Mechanics, Blacksburg, Virginia
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas at Southwestern Medical School, Dallas, Texas.
| |
Collapse
|
8
|
Iida N, Ono J, Mizuhara Y, Narumoto J. The subjective assessment of work and social adjustment impairments and associated psychopathologies in Japanese adult female patients with anorexia nervosa. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e151. [PMID: 38868735 PMCID: PMC11114435 DOI: 10.1002/pcn5.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 06/14/2024]
Abstract
Aim Patients with anorexia nervosa (AN) sometimes undergo a chronic course, and they hardly maintain social participation. Work and social adjustment impairments are generally significantly associated with the clinical symptoms of eating disorders. Psychopathologies associated with the subjective social difficulties of patients with AN have been unclear. This study examined the association between AN psychopathologies and work and social adjustment impairments in adult female patients with AN. Methods This study included 36 Japanese adult female patients with AN who completed the Work and Social Adjustment Scale (WSAS) and the Eating Disorder Inventory-2 (EDI-2). Spearman's rank correlation coefficient was used to assess correlations between WSAS and EDI-2 or demographic variables. Results The mean age was 31.8 years, the mean current body mass index was 13.4 kg/m2, and the median illness duration was 5 years. Patients demonstrated social difficulties, especially in social leisure activities. The total WSAS scores were significantly correlated with EDI-2 "impulse regulation" and "asceticism." WSAS "social leisure" was significantly correlated with EDI-2 "bulimia," "interoceptive awareness," "impulse regulation," and "asceticism." Conclusion Psychopathologies, such as impulse regulation, asceticism, and interoceptive awareness, may be related factors to social difficulties. Emotion regulation, such as impulse regulation and emotional awareness, could be an important realm of treatment not only for psychopathology but also for social functioning in patients with AN.
Collapse
Affiliation(s)
- Naoko Iida
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
| | - Junko Ono
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
- Kyoto Prefectural Comprehensive Mental Health and Welfare CenterKyotoJapan
| | - Yuki Mizuhara
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
- Department of Child PsychiatryKyoto Prefectural Child Development Support CenterKyotoJapan
| | - Jin Narumoto
- Department of PsychiatryKyoto Prefectural University ofKyotoJapan
| |
Collapse
|
9
|
Bellard A, Mathew J, Sun W, Denkow L, Najm A, Michael-Grigoriou D, Trotter P, McGlone F, Fairhurst M, Cazzato V. Topography and relationship-specific social touching in individuals displaying body image disturbances. Sci Rep 2023; 13:13198. [PMID: 37580362 PMCID: PMC10425375 DOI: 10.1038/s41598-023-39484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023] Open
Abstract
Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the 'imagined' experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to 'social' body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.
Collapse
Affiliation(s)
- Ashleigh Bellard
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jyothisa Mathew
- Department of Psychology, Bundeswehr Universität, Munich, Germany
| | - Wenhan Sun
- Faculty of Philosophy and Philosophy of Science, Munich Center for Neuroscience, Ludwig Maximilian University, Munich, Germany
| | - Linda Denkow
- Department of Psychology, Bundeswehr Universität, Munich, Germany
| | - Ali Najm
- GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
| | - Despina Michael-Grigoriou
- GET Lab, Department of Multimedia and Graphic Arts, Cyprus University of Technology, Limassol, Cyprus
| | - Paula Trotter
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Francis McGlone
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Merle Fairhurst
- Faculty of Electrical and Computer Engineering, Centre for Tactile Internet With Human-in-the-Loop (CeTI), Technische Universität Dresden, Dresden, Germany.
| | - Valentina Cazzato
- Faculty of Health, Research Centre for Brain and Behaviour, School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom.
| |
Collapse
|
10
|
Harper JA, Palka JM, McAdams CJ. Interpersonal attribution bias and social evaluation in adolescent eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:258-270. [PMID: 36349493 PMCID: PMC9898092 DOI: 10.1002/erv.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/19/2022] [Accepted: 10/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Improved understanding of adolescent eating disorders (EDs), including identification and refinement of treatment and recovery targets, may help improve clinical outcomes. Interpersonal function is a proposed risk and maintenance factor that may be particularly relevant given the significance of adolescence for both psychosocial development and ED onset. This study examined self-referential thinking in adolescents with EDs compared to healthy adolescents. METHOD Twenty-nine adolescents with EDs and 31 healthy controls completed a self-report measure of interpersonal attributions as well as a verbal appraisal task that required conducting direct and indirect evaluations about oneself and direct evaluations about others. RESULTS The ED group had a more negative self-attribution bias than the control group (p = 0.006) even when controlling for depression severity. Additionally, the ED group exhibited less positive direct self (p < 0.001), direct social (p = 0.015), and social reflected self-appraisals (p = 0.011) than the healthy cohort. After including depression as a covariate in the verbal appraisal model, the model was no longer significant, suggesting group differences related to social appraisals may be mediated by depression. CONCLUSIONS Adolescents with EDs have more negative interpersonal beliefs than comparison adolescents. Future studies are needed to determine how the constructs identified here relate to clinical course.
Collapse
Affiliation(s)
- Jessica A. Harper
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
| | - Jayme M. Palka
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Carrie J. McAdams
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Children’s Medical Center, Dallas, Texas, USA
| |
Collapse
|
11
|
Aviv I, Shorer M, Fennig S, Aviezer H, Singer-Harel D, Apter A, Pilowsky Peleg T. [Formula: see text]Persistent post-concussion symptoms in children: pre-injury social difficulties and acute stress reaction as risk factors. Child Neuropsychol 2023; 29:115-135. [PMID: 35545855 DOI: 10.1080/09297049.2022.2072823] [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: 10/18/2022]
Abstract
Following mild traumatic brain injury (mTBI) children usually experience one or more somatic, cognitive, and/or emotional-behavioral post-concussion symptoms (PCS). PCS may be transient, however for some children, persistent post-concussion symptoms (PPCS) might linger for months or years. Identifying risk factors for PPCS may allow earlier interventions for patients at greater risk. We examined pre-injury social difficulties and acute stress reaction as risk factors to PPCS in children. Participants were 83 children (aged 8-16) with mTBI. In a prospective follow-up, pre-injury social difficulties, 24-hours post-concussion symptoms, and acute stress reactions were tested as predictors of one-week and four-months PCS reports. Parents' reports, self-reports, and neurocognitive tests were employed. One-week PCS level was associated with acute stress, and not with 24-hours post-concussion symptoms or pre-injury social difficulties. Four-months PCS level was predicted by pre-injury social difficulties and 24-hours post-concussion symptoms, with no contribution of acute stress. Interestingly, less symptoms at 24-hour from injury were associated with a higher level of PCS at four months. Cognitive functioning at four months was predicted by acute stress, with no contribution of 24-hours post-concussion symptoms or pre-injury social difficulties. Cognitive functioning did not differ between children with and without PPCS. In conclusion, non-injury, socio-emotional factors (pre-injury social difficulties, acute stress) should be considered, alongside injury-related factors, in predicting recovery from mTBI. Pre-injury social difficulties and stress reaction to the traumatic event might pose an emotional burden and limit one's social support during recovery, thus require clinical attention in children following mTBI.
Collapse
Affiliation(s)
- Irit Aviv
- Department of Psychology, The Hebrew University, Jerusalem, Israel.,Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Maayan Shorer
- Department of Psychology, Ruppin Academic Center, Emek-Hefer, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Hillel Aviezer
- Department of Psychology, The Hebrew University, Jerusalem, Israel
| | - Dana Singer-Harel
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University, Jerusalem, Israel.,The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| |
Collapse
|
12
|
Monteleone AM, Cascino G, Ruzzi V, Marafioti N, Marone L, Croce Nanni R, Troisi A. Non-verbal social communication in individuals with eating disorders: an ethological analysis in experimental setting. Eat Weight Disord 2022; 27:3125-3133. [PMID: 35829898 PMCID: PMC9803750 DOI: 10.1007/s40519-022-01442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Evidence that social difficulties promote the development and the maintenance of eating disorders (EDs) derive from self-reported data and only partially from experimental tasks. This study objectively assessed non-verbal behaviors of individuals with EDs in a psycho-social stress scenario. METHODS Thirty-one women suffering from EDs (13 with anorexia nervosa and 18 with bulimia nervosa) and 15 healthy women underwent the Trier Social Stress Test (TSST), the paradigm of psycho-social stress, and were videotaped. Throughout the procedure, anxiety feelings were measured by the State-Trait Anxiety Inventory state subscale and saliva samples were collected to evaluate cortisol levels. Non-verbal behaviors were analyzed through the Ethological Coding System for Interviews and were compared between study samples through multivariate analysis of variance. Multivariate regression analyses were performed to assess the association between anxiety, cortisol and behavioral responses to TSST. RESULTS Women with EDs showed reduced submissiveness, flight (cutoff from social stimuli) and gesture compared to healthy peers during TSST. Submissiveness and flight behaviors were negatively associated with stress-induced anxiety, while TSST-induced anxiety and cortisol increases were positively associated with looking at the other's face behavior in participants with EDs. In this population, cortisol reactivity was also positively associated with submissiveness and negatively with gesture. CONCLUSION Women with EDs showed a hostile and freezing response to acute psycho-social stress: reduced submissiveness and flight may represent strategies to manage social anxiety. These findings confirm that the non-verbal behavior assessment provides complementary information to those derived from traditional measurements and suggests research and clinical implications. LEVEL OF EVIDENCE I Evidence obtained from experimental study.
