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Kindermann D, Rollmann I, Orth M, Friederich HC, Nikendei C. Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy. Psychother Res 2024; 34:774-789. [PMID: 37706484 DOI: 10.1080/10503307.2023.2254917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy. We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor. The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate. Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.
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Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Orth
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Miniati M, Lippi M, Palagini L, Conversano C, Orrù G, Gemignani A, Perugi G. Is Interoception Deficit Linking Alexithymia and Eating Spectrum Symptoms? Study on a Non-Clinical Sample of Young Adults. Healthcare (Basel) 2024; 12:586. [PMID: 38470697 PMCID: PMC10931238 DOI: 10.3390/healthcare12050586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
We investigated if interoceptive deficits could be the link between alexithymic traits and eating spectrum manifestations in a non-clinical sample. One-hundred sixty-one young adults (mean age: 23.2 ± 2.4 years) were evaluated with the Toronto Alexithymia Scale-20 (TAS-20), the Interoceptive Accuracy Scale (IAS), the Interoceptive Confusion Questionnaire (ICQ), and the Eating Attitudes Test-26 (EAT-26). Questionnaires were administered with an online procedure (Microsoft Form, Office 365 A1, Pisa, Italy) (Study Protocol #0012005/2023). We compared ICQ, IAS, and TAS-20 scores in subjects who met the threshold for a potential eating spectrum disorder according to EAT-26 scores ≥ 20 (n = 27) vs. subjects who scored <20 (n = 134), with an ANCOVA corrected for 'age' and 'gender'. Subjects with EAT-26 ≥ 20, scored significantly higher at ICQ (54.4 ± 13.2 vs. 50.2 ± 6.8; p = 0.011), TAS-20 'Total Score' (60.8 ± 11.9 vs. 58.1 ± 9.2; p = 0.006), and TAS-20 'Identifying Feelings' (21.5 ± 7.6 vs. 17.3 ± 5.8; p = 0.0001). A binary logistic regression analysis, with EAT-26 scores < 20 vs. ≥20 as the dependent variable, and ICQ, IAS, TAS-20 total scores and dimensions, age, and gender (categorical) as covariates, showed that the only variable predicting eating spectrum symptomatology was 'ICQ Total Score' (OR = 1.075, 95% CI: 1.016-1.139; p = 0.013). Interoceptive confusion was the dimension linking the occurrence of alexithymic traits and eating spectrum manifestations.
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Affiliation(s)
- Mario Miniati
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (G.P.)
| | - Maria Lippi
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.L.); (C.C.); (G.O.); (A.G.)
| | - Laura Palagini
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (G.P.)
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.L.); (C.C.); (G.O.); (A.G.)
| | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.L.); (C.C.); (G.O.); (A.G.)
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.L.); (C.C.); (G.O.); (A.G.)
| | - Giulio Perugi
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (L.P.); (G.P.)
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Vaioli G, Bastoni I, Villa V, Mendolicchio L, Castelnuovo G, Mauro A, Scarpina F. "I cannot see your fear!" Altered recognition of fearful facial expressions in anorexia nervosa. Front Psychol 2023; 14:1280719. [PMID: 38125860 PMCID: PMC10732310 DOI: 10.3389/fpsyg.2023.1280719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Background The evidence about facial emotion recognition in anorexia nervosa as the role of alexithymic traits on this emotional ability is conflicting and heterogeneous. Objective We assessed the capability of recognizing facial expressions of two primary emotions, fear, and anger, in the context of anorexia nervosa. Methods Women affected by anorexia nervosa were compared with healthy weight women in a well-established implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the individual levels of alexithymia were assessed through a standard self-report questionnaire. Results Participants with anorexia nervosa reported a significantly lower performance in terms of reaction time and accuracy when the emotion of fear-but not anger-was the target. Notably, such an alteration was linked to the levels of alexithymia reported in the self-report questionnaire. Conclusion In anorexia nervosa, difficulties in processing facial fearful (but not angry) expressions may be observed as linked to higher expressions of alexithymic traits. We suggested future research in which emotional processing will be investigated taking into account the role of the bodily dimensions of emotional awareness.
