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Longo P, Bevione F, Amodeo L, Martini M, Panero M, Abbate-Daga G. Perfectionism in anorexia nervosa: Associations with clinical picture and personality traits. Clin Psychol Psychother 2023. [PMID: 37970961 DOI: 10.1002/cpp.2931] [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: 06/28/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
Although many researchers addressed the topics, no consistent data are currently available regarding the relationship between perfectionism and personality traits in anorexia nervosa (AN). The present study aimed to assess differences between high- and low-perfectionism groups of patients with AN and to identify which variables show the strongest association with perfectionism. A group of inpatients with AN (n = 193) was recruited and completed a battery of self-report questionnaires regarding eating-related and general psychopathology, perfectionism, and personality. On the basis of perfectionism scores, patients were divided into high- and low-perfectionism groups. High-perfectionist patients displayed higher eating-related and general psychopathology; higher depressive, cyclothymic, irritable and anxious temperament, and lower self-directedness, cooperativeness and self-esteem. Perfectionism was associated with the drive for thinness, cooperativeness, self-esteem and anxious temperament. On the basis of the two personality traits most strongly correlated with perfectionism (i.e., cooperativeness and anxious temperament), patients could be correctly assigned to the high- or low-perfectionism group by an algorithm. The study suggests that perfectionism in AN is related to eating psychopathology, especially of restrictive type, and personality features such as cooperativeness and anxious temperament. These findings confirm the important role of perfectionism in AN, not only concerning eating behaviour but personality as well.
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Affiliation(s)
- Paola Longo
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Bevione
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Amodeo
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Martini
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Matteo Panero
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Eating disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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Halls D, Batchelor R, Holetic V, Leppanen J, Williams S, Tchanturia K. Longitudinal exploration of biopsychosocial profiles in individuals with anorexia nervosa. J Psychiatr Res 2023; 167:16-22. [PMID: 37806284 DOI: 10.1016/j.jpsychires.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/14/2023] [Accepted: 09/01/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Previous work in individuals with Anorexia Nervosa (AN) has demonstrated a range of psycho-social difficulties such as increased anxiety, depression, obsessive-compulsive symptoms, as well as difficulties in work and with interpersonal interactions. However, making inferences regarding the stability of these psycho-social difficulties from previous studies is challenging, due to lack of a control group and known frequentist statistical issues. METHODS 134 participants, 40 healthy controls (HC) and 94 participants with AN, completed self-reported measures designed to explore eating disorder concerns, body mass index, mood symptoms, work and social functioning as well as traits associated with autism at two time points, two years apart. A principal component analysis and Bayesian mixed effects models were used to build and explore group differences in bio-psychosocial profiles at time points. RESULTS The Bayesian models demonstrated evidence for individuals with AN having higher scores for a component representing psycho-social difficulties and lower scores for a component representing biological difficulties compared to HC, at both time points. There was no evidence of a group difference for a component representing autism. CONCLUSIONS Our results demonstrate that persistent psycho-social difficulties are a feature in individuals with AN.
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Affiliation(s)
- Daniel Halls
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Rachel Batchelor
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Victoria Holetic
- South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK; South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, UK; Psychology Department, Illia State University, Tbilisi, Georgia.
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Li Z, Leppanen J, Webb J, Croft P, Byford S, Tchanturia K. Analysis of symptom clusters amongst adults with anorexia nervosa: Key severity indicators. Psychiatry Res 2023; 326:115272. [PMID: 37276647 PMCID: PMC10790244 DOI: 10.1016/j.psychres.2023.115272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023]
Abstract
This study used cluster analysis to explore clinically relevant subgroups of adult patients with anorexia nervosa (AN). Patients were clustered based on their body mass index (BMI), eating disorder symptomatology, anxiety and depression symptoms and autistic characteristics. The difference between clusters in work and social functioning, duration of illness, bingeing and purging behaviour, previous hospitalisations and number of comorbidities was also investigated. Two meaningful clusters emerged: a higher symptoms cluster with more severe eating pathology, anxiety, depression, and more autistic traits, and a second cluster with lower symptoms. BMI did not make major contributions to cluster formation. The higher symptoms cluster also reported lower self-efficacy to change, more previous hospitalisations, comorbid diagnoses, binge eating and purging behaviours and use of psychotropic medication. Our findings suggest that weight alone may not be a significant severity indicator amongst inpatients with AN, and targeted treatment of AN should consider a broader range of symptom severity indicators.