Collapse
Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy.
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Niccolò Marafioti
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | - Luigi Marone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna Delle Grazie, 80138, Naples, Italy
| | | | - Alfonso Troisi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
13
|
Rowlands K, Beaty T, Simic M, Grafton B, Hirsch C, Treasure J, Cardi V. Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial. Int J Eat Disord 2022; 55:1506-1520. [PMID: 36147018 PMCID: PMC9825839 DOI: 10.1002/eat.23809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study aimed to investigate whether a computerized cognitive bias modification training delivered remotely would reduce expectations of rejection in adolescents with eating disorders. METHOD Sixty-seven adolescents aged 12-18 (99.5% female) with an eating disorder diagnosis (94% anorexia nervosa) and receiving specialist treatment were recruited. Participants were randomized to an intervention condition (n = 37) which included treatment as usual (TAU) supplemented by nine sessions of online cognitive bias modification training for social stimuli (CBMT + TAU), or a control condition (n = 30), which included TAU only. Participants were invited to complete assessments at baseline and post-intervention. RESULTS In the intervention condition, 22/37 participants completed six or more training sessions and post-intervention measures, the pre-defined criteria to be considered "completers." In the control condition, 28/30 participants completed the post-intervention measures. Participants who completed the intervention displayed a significantly greater reduction in negative interpretations of ambiguous social scenarios, with a medium effect size (p = .048, ηp2 = .090), and eating disorder psychopathology, with a medium effect size (p = .027, ηp2 = .105), compared to participants in the control condition. No significant between-group differences were found on emotional response to criticism, and anxiety and depression symptoms post-intervention (ps > .05; small effect sizes). DISCUSSION Enhancing treatment as usual with CBMT targeting expectations of social rejection might be feasible and effective to reduce expectations of social rejection and eating disorder psychopathology in adolescents with eating disorders. Training adaptations might be necessary to impact on emotional processing and comorbid psychological distress. PUBLIC SIGNIFICANCE Adolescents with eating disorders who completed a brief (4-week) online cognitive training intervention, alongside their usual treatment, reported greater reductions in expectations of social rejection and eating disorder psychopathology after the intervention, compared to a separate group of patients who received their usual treatment only. This brief and accessible intervention may be a helpful treatment adjunct for adolescents with eating disorders.
Collapse
Affiliation(s)
- Katie Rowlands
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Taryn Beaty
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Mima Simic
- Child and Adolescent Eating Disorders ServiceSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Ben Grafton
- Centre for the Advancement of Research on EmotionSchool of Psychological Science, University of Western AustraliaCrawleyAustralia
| | - Colette Hirsch
- Psychology DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Janet Treasure
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Valentina Cardi
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK,Department of General PsychologyUniversity of PadovaItaly
| |
Collapse
|
14
|
Todisco P, Meneguzzo P, Garolla A, Diomidous E, Antoniades A, Vogazianos P, Tozzi F. Understanding dropout and non-participation in follow-up evaluation for the benefit of patients and research: evidence from a longitudinal observational study on patients with eating disorders. Eat Disord 2022; 31:337-352. [PMID: 36271711 DOI: 10.1080/10640266.2022.2135738] [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] [Indexed: 11/03/2022]
Abstract
Treatment outcomes in eating disorders (EDs) are still an open field for clinicians and researchers. Besides difficulties in egosyntonic-linked treatment engagements, dropout is one of the most crucial elements that cause a reduction in the treatment efficacy. Thus, the aim of this study is to evaluate factors that could contribute to high dropout rates and non-participation in follow-up evaluation in patients with ED. This study used a large sample of patients from a specialized ED ward and day hospital (DH). A sample of 428 individuals was recruited for this study. Psychological and demographic data were collected at the time of hospitalization and discharge from the facilities. These data were used to explore a possible link between dropout and follow-up non-participation. Specially, the random forest was used to rank demographic and psychological features in importance and evaluate the top results with regression analyses for statistical significance. A dropout rate of 12.14% during inpatient and DH treatment was found. Anger-hostility and general psychopathology were found to be predictors of dropout during treatment, while the duration of the hospitalization predicted non-participation at the six-month follow-up. Specific psychological features should be considered before and during treatments for patients with EDs to reduce dropout rates. The duration of the hospitalization should also be evaluated as a relevant healthcare element that could affect engagement and, accordingly, outcome.
Collapse
Affiliation(s)
- Patrizia Todisco
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano (VI), Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa Di Cura "Villa Margherita", Arcugnano (VI), Italy
| | - Eva Diomidous
- Research & Development, Stremble Ventures, Limassol, Cyprus
| | | | - Paris Vogazianos
- Behavioral Sciences Department, European University Cyprus , Nicosia, Cyprus
| | - Federica Tozzi
- Research & Development, Stremble Ventures, Limassol, Cyprus
| |
Collapse
|
15
|
Barberis N, Calaresi D, Cannavò M, Verrastro V. Body mass index and quality of life in individuals with polycystic ovary syndrome: Dysmorphic concerns and eating disorders as mediators. Front Public Health 2022; 10:962083. [PMID: 36276397 PMCID: PMC9581187 DOI: 10.3389/fpubh.2022.962083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/06/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Weight issues, dysmorphic concerns and eating disorders are common among individuals with polycystic ovary syndrome (PCOS) and are linked to poor quality of life (QoL). The goal of the current study was to examine whether the association between body mass index (BMI) and QoL was mediated by dysmorphic concerns, examining also the relations with eating disorder symptomatology. Methods Questionnaires were administered to 435 individuals with PCOS aged between 18 and 40 years (M = 27.62; SD = 4.83) to measure dysmorphic concerns, eating disorder symptoms and QoL. Participants were also asked to report their height and weight to compute their BMI. Results Structural equation modeling was used to observe the relationship between the variables. The results revealed a direct relationship between QoL, BMI, dysmorphic concerns and eating disorder symptomatology. In addition, dysmorphic concerns were related to BMI and eating disorder symptomatology. Furthermore, the results showed the mediating role of dysmorphic concerns and eating disorder symptoms in the relationship between BMI and QoL. Conclusion The current results highlight the potential importance of harmful relationships with one's own body and food, explaining why weight issues may be linked to different levels of QoL in PCOS individuals. The implications of these findings are discussed.
Collapse
Affiliation(s)
- Nadia Barberis
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| | - Danilo Calaresi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Marco Cannavò
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy,*Correspondence: Marco Cannavò
| | - Valeria Verrastro
- Department of Health Sciences, Magna Græcia University, Catanzaro, Italy
| |
Collapse
|
16
|
Haltom CE, Halverson TF. Relationship between college lifestyle variables, eating disorder education, and eating disorder risk. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022:1-9. [PMID: 36194243 DOI: 10.1080/07448481.2022.2122720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/18/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
Objective: This study examined relationships between eating disorder risk (EDR), lifestyle variables (e.g., exposure to healthy eating media), and differences among male and female college students. Participants: College students (N = 323) completed survey questionnaires (Fall, 2016). Fifty-three participants retook the survey at a later time. Methods: Participants completed a survey measuring EDR using EDI-3 subscales and 10 college lifestyle variables. Female and male EDR and Time 1 and Time 2 EDR were compared. Relationships between EDR and college life-style variables were examined. Results: Exercise, fewer daily meals, less face-to-face interactions, more digital interactions, less exposure to healthy eating media, and having conversations about body image were associated with EDR risk. Male college students showed an increase in EDR over time. Conclusions: Several lifestyle factors predicted EDR in college females and males. These lifestyle factors are modifiable and may be addressed by colleges during orientation and within the campus environment.
Collapse
Affiliation(s)
- Cris E Haltom
- Department of Psychology, Ithaca College, Ithaca, New York, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, North Carolina, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| |
Collapse
|
17
|
Lukas L, Buhl C, Schulte-Körne G, Sfärlea A. Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa. J Eat Disord 2022; 10:143. [PMID: 36175986 PMCID: PMC9520900 DOI: 10.1186/s40337-022-00661-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms. METHODS Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40). RESULTS Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers. CONCLUSION The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.