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Affiliation(s)
- Giulia Vaioli
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
| | - Ilaria Bastoni
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
| | - Valentina Villa
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
| | - Leonardo Mendolicchio
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, Italy
| | - Gianluca Castelnuovo
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alessandro Mauro
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
| | - Federica Scarpina
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
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Hellerhoff I, Bernardoni F, Bahnsen K, King JA, Doose A, Pauligk S, Tam FI, Mannigel M, Gramatke K, Roessner V, Akgün K, Ziemssen T, Ehrlich S. Serum neurofilament light concentrations are associated with cortical thinning in anorexia nervosa. Psychol Med 2023; 53:7053-7061. [PMID: 36967674 PMCID: PMC10719626 DOI: 10.1017/s0033291723000387] [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: 08/03/2022] [Revised: 12/21/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by severe emaciation and drastic reductions of brain mass, but the underlying mechanisms remain unclear. The present study investigated the putative association between the serum-based protein markers of brain damage neurofilament light (NF-L), tau protein, and glial fibrillary acidic protein (GFAP) and cortical thinning in acute AN. METHODS Blood samples and magnetic resonance imaging scans were obtained from 52 predominantly adolescent, female patients with AN before and after partial weight restoration (increase in body mass index >14%). The effect of marker levels before weight gain and change in marker levels on cortical thickness (CT) was modeled at each vertex of the cortical surface using linear mixed-effect models. To test whether the observed effects were specific to AN, follow-up analyses exploring a potential general association of marker levels with CT were conducted in a female healthy control (HC) sample (n = 147). RESULTS In AN, higher baseline levels of NF-L, an established marker of axonal damage, were associated with lower CT in several regions, with the most prominent clusters located in bilateral temporal lobes. Tau protein and GFAP were not associated with CT. In HC, no associations between damage marker levels and CT were detected. CONCLUSIONS A speculative interpretation would be that cortical thinning in acute AN might be at least partially a result of axonal damage processes. Further studies should thus test the potential of serum NF-L to become a reliable, low-cost and minimally invasive marker of structural brain alterations in AN.
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Affiliation(s)
- Inger Hellerhoff
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Child and Adolescent Psychiatry, Eating Disorder Research and Treatment Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Bernardoni
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Joseph A. King
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Arne Doose
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Sophie Pauligk
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Friederike I. Tam
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Child and Adolescent Psychiatry, Eating Disorder Research and Treatment Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Merle Mannigel
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Gramatke
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katja Akgün
- Center of Clinical Neuroscience, Neurological Clinic, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Neurological Clinic, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental Neurosciences, Translational Developmental Neuroscience Section, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Child and Adolescent Psychiatry, Eating Disorder Research and Treatment Center, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Harms CA, Barley OR. Alexithymia and Impulsivity in Combat Sports - A Tale of Three Measures. Psychol Rep 2023:332941231201951. [PMID: 37732934 DOI: 10.1177/00332941231201951] [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: 09/22/2023]
Abstract
The purpose of this study was to compare the psychometric properties of two measures of alexithymia - the Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ) - as well as the Barratt Impulsiveness Scale 11 measure of behavioural impulsivity because the psychometric properties of these scales have not been established in athletes. As part of a larger study, 298 participants completed an online survey that included the TAS-20, PAQ, and BIS 11, as well personal- (age and gender) and sport-specific (primary combat sport and level of competition) demographic measures. A unidimensional model was retained for the TAS-20. A unidimensional model with the possibility of multidimensional measure was retained for the PAQ, with the viability of a subscale for Generalised Externally Orientated Thinking supported. The only versions of the BIS that were retainable were unidimensional models for the BIS-15 (a 15-item version of the BIS 11) and the BIS-Brief (an 8-item version of the BIS 11). As expected, the measures of alexithymia were highly correlated. The associations between impulsivity and alexithymia as well as age and alexithymia were small in nature, with none these associations moderated by level of gender, level of competition, or primary sport for the participants. No differences in alexithymia or impulsivity according to gender, level of competition, or primary sport were noted for the participants. Implications of these findings for the measures of alexithymia - the TAS-20 and PAQ - and impulsivity - the BIS-15 and BIS-Brief - examined in the present study with athletes (as well as with other populations) are discussed.