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Affiliation(s)
- Zhuo Li
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Jenni Leppanen
- Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Jessica Webb
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Croft
- National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Byford
- King's Health Economics, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- King's College London, London, Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, UK; National Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK; Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia.
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Martini M, Longo P, Tamarin T, Toppino F, Brustolin A, Abbate-Daga G, Panero M. Exploring Caloric Restriction in Inpatients with Eating Disorders: Cross-Sectional and Longitudinal Associations with Body Dissatisfaction, Body Avoidance, Clinical Factors, and Psychopathology. Nutrients 2023; 15:3409. [PMID: 37571346 PMCID: PMC10420884 DOI: 10.3390/nu15153409] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Reduction in food intake is an important feature of eating disorders (EDs). However, whereas self-reported cognitive control over food (i.e., dietary restraint) is commonly assessed, we are not aware of any study evaluating the actual reduction in caloric intake (i.e., caloric restriction, CR) and its relationships with psychopathological, clinical, and anamnestic factors in individuals with EDs. In this study, we quantified caloric intake, CR, and weight suppression in 225 ED inpatients and explored significant relationships with self-reported eating symptoms, body dissatisfaction, body avoidance, personality, and affective symptoms. For underweight inpatients (n = 192), baseline predictors of caloric intake and restriction at discharge were assessed through a data-driven approach. CR at admission was significantly related to eating symptomatology, state anxiety, and body image. In regression models, CR, higher BMI, binge-purging symptoms, and the interaction between weight suppression and CR were significantly related to body dissatisfaction. The best psychopathological predictors of caloric intake and restriction at discharge for underweight inpatients were perfectionistic concern over mistakes and state anxiety. These results suggest that caloric restriction is associated to relevant ED features and warrant for a multidimensional assessment of ED psychopathology.
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Affiliation(s)
| | | | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 11, 10126 Turin, Italy; (M.M.); (P.L.); (T.T.); (F.T.); (A.B.); (M.P.)
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Panero M, Abbate-Daga G. What's New in Research during the Current Epidemic Wave of Eating Disorders? J Clin Med 2023; 12:3994. [PMID: 37373686 DOI: 10.3390/jcm12123994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic has caused physical health concerns and has significantly impacted mental health [...].
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Affiliation(s)
- Matteo Panero
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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Martini M, Longo P, Delsedime N, Abbate-Daga G, Panero M. Increased General, Eating, and Body-Related Psychopathology in Inpatients in a Specialized Eating Disorders Unit after the Beginning of the COVID-19 Pandemic: A Retrospective Comparison with the Pre-Pandemic Period. J Clin Med 2023; 12:jcm12020573. [PMID: 36675502 PMCID: PMC9866300 DOI: 10.3390/jcm12020573] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
The study of the effects of the COVID-19 pandemic on individuals who attended mental health services is needed to identify the specific vulnerabilities associated to this challenging period. Despite several analyses reporting the worsening of eating disorders symptomatology after the beginning of the pandemic, characterizations of adult inpatients with eating disorders are still lacking. We conducted a retrospective analysis to assess whether adult individuals who underwent hospitalization in a specialized eating disorders unit in the two years after the beginning of the COVID-19 pandemic differed in clinical presentation, psychopathological measures, and treatment outcomes from inpatients hospitalized in the two years before. In the comparison between the two groups, the individuals who began treatment after the start of the pandemic presented with more physical hyperactivity and more severe psychopathological scores in most of the areas investigated, with differences in eating symptoms still evident at discharge. Notably, body-related symptoms (i.e., body shape concerns, body checking, body avoidance) were associated with the pandemic, and also for inpatients with extreme anorexia nervosa. This retrospective analysis does not allow us to separate the impact of COVID-19 from other potentially relevant co-occurring factors; however, these findings help in understanding how the pandemic could have affected individuals that needed specialized intensive treatment.