Collapse
Affiliation(s)
- Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Christina Buhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany.
| |
Collapse
|
18
|
Escoffié A, Pretorius N, Baudinet J. Multi-family therapy for bulimia nervosa: a qualitative pilot study of adolescent and family members' experiences. J Eat Disord 2022; 10:91. [PMID: 35786421 PMCID: PMC9250718 DOI: 10.1186/s40337-022-00606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-family therapy (MFT-BN) is a new treatment for adolescent bulimia nervosa with emerging empirical support. It extends the bulimia nervosa focussed family therapy model, by offering treatment in a group setting. Up to nine families work together with a team of clinicians over the course of 20 weeks. No qualitative study to date has investigated the experience of MFT-BN. This study aimed to explore this from the adolescent and parent/caregiver perspective. METHODS Participants from two consecutive MFT-BN groups facilitated at the Maudsley Hospital in London, UK, were invited to participate in either a focus group or individual qualitative interview about the experience of MFT-BN. Of the 19 eligible participants (from 9 families), 15 (8 parents, 1 older sibling, 6 adolescents) consented and participated. Audio-recordings of interviews and focus groups were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Three main themes were identified; (1) seeing and being seen, (2) holistic shift, (3) the unspoken. Participants reported overall shifts in cognitions, emotions, behaviours, and relationships both individually and within the family as a result of attending MFT-BN. Meeting other families with similar struggles and sharing experiences, skills and learning helped reduce isolation and promote change. There was also a sense from participants that some things did not, or could not, be spoken about in the group context and that more direct and challenging conversations might have been helpful at times. DISCUSSION The current study identifies some of the perceived benefits and challenges of MFT-BN. The three themes demonstrate the holistic nature of change that can occur across the treatment, as well as the power and limits of the group therapy setting and process. Further research is needed to explore the experience of MFT-BN and its outcomes across a more diverse range of participants and treatment settings.
Collapse
Affiliation(s)
- Anabel Escoffié
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Natalie Pretorius
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK. .,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| |
Collapse
|
19
|
Luo Y, Mendoza C, Pelfrey S, Lohrenz T, Gu X, Montague PR, McAdams CJ. Elevated Neurobehavioral Responses to Negative Social Interactions in Women With Bulimia Nervosa. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:696-705. [PMID: 33561543 PMCID: PMC8342632 DOI: 10.1016/j.bpsc.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bulimia nervosa (BN) is a complex psychiatric illness that includes binge-purge behaviors and a belief that one's value as a person depends on body shape and weight. Social pressure strongly influences the development and maintenance of BN, but how this manifests neurobiologically within an individual remains unknown. We used a computational psychiatry approach to evaluate neural mechanisms underlying social interactions in BN. METHODS Behavioral and functional magnetic resonance imaging data were collected from 24 women with BN and 26 healthy comparison women using an iterated social exchange game. Data were sorted round by round based on whether the mathematically computed social signals indicated an improving (positive reciprocity) or deteriorating (negative reciprocity) relationship for each participant. RESULTS Social interactions with negative reciprocity resulted in more negative behavioral responses and stronger neural activations in both cortical and subcortical regions in women with BN than healthy comparison women. No behavioral or neural differences were observed for interactions demonstrating positive reciprocity, suggesting a very specific form of psychopathology in BN: amplification of negative self-relevant social interactions. Cortical activations (e.g., temporoparietal junction and dorsolateral prefrontal cortex) did not covary with mood symptoms, while subcortical activations (e.g., amygdala and dorsal striatum) were associated with acute psychopathology. CONCLUSIONS These data provide a first step toward a mechanistic neuropsychological model of aberrant social processing in BN, demonstrating how a computational psychiatric approach can elucidate neural mechanisms for complex psychiatric illnesses. Future treatments for BN may include targeting neural regions that support these negative biases in social perceptions.
Collapse
Affiliation(s)
- Yi Luo
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | | | - Sarah Pelfrey
- Department of Psychiatry, UT Southwestern Medical School, Dallas, Texas
| | - Terry Lohrenz
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia
| | - Xiaosi Gu
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York
| | - P Read Montague
- Fralin Biomedical Research Institute at VTC, Virginia Polytechnic Institute and State University, Roanoke, Virginia; Department of Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia; Virginia Tech-Wake Forest University School of Biomedical Engineering and Mechanics, Blacksburg, Virginia; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
| | - Carrie J McAdams
- Department of Psychiatry, UT Southwestern Medical School, Dallas, Texas.
| |
Collapse
|
20
|
Rangel Paniz G, Lebow J, Sim L, Lacy BE, Farraye FA, Werlang ME. Eating Disorders: Diagnosis and Management Considerations for the IBD Practice. Inflamm Bowel Dis 2022; 28:936-946. [PMID: 34096582 DOI: 10.1093/ibd/izab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Graziella Rangel Paniz
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico, United States
| | - Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Monia E Werlang
- Division of Gastroenterology and Liver Center, Prisma-Health-Upstate, University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, United States
| |
Collapse
|
21
|
French EN, Eneva K, Arlt JM, Yiu A, Chen EY. Negative mood induction effects on problem-solving task in women with eating disorders: a multi-method examination. J Eat Disord 2022; 10:73. [PMID: 35598002 PMCID: PMC9123706 DOI: 10.1186/s40337-022-00591-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/08/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The effects of negative affect on problem-solving and its psychophysiological correlates are poorly understood in eating disorder populations. METHODS This study examined respiratory sinus arrhythmia (RSA) and skin conductance responses of women with Binge Eating Disorder (BED: n = 56), Anorexia Nervosa (AN: n = 12), Bulimia Nervosa (BN: n = 32), and 24 healthy controls (HCs) at baseline, and then during: a negative mood induction task, an adapted Means Ends Problem-Solving (MEPS) task, and recovery. The MEPS task included four interpersonal scenarios: (1) binge-eating as a solution to stress, (2) job loss, (3) rejection by friends, and (4) by a significant other. RESULTS We found that individuals with eating disorders reported less positive mood than HCs and individuals with BN and BED reported more negative mood and greater urges to binge than HCs. After a negative mood induction, women with BED provided significantly less effective problem-solving strategies compared to HCs and women with BN for the binge-eating MEPS scenario. Relative to baseline and the negative mood induction, all participants exhibited significantly higher skin conductance measures throughout the MEPS scenarios and recovery. BED showed significantly lower respiratory sinus arrhythmia (RSA) levels than individuals with BN and HCs throughout the protocol. CONCLUSIONS The multimethod findings suggest individuals with BED are likely to have disorder-specific problem-solving difficulties after a negative mood induction.
Collapse
Affiliation(s)
- Elan N French
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Kalina Eneva
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Jean M Arlt
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Angelina Yiu
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Eunice Y Chen
- Temple Eating Disorders Program, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
| |
Collapse
|
22
|
Bray B, Bray C, Bradley R, Zwickey H. Binge Eating Disorder Is a Social Justice Issue: A Cross-Sectional Mixed-Methods Study of Binge Eating Disorder Experts' Opinions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6243. [PMID: 35627779 PMCID: PMC9141064 DOI: 10.3390/ijerph19106243] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Binge eating disorder is an autonomous DSM-V diagnosis characterized by discrete rapid consumption of objectively large amounts of food without compensation, associated with loss of control and distress. Environmental factors that contribute to binge eating disorder continue to evolve. This mixed-methods cross-sectional study assessed whether there is consensus among experts in the field about environmental factors that influence adult binge eating disorder pathology. METHODS Fourteen expert binge eating disorder researchers, clinicians, and healthcare administrators were identified internationally based on federal funding, PubMed-indexed publications, active practice in the field, leadership in relevant societies, and/or clinical and popular press distinction. Semi-structured interviews were recorded anonymously and analyzed by ≥2 investigators using reflexive thematic analysis and quantification. RESULTS Identified themes included: (1) systemic issues and systems of oppression (100%); (2) marginalized and under-represented populations (100%); (3) economic precarity and food/nutrition insecurity/scarcity (93%); (4) stigmatization and its psychological impacts (93%); (5) trauma and adversity (79%); (6) interpersonal factors (64%); (7) social messaging and social media (50%); (8) predatory food industry practices (29%); and (9) research/clinical gaps and directives (100%). CONCLUSIONS Overall, experts call for policy changes around systemic factors that abet binge eating and for greater public education about who can have binge eating disorder. There is also a call to take and account for the narratives and life experiences of individuals with binge eating disorder to better inform our current understanding of the diagnosis and the environmental factors that impact it.
Collapse
Affiliation(s)
- Brenna Bray
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
| | - Chris Bray
- Wilder Research Division, Amherst H. Wilder Foundation, Saint Paul, MN 55104, USA;
| | - Ryan Bradley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
- Herbert Wertheim School of Public Health, University of California, San Diego, CA 97037, USA
| | - Heather Zwickey
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR 97201, USA; (R.B.); (H.Z.)