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Affiliation(s)
- Craig A Harms
- School of Arts and Humanities, Psychology and Criminology, Edith Cowan University, Joondalup, WA, Australia
| | - Oliver R Barley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Bizzi F, Riva A, Charpentier Mora S, Tironi M, Sforza SE, Milani LM, Nacinovich R. Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3670. [PMID: 36834365 PMCID: PMC9959039 DOI: 10.3390/ijerph20043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Anna Riva
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Simone Charpentier Mora
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Sofia Elena Sforza
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine and Surgery, University of Brescia, 25123 Brescia, Italy
| | - Lorenzo Maria Milani
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- NeuroMI—Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milan, Italy
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7
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Elwyn R. A lived experience response to the proposed diagnosis of terminal anorexia nervosa: learning from iatrogenic harm, ambivalence and enduring hope. J Eat Disord 2023; 11:2. [PMID: 36604749 PMCID: PMC9815687 DOI: 10.1186/s40337-022-00729-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
The ethical approach to treatment non-response and treatment refusal in severe-enduring anorexia nervosa (SE-AN) is the source of significant ethical debate, particularly given the risk of death by suicide or medical complications. A recent article proposed criteria to define when anorexia nervosa (AN) can be diagnosed as 'terminal' in order to facilitate euthanasia or physician-assisted suicide (EAS), otherwise known as medical assistance in dying, for individuals who wish to be relieved of suffering and accept treatment as 'futile'. This author utilises their personal lived experience to reflect on the issues raised, including: treatment refusal, iatrogenic harm, suicidality and desire to end suffering, impact of diagnosis/prognosis, schemas, alexithymia, countertransference, ambivalence, and holding on to hope. Within debates as critical as the bioethics of involuntary treatment, end-of-life and EAS in eating disorders, it is crucial that the literature includes multiple cases and perspectives of individuals with SE-AN that represent a wide range of experiences and explores the complexity of enduring AN illness, complex beliefs, communication patterns and relational dynamics that occur in SE-AN.
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Affiliation(s)
- Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia.
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Liu J, Zhao K, Kang W, Tong S, Xu Y, Jin W, Qiao M, Li Y, Hong L, Yao K, Zheng T. The Association of Borderline Personality Features and Self-Injury Among Adolescents with Non-Suicidal Self-Injury: The Mediating Role of Alexithymia. Psychol Res Behav Manag 2023; 16:1741-1754. [PMID: 37187782 PMCID: PMC10178905 DOI: 10.2147/prbm.s404057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Non-suicidal self-injury (NSSI) is becoming an increasingly prevalent phenomenon among adolescents, endangering their health. The aims of this study were to 1) explore the associations between borderline personality features, alexithymia and NSSI and 2) examine if alexithymia mediates the relationships between borderline personality features and both the severity of NSSI and the various functions that maintain NSSI in adolescents. Methods This cross-sectional study recruited 1779 outpatient and inpatient aged 12-18 years from psychiatric hospitals. All adolescents completed a structured four-part questionnaire including demographic items, the Chinese version of the Functional Assessment of Self-Mutilation, the Borderline Personality Features Scale for Children and the Toronto Alexithymia Scale. Results The structural equation modelling results indicated that alexithymia partially mediated the associations between borderline personality features and both the severity of NSSI and the emotion regulation function of NSSI (B = 0.058 and 0.099, both p < 0.001), after controlling for age and sex. Discussion These findings suggest that alexithymia may play a role in the mechanism and treatment of NSSI among adolescents with borderline personality features. Further longitudinal studies are essential to validate these findings.