- Herbert Wertheim School of Public Health, University of California, San Diego, CA 97037, USA
| |
Collapse
|
23
|
Bronstein MV, Everaert J, Kummerfeld E, Haynos AF, Vinogradov S. Biased and inflexible interpretations of ambiguous social situations: Associations with eating disorder symptoms and socioemotional functioning. Int J Eat Disord 2022; 55:518-529. [PMID: 35132668 PMCID: PMC9392902 DOI: 10.1002/eat.23688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Research indicates that difficulties across multiple socioemotional functioning domains (e.g., social emotion expression/regulation, response to social elicitors of emotion) and negatively biased interpretations of ambiguous social situations may affect eating disorder symptoms. The impact of inflexible interpretations of social situations on eating disorder symptoms is less clear. The present study therefore examined relations between inflexible and biased social interpretations, socioemotional functioning, and eating disorder symptoms. METHOD A total of 310 participants from the general population, recruited from an online crowdsourcing platform, completed measures of socioemotional functioning (e.g., rejection sensitivity, negative social exchange), eating disorder symptoms, and positive and negative interpretation bias and inflexibility on a single measurement occasion. RESULTS Socioemotional functioning impairments (Pillai's trace = 0.11, p < .001), but not negative (β = .07, p = .162) or positive (β = -.01, p = .804) interpretation bias or inflexible interpretations (β = .04, p = .446), were associated with eating disorder symptoms in multiple regression models. In network analyses controlling statistically for multiple markers of socioemotional functioning, eating disorder symptoms were directly associated with negative (but not positive) interpretation bias. Inflexible interpretations were indirectly linked to symptoms via co-dampening of positive emotions. Exploratory causal discovery analyses suggested that several socioemotional functioning variables (social anxiety, depression, negative social exchange) may cause eating disorder symptoms. CONCLUSIONS Consistent with cognitive-interpersonal models of disordered eating, our results suggest that less accurate (biased, inflexible) interpretations of social information contribute to patterns of cognition (anxious anticipation of rejection) and emotion regulation (down-regulation of positive social emotion) thought to encourage disordered eating. PUBLIC SIGNIFICANCE This study suggests that less accurate interpretations of ambiguous social information encourage anxious anticipation of rejection and downregulation of positive social emotions, both of which are thought to promote eating disorder symptoms. Knowledge provided by this study about the likely relations between interpretive processes, social/emotional functioning, and eating disorder symptoms may help inform treatments for eating disorders, particularly those that attempt to modify patterns of interpretation.
Collapse
Affiliation(s)
- Michael V. Bronstein
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ann F. Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
24
|
Ragnhildstveit A, Slayton M, Jackson LK, Brendle M, Ahuja S, Holle W, Moore C, Sollars K, Seli P, Robison R. Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions. Brain Sci 2022; 12:brainsci12030382. [PMID: 35326338 PMCID: PMC8963252 DOI: 10.3390/brainsci12030382] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive–compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.
Collapse
Affiliation(s)
- Anya Ragnhildstveit
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Correspondence: ; Tel.: +1-(801)-448-3331
| | - Matthew Slayton
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
| | - Laura Kate Jackson
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Madeline Brendle
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT 84112, USA
| | - Sachin Ahuja
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Willis Holle
- Integrated Research Literacy Group, Draper, UT 84020, USA; (L.K.J.); (M.B.); (W.H.)
| | - Claire Moore
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Kellie Sollars
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
| | - Paul Seli
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA; (M.S.); (P.S.)
| | - Reid Robison
- Novamind, Draper, UT 84020, USA; (S.A.); (C.M.); (K.S.); (R.R.)
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84108, USA
| |
Collapse
|
25
|
Risk of eating disorders in a representative sample of Italian adolescents: prevalence and association with self-reported interpersonal factors. Eat Weight Disord 2022; 27:701-708. [PMID: 34014507 PMCID: PMC8933299 DOI: 10.1007/s40519-021-01214-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/11/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Adolescence represents a critical period for the onset of eating disorders (EDs). The present study aimed to provide the prevalence of individuals at risk for EDs psychopathology in a representative population of adolescents aged 14-19 and to characterize this population regarding interpersonal and psychological factors. METHODS The percentage of participants at risk for EDs in a representative high school population was assessed through the SCOFF screening questionnaire (cut-off score: 3) in the total sample (N: 6551) and in gender-based subgroups for different body mass index (BMI) categories. Odds ratios for being at risk of ED (SCOFF ≥ 3) were esteemed in a multivariable analysis including self-reported parental education, quality of family and peer relationships, bullying victimization, age at first sexual intercourse, and psychological distress. RESULTS A SCOFF score ≥ 3 was found in 31.0% of participants (boys: 19.4%; girls: 44.6%), with a greater prevalence among higher BMI categories. Bad family relationships, being bullied, having the first sexual intercourse before the age of 14, and experiencing high distress were associated with this risk condition. Among girls, bad peer relationships were associated with a low-risk SCOFF score. CONCLUSION A remarkable percentage of adolescents reported significant body image or eating concerns. Screening programs are deeply needed, and particular attention should be devoted to interpersonal factors, such as the quality of family relationships and interactions with peers, which represent potential indicators of this vulnerability. LEVEL OF EVIDENCE Level V - Cross-sectional study.
Collapse
|
26
|
Webb H, Dalton B, Irish M, Mercado D, McCombie C, Peachey G, Arcelus J, Au K, Himmerich H, Johnston AL, Lazarova S, Pathan T, Robinson P, Treasure J, Schmidt U, Lawrence V. Clinicians' perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic. J Eat Disord 2022; 10:30. [PMID: 35209957 PMCID: PMC8867458 DOI: 10.1186/s40337-022-00555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/07/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. However, the impact on clinicians working in these services is largely unknown. We therefore explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic. METHODS Between May 2020 and June 2021, we interviewed clinicians (n = 21) who delivered IP and/or DP treatment to patients with severe AN in four specialist eating disorder services in the United Kingdom. Data relating to experiences during COVID-19 were analysed using reflexive thematic analysis. RESULTS We identified six themes: Disruptions to Routine Treatment; Introduction of Virtual Treatment; Separation from Treatment, Others and the World; Impact on Recovery; Impact on Staff; and Pressure on Referral Pathways. COVID-19 posed significant challenges to IP and DP services: forcing closures, operating with restrictions and virtual treatment, and impacting delivery of essential treatment components, referral pathways, clinician wellbeing, risk management, and patient isolation and recovery trajectories. Opportunities arose, in particular in DP services offering virtual support. CONCLUSIONS COVID-19 challenged the continuation of multidisciplinary treatment. The findings underline the necessity for medical, psychological, practical, and nutritional support, as well as carer involvement and fostering social connections to remain at the forefront of intensive treatment for severe AN. They also emphasise the uncertainty surrounding which intensive treatment may be best suited to which patient when, particularly within the context of virtual DP support.
Collapse
Affiliation(s)
- Hannah Webb
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Bethan Dalton
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Madeleine Irish
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Daniela Mercado
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Catherine McCombie
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gemma Peachey
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, UK
| | - Katie Au
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Hubertus Himmerich
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | | | | | - Tayeem Pathan
- Surrey and Boarder Partnership, NHS Foundation Trust, Surrey, UK
| | - Paul Robinson
- Division of Medicine, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Janet Treasure
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- PO59 Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - Vanessa Lawrence
- Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
27
|
Abstract
PURPOSE Early detection of eating disorders (EDs) could improve their prognosis, decrease morbidity and mortality, and prevent the risk of evolution towards a chronic form and somatic, psychiatric and psychosocial complications. The objective of this review was to examine the current scientific data concerning the early detection of EDs, which is one of the facets of secondary prevention. METHOD A scoping literature review was carried out following the PRISMA-ScR criteria, including all articles on ED detection published up to 2021 on PUBMED and PSYCINFO. RESULTS 43 articles were included. Anorexia nervosa and bulimia nervosa were the most widely studied disorders. The articles focused on professionals from the medical field (GPs, psychiatrists, gynaecologists, gastroenterologists and residents), from the paramedical field, from education and sport, and from the general population. The assessments conducted with the professionals receiving interventions aiming to improve detection demonstrated their efficacy. Interventions for ED detection in the general population and at school seemed less efficacious. CONCLUSION The results highlighted some lines of action to be implemented. They pointed towards improving initial and continuing education for professional carers; e-learning could be an interesting solution for continuing education. Improving training with specific instructors, school personnel and sports professionals is also one of the solutions for a better detection of EDs. Specific recommendations could be published for fitness centre professionals to help them to deal with clients suspected of having an ED. Among secondary school students and in the general population, a better dissemination of mental health literacy and the development of mental health first aid programs could help improve early detection. LEVEL OF EVIDENCE Level I: Evidence obtained from systematic reviews.