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Affiliation(s)
- Jie Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Ke Zhao
- Lishui Second People's Hospital Affiliated to Wenzhou Medical University, Lishui, People’s Republic of China
| | - Wei Kang
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Siyu Tong
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Wei Jin
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Mengxuan Qiao
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yuan Li
- School of Mental Health, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Lan Hong
- The Third Hospital of Quzhou, Quzhou, People’s Republic of China
| | - Keqing Yao
- Shenzhen Mental Health Center, Shenzhen, Guangdong, People’s Republic of China
- Shenzhen Kangning Hospital, Shenzhen, Guangdong, People’s Republic of China
- Correspondence: Keqing Yao, Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People’s Republic of China, Tel +86-755-82927264, Email
| | - Tiansheng Zheng
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, People’s Republic of China
- Tiansheng Zheng, The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, People’s Republic of China, Email
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9
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Riva A, Pigni M, Bomba M, Nacinovich R. Adolescents with anorexia nervosa with or without non-suicidal self-injury: clinical and psychopathological features. Eat Weight Disord 2022; 27:1729-1737. [PMID: 34585367 DOI: 10.1007/s40519-021-01311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) and non-suicidal self-injury (NSSI) share typical onset in adolescence, greater prevalence in females and similar risk factors. Nevertheless, clinical features of eating disorders (ED) in this population are still under-investigated, especially associated to psychological features. METHODS The present study aims at comparing clinical and ED characteristics and psychopathological traits in a sample of 253 female adolescents with AN with or without NSSI and to determine possible clinical and psychological predictors on the presence of NSSI. The two groups were compared through multivariate analyses, while correlation and regression analyses were conducted to determine possible associations and predictors. RESULTS AN + NSSI group showed higher prevalence of binging-purging-type AN (p < .001), and mean higher age (p = .008) and Body Mass Index (BMI) (p = .002) than AN without NSSI group. Concerning psychological scales, AN + NSSI group showed higher scores in mostly of the sub-scale of the test Eating Disorders Inventory-3, higher scores at the scale for depression (p < 0.001) and higher scores at the three indexes of Symptom Checklist 90-Revised test, Global Severity Index (p < 0.001), Positive Symptoms total (p = .003) and Positive Symptom Distress Index (p < 0.001). No differences emerged at Children's Global Assessment Scale and at scale for evaluation of alexithymia. Regression analyses showed that a diagnosis of binging-purging-type AN (p = .001) predicts NSSI. CONCLUSION Results suggest that adolescents with AN and NSSI show peculiar clinical features with higher prevalence of binging-purging-type AN and more severe psychopathological traits than adolescents with AN without NSSI. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Anna Riva
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy.
| | - Maria Pigni
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Monica Bomba
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, University of Milan Bicocca, S. Gerardo Hospital, ASST of Monza, Via Pergolesi, 33, 20900, Monza, Italy
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Mannarini S, Kleinbub JR. Parental-Bonding and Alexithymia in Adolescents with Anorexia Nervosa, Their Parents, and Siblings. Behav Sci (Basel) 2022; 12:123. [PMID: 35621420 PMCID: PMC9137782 DOI: 10.3390/bs12050123] [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] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/17/2022] Open
Abstract
Anorexia nervosa (AN) patients and their family-members share alexithymia, anxiety, depression, and other psychological symptoms, in the context of altered attachment. These domains have been individually studied in the context of eating disorders; few attempts have been made to study their interaction, especially including family members. In this study, alexithymia, parental-bonding, and psychopathology were assessed in 32 Italian families consisting of an adolescent AN patient, a sibling, and their parents. We aimed to (a) describe a sample of Italian families with a child affected by AN, notably including siblings; (b) investigate interactions between assessed constructs in patients and their siblings; and (c) investigate possible intergenerational effects. Results showed high alexithymia and psychopathological symptoms in patients but not in siblings, although the latter reported high obsession-compulsion and paranoid ideation scores. Patients' and siblings' alexithymia correlated with psychopathology. Parents reported generally low alexithymia. Perceived parental bonding was found to be suboptimal in most participants, yet no clear relationship was found between specific parenting styles and other measured traits, nor did we find any other relevant intergenerational effect. Anorexia nervosa implies psychological difficulties for all family members. Siblings' psychopathological traits are especially concerning and currently understudied. Implications for future research and clinical interventions are discussed.