Collapse
|
28
|
Rowlands K, Grafton B, Cerea S, Simic M, Hirsch C, Cruwys T, Yellowlees R, Treasure J, Cardi V. A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls. J Affect Disord 2021; 295:397-404. [PMID: 34500369 DOI: 10.1016/j.jad.2021.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive biases towards social stimuli have been identified as one of the putative modifiable mechanisms to remediate interpersonal difficulties in adolescents with mental disorders. However, evidence for these biases in adolescents with eating disorders is scarce. METHODS This study assessed interpersonal sensitivity, cognitive biases towards social stimuli, and quantity and quality of social group memberships in adolescents with eating disorders (n = 80), compared to healthy controls (n = 78), and examined whether a negative interpretation bias would mediate the relationship between interpersonal sensitivity, eating disorder symptoms and positive group memberships. RESULTS Adolescents with eating disorders displayed greater interpersonal awareness, negative interpretation biases of ambiguous social information and poorer quality relationships with their social groups compared to healthy controls. In a simple mediation model, interpersonal awareness predicted eating disorder symptoms, and this effect was partially mediated by a negative interpretation bias. CONCLUSIONS Psychological interventions which aim to reduce a negative interpretation bias might help to reduce the severity of eating disorder symptoms in adolescents with eating disorders.
Collapse
Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Silvia Cerea
- Department of General Psychology, University of Padova, Italy
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Colette Hirsch
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra ACT 2601, Australia
| | - Robyn Yellowlees
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Italy
| |
Collapse
|
29
|
Monteleone AM, Cascino G, Marciello F, Abbate-Daga G, Baiano M, Balestrieri M, Barone E, Bertelli S, Carpiniello B, Castellini G, Corrivetti G, De Giorgi S, Favaro A, Gramaglia C, Marzola E, Meneguzzo P, Monaco F, Oriani MG, Pinna F, Rania M, Redaelli CA, Renna C, Ricca V, Salvo P, Baldissera E, Segura-Garcia C, Todisco P, Volpe U, Zeppegno P, Monteleone P. Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: a retrospective Italian multicentre study. Eat Weight Disord 2021; 26:2443-2452. [PMID: 33426630 PMCID: PMC7797193 DOI: 10.1007/s40519-020-01097-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The COVID-19 pandemic restrictions had negative impact on the psychopathology of people with Eating Disorders (EDs). Factors involved in the vulnerability to stressful events have been under-investigated in this population. We aimed to assess which factors contributed to COVID-19-induced worsening in both general and specific psychopathology. METHODS Three-hundred and twelve people with a clinically defined diagnosis of an ED and undergoing a specialist ED treatment in different Italian ED services before the spreading of COVID-19 pandemic filled in an online survey. ED specific and general psychopathology changes after COVID-19 quarantine were retrospectively evaluated. Factors related to COVID-19 concerns (financial condition, fear of contagion, perceived social isolation/support, satisfaction in peer, family or sentimental relationships), illness duration and treatment-related variables (type of treatment provided, type of access to care, satisfaction with therapeutic relationships) were included as predicting factors in a structural equational model, which included latent variables consisting of general and ED psychopathology items as outcomes. RESULTS A perceived low quality of therapeutic relationships, fear of contagion and increased isolation were positively associated with psychopathology worsening. Reduced satisfaction with family and with friends' relationships and reduced perceived social support were associated with ED and general symptoms deterioration, respectively. No significant effect emerged for intimate relationships, illness duration, economic condition and type of treatment. CONCLUSIONS This study provides a comprehensive evaluation of clinical variables associated with psychopathological changes during the COVID-19 lockdown period highlighting potential risk and resilience factors and, possibly, informing treatment as well as prevention strategies for EDs. LEVEL OF EVIDENCE IV Evidence obtained from multiple time series analysis such as case studies.
Collapse
Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Napoli, Italy.
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Monica Baiano
- Centro Unico Disturbi Comportamento Alimentare, ASUFC, Udine, Italy
| | | | - Eugenia Barone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, 80138, Napoli, Italy
| | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Giulio Corrivetti
- European Biomedical Research Institute of Salerno (EBRIS), Salerno, Italy
| | - Serafino De Giorgi
- Center for the Treatment and Research on Eating Disorders, Mental Health Department, ASL Lecce, Lecce, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Carla Gramaglia
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padua, Italy.,Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | | | | | - Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marianna Rania
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Caterina Renna
- Center for the Treatment and Research on Eating Disorders, Mental Health Department, ASL Lecce, Lecce, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Pierandrea Salvo
- Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Catanzaro, Italy
| | - Erika Baldissera
- Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Umberto Volpe
- Section of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Zeppegno
- Psychiatry Institute, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry Scuola Medica Salernitana, Section of Neurosciences, University of Salerno, Salerno, Italy
| |
Collapse
|
30
|
Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
Collapse
Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| |
Collapse
|
31
|
Hagan WS, Mericle S, Hunt BJ, Harper JA, Palka JM, Pelfrey S, McAdams CJ. Qualitative patient experiences from the Self-Blame and Perspective-Taking Intervention for eating disorders. J Eat Disord 2021; 9:127. [PMID: 34649621 PMCID: PMC8515668 DOI: 10.1186/s40337-021-00483-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Problems in social cognition and social support contribute to eating disorders (ED). Group therapy provides an ideal format to create an experiential learning environment focused on understanding social interactions. This pilot study examined the qualitative content of the participants' experiences in the Self-Blame and Perspective-Taking Intervention (SBPI) for ED. METHODS The SBPI was a 4-week group therapy intervention involving art therapy and psychoeducation that focused on social behaviors in ED patients. Participants received surveys immediately after the intervention and at 1 to 4 weeks after the post-intervention. Thematic analyses of qualitative feedback were performed using Braun and Clarke's thematic analysis framework. RESULTS Inductive analyses revealed three main themes: (1) Developing self-acceptance through emotional reflection, (2) Changing expectations with neurosocial knowledge, and (3) Bonding and vulnerability in social interactions; all concepts intentionally targeted by the SBPI. Participants varied in their support of a guideline to exclude personal discussion of ED-related cognitions and behaviors in the group. CONCLUSIONS As a whole, patients valued the combination of psychosocial education with group experientials focused on social behavior. Positive feedback from the SBPI suggests that adjunctive treatments that target mental-wellness constructs indirectly related to ED pathology may be helpful by allowing patients to see themselves as separable from the illness. Trial registration ClinicalTrials.gov, NCT0487758. Registered 7 May 2021-Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04877158 .
Collapse
Affiliation(s)
- Whitney Smith Hagan
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Susan Mericle
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Bethany J Hunt
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Jessica A Harper
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Jayme M Palka
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Sarah Pelfrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA.
| |
Collapse
|
32
|
Allison S, Warin M, Bastiampillai T, Looi JCL, Strand M. Recovery from anorexia nervosa: the influence of women's sociocultural milieux. Australas Psychiatry 2021; 29:513-515. [PMID: 33939932 DOI: 10.1177/10398562211010796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Young women living in industrialised westernised societies have a higher prevalence of anorexia nervosa, partly due to a cultural emphasis on thinness as a beauty ideal. Sociocultural milieux might promote recovery from anorexia nervosa amongst young women. The current article is a commentary about the social influences on recovery from anorexia nervosa - based on social anthropology, narratives of people with lived experience, and clinical studies. CONCLUSION Anorexia nervosa increases social withdrawal, and recovery leads to re-engagement with meaningful relationships. Recovery also empowers women as 'cultural critics' who challenge assumptions about the thinness beauty ideal and gender roles. The gradual process of full or partial recovery often occurs during emerging adulthood (aged 20-29). In this life stage, adolescent friendship groups are dissolving as women move from education to work, reducing the danger of weight-based teasing by peers, which is an environmental risk factor for disordered eating. Women recovering from anorexia nervosa may connect with those aspirations of peers and mentors that eschew a focus on weight and shape, but relate to the life-stage tasks of starting careers, beginning new friendships, selecting life partners and family formation - that is, a broader role in larger relationship networks.
Collapse
Affiliation(s)
- Stephen Allison
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Megan Warin
- School of Social Sciences, University of Adelaide, Adelaide, SA, Australia.,Fay Gale Centre for Research on Gender, University of Adelaide, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,Department of Psychiatry, Monash University, Melbourne, VIC, Australia
| | - Jeffrey C L Looi
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,Academic Unit of Psychiatry and Addiction Medicine, the Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia
| | - Mattias Strand
- Transcultural Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
33
|
Caqueo-Urízar A, Urzúa A, Flores J, Acevedo D, Lorca JH, Casanova J. Relationship between eating disorders and internalized problems in chilean adolescents. J Eat Disord 2021; 9:118. [PMID: 34565472 PMCID: PMC8474780 DOI: 10.1186/s40337-021-00474-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are associated with internalized problems (INTP), such as depression and anxiety. Evidence shows that ED and INTP are associated with comorbidities. The relationship between these variables has not been the focus of studies on young people from Northern Chile. Children and adolescents are considered as an at-risk group, since they have been found to experience greater vulnerability to psychological problems than other age groups within the population and given the scarcity of studies in Chile, it is necessary to study the relationship between these variables. METHODS This study analyzed the relationship between ED and INTP in Chilean high school students aged 12 to 18 years using Pearson's correlation. This is a non-experimental and transactional correlational study. We included 2277 students belonging to the public, government-subsidized, and private educational establishments in Northern Chile. The Child and Adolescent Evaluation System [Sistema de Evaluación de Niños y Adolescentes (SENA)] was used to detect a range of INTP, as well as ED. The Brief Self-Control Scale was used in this study. RESULTS A strong and direct correlation of the eating disorder variable with depression and anxiety was found. Additionally, significant differences were observed with sex, highlighting females with a higher presence of INTP and ED. CONCLUSIONS There is a need to establish strategies in the school setting for detecting frequent symptomatology in adolescents with INTP and ED to achieve a timely and accessible intervention. Since the symptomatology of ED is more prevalent in adolescents, this research evaluated relationships between ED and INTP in young people from Northern Chile. This research is relevant because the evidence on this topic in Chile is scarce and the relationships found could be the first research on the subject and serve to design an intervention plan at the school level in the medium and long terms. It is a non-experimental and transactional correlational study because all variables were measured at a single moment, and it sought to establish relationships between variables without assuming causality. The sample of secondary school students consisted of 2277 students, belonging to the public, subsidized, and private schools. Strong relationships were observed between INTP and ED, the strongest correlations being with the variables depression and anxiety. In addition, female participants presented greater problems in ED and INTP.