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Affiliation(s)
- Stefania Mannarini
- Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy;
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy
| | - Johann Roland Kleinbub
- Interdepartmental Center for Family Research (CIRF), University of Padova, Via Venezia, 14-35131 Padova, PD, Italy;
- Section of Applied Psychology, Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Via Venezia, 14-35131 Padova, PD, Italy
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11
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Reilly EE, Brown TA, Arunagiri V, Kaye WH, Wierenga CE. Exploring changes in alexithymia throughout intensive dialectical behavior therapy for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2022; 30:193-205. [PMID: 35137501 DOI: 10.1002/erv.2887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Alexithymia is proposed as a prominent clinical feature of eating disorders (EDs). However, despite theoretical reason to believe that alexithymia could interfere with the success of treatments, few studies have tested whether alexithymia changes over the course of treatment. The goals of the current study were to evaluate (a) changes in alexithymia over the course of intensive Dialectical Behaviour Therapy (DBT) for EDs, and (b) associations between alexithymia and ED symptoms over time. METHOD A mixed-diagnostic group of patients with EDs (N = 894) completed the Eating Disorders Examination-Questionnaire (EDE-Q) and the Toronto Alexithymia Scale (TAS-20) throughout intensive treatment and at various lengths of follow-up (6, 12, 24 months). RESULTS Results suggested that even after controlling for relevant covariates, there were significant decreases in alexithymia from intake to discharge and discharge to follow-up. Models exploring changes in self-reported ED symptoms indicated that TAS-20 scores significantly related to ED symptoms across timepoints, such that greater alexithymia was associated with greater severity of symptoms. CONCLUSIONS Altogether, findings support an association between alexithymia and ED symptoms over treatment and suggest that emotion-focussed therapies like DBT may result in decreases in alexithymia. Future research should explore whether this effect is consistent across therapies without an emotional focus.
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Affiliation(s)
- Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA.,Eating Disorders Center for Treatment and Research, University of California, San Diego, San Diego, California, USA
| | - Vinushini Arunagiri
- Department of Psychology, Hofstra University, Hempstead, New York, USA.,Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Walter H Kaye
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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12
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Meneguzzo P, Garolla A, Bonello E, Todisco P. Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother 2021; 29:718-724. [PMID: 34432335 PMCID: PMC9291290 DOI: 10.1002/cpp.2665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive–behavioural therapy and a flexible and personalized component implemented by third‐wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re‐evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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13
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Gaggero G, Bonassi A, Dellantonio S, Pastore L, Aryadoust V, Esposito G. A Scientometric Review of Alexithymia: Mapping Thematic and Disciplinary Shifts in Half a Century of Research. Front Psychiatry 2020; 11:611489. [PMID: 33362614 PMCID: PMC7758403 DOI: 10.3389/fpsyt.2020.611489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
The term "alexithymia" was introduced in the lexicon of psychiatry in the early '70s by Sifneos to outline the difficulties manifested by some patients in identifying and describing their own emotions. Since then, the construct has been broadened and partially modified. Today this describes a condition characterized by an altered emotional awareness which leads to difficulties in recognizing your own and others' emotions. In half a century, the volume of scientific products focusing on alexithymia has exceeded 5,000. Such an expansive knowledge domain poses a difficulty for those willing to understand how alexithymia research has developed. Scientometrics embodies a solution to this issue, employing computational, and visual analytic methods to uncover meaningful patterns within large bibliographical corpora. In this study, we used the CiteSpace software to examine a corpus of 4,930 publications on alexithymia ranging from 1980 to 2020 and their 100,251 references included in Web of Science. Document co-citation analysis was performed to highlight pivotal publications and major research areas on alexithymia, whereas journal co-citation analysis was conducted to find the related editorial venues and disciplinary communities. The analyses suggest that the construct of alexithymia experienced a gradual thematic and disciplinary shift. Although the first conceptualization of alexithymia came from psychoanalysis and psychosomatics, empirical research was pushed by the operationalization of the construct formulated at the end of the '80s. Specifically, the development of the Toronto Alexithymia Scale, currently the most used self-report instrument, seems to have encouraged both the entrance of new disciplines in the study of alexithymia (i.e., cognitive science and neuroscience) and an implicit redefinition of its conceptual nucleus. Overall, we discuss opportunities and limitations in the application of this bottom-up approach, which highlights trends in alexithymia research that were previously identified only through a qualitative, theory-driven approach.
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Affiliation(s)
- Giulia Gaggero
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Andrea Bonassi
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.,Mobile and Social Computing Lab, Bruno Kessler Foundation, Trento, Italy
| | - Sara Dellantonio
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy
| | - Luigi Pastore
- Department of Education, Psychology, Communication, University of Bari, Bari, Italy
| | - Vahid Aryadoust
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Rovereto, Italy.,Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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