Collapse
Affiliation(s)
- Alejandra Caqueo-Urízar
- Instituto de Alta Investigación, Universidad de Tarapacá, Calle Antofagasta n°1520, Arica, 1000000, Chile.
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta, Chile
| | - Jerome Flores
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Daniel Acevedo
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Jessica Herrera Lorca
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| | - Jenifer Casanova
- Escuela de Psicología Y Filosofía, Universidad de Tarapacá & Centro Justicia Educacional CJE, Santiago, Chile
| |
Collapse
|
34
|
Richson BN, Johnson SN, Swanson TJ, Christensen KA, Forbush KT, Wildes JE. Predicting probable eating disorder case-status in men using the Clinical Impairment Assessment: Evidence for a gender-specific threshold. Eat Behav 2021; 42:101541. [PMID: 34332312 PMCID: PMC10044494 DOI: 10.1016/j.eatbeh.2021.101541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/28/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The Clinical Impairment Assessment (CIA) is a widely used self-report measure of the psychosocial impairment associated with eating-disorder symptoms. Past studies recommended a global CIA score of 16 to identify clinically significant impairment associated with a probable eating disorder (ED). However, to date, research on the properties of the CIA has been conducted in majority-women samples. Preliminary research on gender differences in CIA scores suggested men with EDs report less impairment on the CIA relative to women with EDs. Thus, the purpose of this study was to test if a different impairment threshold is needed to identify cases of men with EDs. We hypothesized that a lower CIA threshold, relative to that identified in majority-women samples, would most accurately identify men with EDs. Participants (N = 162) were men from our university-based and general community-based ED participant registry who completed the CIA and Eating Disorder Diagnostic Scale. Both precision-recall and receiver operating characteristic curves assessed what CIA global score threshold most accurately identified men with EDs. Both analytic approaches indicated that a CIA global score of 13 best predicted ED case-status in men. Consistent with past research, men with a clinically significant ED appear to report lower impairment on the CIA. Results have implications for screening and assessing for substantial ED-related impairment in men. Additionally, past research using the CIA to identify men with EDs may have under-identified men with clinically significant symptoms.
Collapse
Affiliation(s)
| | - Sarah N Johnson
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | | | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, USA.
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| |
Collapse
|
35
|
Corsi E, Cardi V, Sowden S, Coll M, Cascino G, Ricca V, Treasure J, Bird G, Monteleone AM. Socio-cognitive processing in people with eating disorders: Computerized tests of mentalizing, empathy and imitation skills. Int J Eat Disord 2021; 54:1509-1518. [PMID: 34056730 PMCID: PMC8453969 DOI: 10.1002/eat.23556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Eating disorders are psychiatric illnesses characterized by extreme eating behaviors, such as sustained food restriction or loss of control over eating. Symptoms are thought to be maintained by a variety of mechanisms, one of which may be the socio-cognitive impairments associated with eating disorders. While some previous work has addressed socio-cognitive impairments in eating disorders, this work has relied mostly on self-report data. METHOD Here we employed computerized tests of (a) mentalizing (ability to infer the mental states of others); (b) empathy (the degree to which the emotional states of others can be identified and the degree to which the states of others impact one's own emotional state); and (c) imitation (the degree to which observation of another's actions prompts the performance of those actions); in a group of 78 women with an eating disorder and a matched control group of 66 healthy women. RESULTS People with eating disorders showed both hyper- and hypo-mentalizing and reduced accuracy of emotional and cognitive mental state inference. They displayed less imitation of observed actions, but no differences in empathy compared to healthy controls. Although anxiety and depressive symptoms had significant effects on mentalizing, most of the observed inter-group differences persisted. DISCUSSION Women with eating disorders have difficulties mentalizing and imitating observed actions despite intact non-social automatic imitation, compared to healthy controls. These findings provide an indication that intervention modules to strengthen specific areas of social cognition might be helpful to improve patients' social skills.
Collapse
Affiliation(s)
- Elisa Corsi
- Department of Psychological Medicine, Section of Eating DisordersInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Valentina Cardi
- Department of Psychological Medicine, Section of Eating DisordersInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Department of General PsychologyUniversity of PadovaPadovaItaly
| | | | | | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana’, Section of NeurosciencesUniversity of SalernoSalernoItaly
| | - Valdo Ricca
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating DisordersInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Geoffrey Bird
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | | |
Collapse
|
36
|
Monteleone AM, Mereu A, Cascino G, Castiglioni MC, Marchetto C, Grasso M, Pontillo M, Pisano T, Vicari S, Zanna V. Coping With Adolescents Affected by Anorexia Nervosa: The Role of Parental Personality Traits. Front Psychol 2021; 12:678745. [PMID: 34305733 PMCID: PMC8292794 DOI: 10.3389/fpsyg.2021.678745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Anorexia nervosa (AN) promotes psychological distress in caregivers who adopt different coping strategies. Dysfunctional caregiving styles exacerbate further distress in the patient promoting the maintenance of the illness. We aimed to assess the possible contribution of personality traits of caregivers to the adoption of different coping strategies to deal with the affected relative. Methods About 87 adolescents with AN were recruited. Their parents completed the Family Coping Questionnaire for Eating Disorders (FCQ-EDs) and the Temperament and Character Inventory-Revised (TCI-R). Differences between mothers and fathers were assessed through the independent sample t-test. Multivariate regression analyses were run to assess if personality traits, the occurrence of psychiatry conditions in the parents, the marital status, and the duration of the illness predicted parental coping strategies. Results The group of mothers showed higher levels of avoidance and seeking for information coping strategies than the sample of fathers. Lower illness duration predicted higher collusion with the illness in both parents. Harm avoidance, cooperativeness, and self-directedness positively predicted parental coercion, collusion, and seeking for information strategies with some differences between mothers and fathers. Discussion Illness duration and personality traits of parents affect the type of parental coping strategies developed to face AN in adolescents. These variables should be considered in the assessment of families of adolescents with AN and may be addressed to promote more fine-tuned clinical interventions for caregivers.
Collapse
Affiliation(s)
| | - Alberta Mereu
- Child and Adolescent Psychiatry, Center of Excellence in Neuroscience, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Maria Chiara Castiglioni
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Chiara Marchetto
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Melissa Grasso
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Maria Pontillo
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Tiziana Pisano
- Child and Adolescent Psychiatry, Center of Excellence in Neuroscience, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Valeria Zanna
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| |
Collapse
|
37
|
Kerr-Gaffney J, Mason L, Jones E, Hayward H, Harrison A, Murphy D, Tchanturia K. Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa. J Autism Dev Disord 2021; 51:2077-2090. [PMID: 32910314 PMCID: PMC8124046 DOI: 10.1007/s10803-020-04686-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
Collapse
Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Ilia State University, Tbilisi, GA, USA
| |
Collapse
|
38
|
Rowlands K, Willmott D, Cardi V, Clark Bryan D, Cruwys T, Treasure J. An examination of social group memberships in patients with eating disorders, carers, and healthy controls. EUROPEAN EATING DISORDERS REVIEW 2021; 29:733-743. [PMID: 34081359 DOI: 10.1002/erv.2840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 12/15/2022]
Abstract
This study compared the quantity and quality of social group memberships in patients with anorexia nervosa (n = 30), carers of patients with anorexia nervosa, unrelated to those patients (n = 30), and two cohorts of healthy controls (n = 60) age-matched to these focal groups. A secondary aim was to examine the associations between the quality of group relationships and severity of eating disorder and depression symptoms in patients; and depression symptoms in carers. Participants completed the online Social Identity Mapping Tool, which was used to measure the quantity and quality of social group memberships (e.g., number of social groups, number of groups rated 'highly positive'). Participants also completed self-report measures of clinical symptoms. Compared to controls, patients reported fewer social groups when eating disorder-related groups were included, and significantly fewer social groups, and community groups in particular, when eating disorder-related groups were excluded. Number of positive groups was negatively associated with severity of eating disorder and depression symptoms in patients when eating disorder-related groups were excluded. Carers reported fewer groups overall, fewer family groups, and fewer positive and supportive groups compared to healthy controls. There was a weak association between the number of positive groups and the severity of depression symptoms in carers. Positive group memberships might play a protective role towards developing more severe eating disorder and depression symptoms.
Collapse
Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Willmott
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Danielle Clark Bryan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
39
|
Leppanen J, Tosunlar L, Blackburn R, Williams S, Tchanturia K, Sedgewick F. Critical incidents in anorexia nervosa: perspectives of those with a lived experience. J Eat Disord 2021; 9:53. [PMID: 33875005 PMCID: PMC8054426 DOI: 10.1186/s40337-021-00409-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although social-emotional difficulties are believed play a key role in anorexia nervosa (AN), there is uncertainty regarding what these difficulties might look like. Previous research has largely focused on a "disease model" of social-emotional processing in AN with little attention paid to positive emotions and experiences. Therefore, the aim of the present study was to obtain a fuller picture of critical life events as identified by those with lived AN experience. METHODS Thirty-four participants aged 16-48 with current or past AN completed an online survey describing self-defined positive and difficult critical events. Thematic analysis was used to assess patterns in participants narrative responses. RESULTS Two major themes were identified in the descriptions of positive critical events: Moments of celebration and Unexpected positive outcomes. These major themes revealed increased external focus and some corrective experiences that challenged the participants pre-existing expectations leading to new positive outcomes. Difficult events clustered into life events that were identified as Eating disorder (ED) related and Non-ED related and included the dimensions of relational conflict and feeling unsupported. DISCUSSION The findings suggest that although negative emotionality was identified in the accounts of those with lived experience of AN capacity for "big-picture" thinking with and explicit focus on others was also identified. Moreover, an openness to corrective experiences that worked to challenge negative expectations was evident for some participants. Together these findings have scope as targets for further clinical research and treatment interventions.
Collapse
Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK.
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Lara Tosunlar
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Rachael Blackburn
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK
- Psychology Department, Illia State University, Tbilisi, Georgia
| | | |
Collapse
|
40
|
Hunt BJ, Smith Hagan W, Pelfrey S, Mericle S, Harper JA, Palka JM, McAdams C. Pilot data from the Self-Blame and Perspective-Taking Intervention for eating disorders. JOURNAL OF BEHAVIORAL AND COGNITIVE THERAPY 2021; 31:57-66. [PMID: 34124699 PMCID: PMC8195261 DOI: 10.1016/j.jbct.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Eating disorders (EDs) are characterized by altered eating behaviors and valuation of self-image, as well as difficulty establishing supportive social relationships. This pilot study evaluated feasibility, acceptability, and clinical responses to a novel and brief group-therapy intervention for EDs, the Self-Blame and Perspective-Taking Intervention (SBPI). The SBPI consisted of four sessions of experiential art therapy activities in conjunction with psychoeducation targeting interpersonal attributions and mentalization. Twenty-four outpatient, treatment-seeking women with EDs participated in the SBPI, with 87.5% completing the intervention and 94% rating their participation positively. ED symptoms, depression, anxiety, self-attribution bias, and self-esteem were assessed before (T1) and after participation (N = 20 at T2; N = 18 at T3). Separate repeated measures MANOVAs were performed to assess these clinical and self-concept variables. Relative to baseline, participants demonstrated significant improvements in two all self-concept measures: self-attribution bias, trait self-esteem and state self-esteem at T2. ED, depression, and anxiety symptoms were significantly decreased at both T2 (1-4 weeks post) and T3 (3-5 months post). The SBPI altered self-concept targets acutely and led to sustained clinical improvements. Future work is needed to evaluate how self-concept and social constructs are related to clinical symptom expression in EDs.
Collapse
Affiliation(s)
- Bethany J Hunt
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Whitney Smith Hagan
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Sarah Pelfrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Susan Mericle
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Jessica A Harper
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Jayme M Palka
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, USA 75390-9070
| |
Collapse
|
41
|
Monteleone AM, Cascino G, Martini M, Patriciello G, Ruzzi V, Delsedime N, Abbate-Daga G, Marzola E. Confidence in one-self and confidence in one's own body: The revival of an old paradigm for anorexia nervosa. Clin Psychol Psychother 2020; 28:818-827. [PMID: 33283906 DOI: 10.1002/cpp.2535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 11/26/2020] [Indexed: 12/31/2022]
Abstract
Impaired interoceptive function represents an important variable in the psychopathology of anorexia nervosa (AN) and is thought to be influenced by maladaptive schemas grounded on early intimate interactions. However, the role of the different psychological processes involved in the interoceptive function has been poorly assessed in AN. We aimed to investigate the associations between adult insecure attachment, interoceptive processes, and psychopathology. One hundred and fifty participants with AN completed self-report questionnaires: the Multidimensional Assessment of Interoceptive Awareness, which measures interoception dimensions; the Attachment Style Questionnaire, assessing adult attachment styles, and the Eating Disorder Inventory-2, exploring eating-related core symptoms. Pearson's correlations were employed to assess the relationships between MAIA and EDI-2 subscores. Structural equation models (SEM) were performed to investigate the relationships between insecure attachment dimensions, interoception, and AN core symptoms as latent variables. Body listening, self-regulating, and trusting were interoceptive dimensions associated with eating psychopathology. As confirmed by an exploratory factor analysis, these interoceptive dimensions are included in a latent variable which points to "confidence" in body sensations. SEM showed that insecure, in particular anxious, attachment predicts body "confidence" and, in turn, AN core symptoms. Confidence in body sensations as a trustworthy source of knowledge represents the specific interoceptive dimension associated with psychopathology in AN. In accordance with Bruch's model of AN, insecure attachment patterns may promote a need to validate inner experiences by external sources conferring vulnerability to symptomatology. These psychopathological pathways could be addressed in clinical interventions.
Collapse
Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Matteo Martini
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nadia Delsedime
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
42
|
Heruc G, Hurst K, Casey A, Fleming K, Freeman J, Fursland A, Hart S, Jeffrey S, Knight R, Roberton M, Roberts M, Shelton B, Stiles G, Sutherland F, Thornton C, Wallis A, Wade T. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 2020; 8:63. [PMID: 33292546 PMCID: PMC7653831 DOI: 10.1186/s40337-020-00341-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. RECOMMENDATIONS The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. CONCLUSIONS These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.
Collapse
Affiliation(s)
- Gabriella Heruc
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
- Eating Disorders Service, Northern Sydney Local Health District, St Leonards, Australia.
| | - Kim Hurst
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- School of Psychology, Griffith University, Gold Coast, Australia
- Eating Disorders Service, Robina Private Hospital, Robina, Australia
| | - Anjanette Casey
- Centre for Psychotherapy, Hunter New England Local Health District, Newcastle, Australia
| | | | - Jeremy Freeman
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
| | | | - Susan Hart
- Nutrition and Dietetics, St Vincent's Hospital, Darlinghurst, Australia
- The Boden Collaboration of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, Australia
| | - Shane Jeffrey
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- River Oak Health, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rachel Knight
- Occupational Therapy, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- The Victorian Centre of Excellence in Eating Disorders, Melbourne, Australia
| | - Michelle Roberton
- The Victorian Centre of Excellence in Eating Disorders, Melbourne, Australia
| | - Marion Roberts
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- Department of General Practice and Primary Health Care, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Beth Shelton
- National Eating Disorders Collaboration, Sydney, Australia
| | - Garalynne Stiles
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Palmerston North, New Zealand
| | - Fiona Sutherland
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- The Mindful Dietitian, Melbourne, Australia
| | | | - Andrew Wallis
- Eating Disorders Service, Sydney Children's Hospital Network, Sydney, Australia
| | - Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Bedford Park, Australia
| |
Collapse
|
43
|
Monteleone AM, Cascino G, Ruzzi V, Pellegrino F, Carfagno M, Raia M, Del Giorno C, Monteleone P, Maj M. Multiple levels assessment of the RDoC "system for social process" in Eating Disorders: Biological, emotional and cognitive responses to the Trier Social Stress Test. J Psychiatr Res 2020; 130:160-166. [PMID: 32823049 DOI: 10.1016/j.jpsychires.2020.07.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Social dysfunction is a putative risk and maintaining factor for Eating Disorders (EDs). We assessed biological, emotional, and cognitive responses to a psychosocial stressor, in order to provide a multilevel investigation of the RDoC social process system in EDs. METHODS Patients were recruited among those seeking treatment for an ED. Cortisol response to Trier Social Stress Test (TSST) was measured in 105 subjects: 35 women with anorexia nervosa (AN), 32 with bulimia nervosa (BN) and 38 healthy women. Anxiety, hunger, and desire to eat throughout TSST were rated in a subgroup of them (23 AN, 21 BN, and 25 control women). Two-way ANOVAs with repeated measures were run to assess differences among groups. RESULTS The TSST-induced cortisol secretion of AN women was significantly higher than in BN and healthy women; this significance disappeared after controlling for body mass index. Compared to healthy women, both AN and BN women showed reduced cortisol reactivity that disappeared after controlling for trait anxiety and ineffectiveness. Both ED groups displayed increased anxiety response to TSST, while only AN group reported greater decreases in hunger and desire to eat. No significant correlations were found between cortisol and anxiety, hunger, or desire to eat in response to TSST. CONCLUSIONS People with EDs are characterized by blunted cortisol reactivity and greater anxiety, hunger, and desire to eat responses to a psychosocial stressor without any significant association between these measures. This study provides the first empirical and multilevel support to a deranged functioning of the RDoC "system for social process" in EDs.
Collapse
Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marialuce Raia
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Chiara Del Giorno
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
44
|
Rowlands K, Wilson E, Simic M, Harrison A, Cardi V. A Critical Review of Studies Assessing Interpretation Bias Towards Social Stimuli in People With Eating Disorders and the Development and Pilot Testing of Novel Stimuli for a Cognitive Bias Modification Training. Front Psychol 2020; 11:538527. [PMID: 33101116 PMCID: PMC7556207 DOI: 10.3389/fpsyg.2020.538527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/21/2020] [Indexed: 12/31/2022] Open
Abstract
People with eating disorders display a negative interpretation bias towards ambiguous social stimuli. This bias may be particularly relevant to young people with the illness due to the developmental salience of social acceptance and rejection. The overall aim of this study was to systematically develop and validate stimuli for a cognitive bias modification training to reduce a social rejection-related negative interpretation bias in young people with eating disorders. A mixed-methods design was used to achieve this aim. A review of the literature was conducted using EMBASE, MEDLINE, PsycINFO, Web of Science, and PubMed. Six studies were included in the review. Focus groups were held with patients with eating disorders, carers and healthcare professionals. Content analysis was used to identify key themes from the qualitative data. Based on these themes, a total of 339 scenarios were generated by the researchers. Salient themes identified from the focus group data included virtual rejection/exclusion, rejection associated with an aspect of the eating disorder, rejection triggered by ambiguous/benign comments or behaviors of others and rejection perceived when confiding in others. Patients rated these scenarios in terms of their age-relevance and emotional salience and 301 scenarios were included in the final stimulus set. These materials may be used by researchers conducting future experimental research into the potential benefits of interpretation bias training for young people with eating disorders.
Collapse
Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Emma Wilson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, United Kingdom
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of General Psychology, University of Padova, Padova, Italy
| |
Collapse
|
45
|
Monteleone AM, Ruzzi V, Patriciello G, Cascino G, Pellegrino F, Vece A, Monteleone P, Maj M. Emotional reactivity and eating disorder related attitudes in response to the trier social stress test: An experimental study in people with anorexia nervosa and with bulimia nervosa. J Affect Disord 2020; 274:23-30. [PMID: 32469810 DOI: 10.1016/j.jad.2020.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/25/2020] [Accepted: 05/10/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND In order to experimentally asses the role of socio-emotional problems in Eating Disorder (ED) psychopathology, we have measured affective states and ED-related attitudes in response to an acute psychosocial stress and their relationships with interpersonal sensitivity in people with Anorexia Nervosa (AN) and Bulimia Nervosa (BN). METHODS Twenty-one women with AN, 21 with BN and 27 healthy women underwent an acute psycho-social challenge, the Trier Social Stress Test. Anxiety feelings, hunger perception, amount of desired food and body dissatisfaction were measured throughout the experimental procedure. The relationships between these variables and with interpersonal sensitivity measures were explored through Pearson's correlation and mediation analyses. RESULTS Stress-induced anxiety was increased in people with EDs. People with AN showed reduced hunger perception, decreased desire for food and a negative association between anxiety feelings and desire for food. In people with EDs, baseline ineffectiveness predicted post-stress body dissatisfaction through the mediation of post-stress anxiety levels. LIMITATIONS The relatively low sample size and the lack of an experimental control condition are the main limitations of the study. CONCLUSIONS The present findings show, for the first time, the relationships between socio-emotional distress and ED-related attitudes in people with EDs, providing experimental support to the interpersonal model of EDs. This gives empirical evidence to treatments targeting interpersonal problems in EDs.
Collapse
Affiliation(s)
- Alessio Maria Monteleone
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy.
| | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy
| | - Giuseppina Patriciello
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy
| | - Alfonso Vece
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Largo Madonna delle Grazie, 80138 , Naples, Italy
| |
Collapse
|
46
|
Konstantakopoulos G, Ioannidi N, Patrikelis P, Gonidakis F. The impact of theory of mind and neurocognition on delusionality in anorexia nervosa. J Clin Exp Neuropsychol 2020; 42:611-621. [PMID: 32633184 DOI: 10.1080/13803395.2020.1786504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study aimed to examine the impact of theory of mind (ToM) deficits on body image delusionality in anorexia nervosa (AN) while accounting for the effect of other cognitive functions. ToM and other cognitive functions were assessed in 46 patients with AN and 42 healthy controls. We used the Brown Assessment of Beliefs Scale to assess the degree of delusionality of body image beliefs in AN patients. Delusional body image beliefs were identified in 26.1% and overvalued ideas in 30.4% of the AN patients. Moderate but significant associations were found between impairments in ToM-overall capacity, cognitive and affective components-and body image delusionality. The effect of overall ToM performance on delusionality remained significant after controlling for other cognitive factors. General intelligence was also significantly associated with delusionality. Our findings support the notion that difficulties in taking the perspective of others contribute to insight impairment in AN. Further investigation is required to examine the effect of failures in social cognition and metacognition on insight in AN.
Collapse
Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, National & Kapodistrian University of Athens , Athens, Greece.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College , London, UK
| | - Nikoleta Ioannidi
- First Department of Psychiatry, National & Kapodistrian University of Athens , Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, National & Kapodistrian University of Athens , Athens, Greece
| | - Frangiskos Gonidakis
- First Department of Psychiatry, National & Kapodistrian University of Athens , Athens, Greece
| |
Collapse
|
47
|
Konstantakopoulos G, Ioannidi N, Patrikelis P, Gonidakis F. Empathy, mentalizing, and cognitive functioning in anorexia nervosa and bulimia nervosa. Soc Neurosci 2020; 15:477-488. [PMID: 32321371 DOI: 10.1080/17470919.2020.1760131] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The existing evidence on the specific profile and the determinants of empathic and mentalizing abilities in anorexia nervosa (AN) and bulimia nervosa (BN) is not conclusive. Moreover, it is not clear whether patients with eating disorders also exhibit diminished ability to accurately appraise their own empathic skills. We examine in AN and BN: (a) the impairments in various aspects of empathy and theory of mind (ToM), while accounting for the effect of other cognitive functions and (b) the accuracy of self-appraisal of empathy. Self-reported and performance-based empathy, ToM, and cognitive functions were assessed in 46 patients with AN, 30 patients with BN, and 42 healthy controls (HC). Both AN and BN patients reported diminished overall empathic abilities, whereas only BN patients reported reduced cognitive empathy compared to HC. Deficits in performance-based empathy were found in both patient groups. Cognitive ToM was impaired only in AN. Significant correlations between self-reported and performance-based empathy were found in BN and HC but not in AN. Cognitive deficits negatively affected the self-appraisal of empathy in AN but not empathic skills per se. Our findings highlight a double deficit related to empathic responding in AN: diminished performance and inaccurate self-appraisal of empathic abilities, indicating dysfunctional self-reflection.
Collapse
Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece.,Department of Psychosis Studies, Institute of Psychiatry, King's College , London, UK
| | - Nikoleta Ioannidi
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, National & Kapodistrian University of Athens, Evangelismos Hospital , Athens, Greece
| | - Frangiskos Gonidakis
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital , Athens, Greece
| |
Collapse
|
48
|
Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness. J Clin Med 2020; 9:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
Collapse
Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| |
Collapse
|
49
|
Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:427-440. [DOI: 10.3758/s13415-020-00777-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
50
|
Monteleone AM, Mereu A, Cascino G, Criscuolo M, Castiglioni MC, Pellegrino F, Patriciello G, Ruzzi V, Monteleone P, Vicari S, Zanna V. Re-conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness. Int J Eat Disord 2019; 52:1263-1273. [PMID: 31313374 DOI: 10.1002/eat.23137] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa. METHODS Four-hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory-3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive-compulsive and post-traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters. RESULTS Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post-traumatic stress problems, drive to thinness, low self-esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self-esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self-esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects. DISCUSSION These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re-conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.
Collapse
Affiliation(s)
| | - Alberta Mereu
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Michela Criscuolo
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Maria Chiara Castiglioni
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Francesca Pellegrino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Valeria Ruzzi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Stefano Vicari
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| | - Valeria Zanna
- Child Neuropsychiatry Unit, Department of Neuroscience, I.R.C.C.S. Children Hospital Bambino Gesù, Rome, Italy
| |
Collapse
|