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Dann KM, Veldre A, Hay P, Touyz S, Andrews S. Assessing cognitive flexibility in anorexia nervosa using eye tracking: A registered report. Int J Eat Disord 2022; 55:1411-1417. [PMID: 35841161 PMCID: PMC9796072 DOI: 10.1002/eat.23779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Cognitive flexibility research in anorexia nervosa (AN) has primarily focused on group differences between clinical and control participants, but research in the general population utilizing the mixed pro- anti-saccade flexibility task has demonstrated individual differences in trait anxiety are a determinant of switching performance, and switching impairments are more pronounced for keypress than saccadic (eye-movement) responses. The aim of the current research is to explore trait anxiety and differences in saccadic and keypress responding as potential determinants of performance on flexibility tasks in AN. METHOD We will compare performance on the mixed pro- anti-saccade paradigm between female adult participants with a current diagnosis of AN and matched control participants, observing both saccadic and keypress responses while controlling for trait anxiety (State - Trait Anxiety Inventory) and spatial working memory (Corsi Block Tapping Test). Associations with eating disorder-related symptoms (Eating Disorder Examination Questionnaire), flexibility in everyday life (Eating Disorder Flexibility Index), and the Clinical Perfectionism Questionnaire will also be assessed. RESULTS Data which controls for individual differences in trait anxiety and assesses flexibility at both the task- and response-set level may be used to more accurately understand differences in performance on cognitive flexibility tasks by participants with AN. DISCUSSION Clarifying the effects of trait anxiety on flexibility, and differences between task- and response-set switching may advance our understanding of how cognitive flexibility relates to flexibility in everyday life and improve translation to therapeutic approaches. PUBLIC SIGNIFICANCE STATEMENT This research will compare performance on a flexibility task between participants with anorexia nervosa (AN) and controls while observing their eye-movements to examine whether trait anxiety and type of response (eye-movement and keypress) are associated with performance. This data may improve our understanding of why participants with AN perform more poorly on cognitive flexibility tasks, and how poor cognitive flexibility relates to eating disorder-related issues with flexibility in everyday life.
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Affiliation(s)
- Kelly M. Dann
- School of PsychologyThe University of SydneySydneyAustralia
| | - Aaron Veldre
- School of PsychologyThe University of SydneySydneyAustralia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of MedicineWestern Sydney UniversitySydneyAustralia
| | - Stephen Touyz
- InsideOut InstituteThe University of SydneySydneyAustralia
| | - Sally Andrews
- School of PsychologyThe University of SydneySydneyAustralia
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Jérolon A, Perduca V, Delsedime N, Abbate-Daga G, Marzola E. Mediation models of anxiety and depression between temperament and drive for thinness and body dissatisfaction in anorexia nervosa. Eat Weight Disord 2022; 27:2569-2581. [PMID: 35460450 PMCID: PMC9556361 DOI: 10.1007/s40519-022-01397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/25/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Anorexia nervosa (AN) is a life-threatening condition in which temperament, anxiety, depression, and core AN body-related psychopathology (drive for thinness, DT, and body dissatisfaction, BD) are intertwined. This relationship has not been to date disentangled; therefore, we performed a multiple mediation analysis aiming to quantify the effect of each component. METHODS An innovative multiple mediation statistical method has been applied to data from 184 inpatients with AN completing: Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Eating Disorders Inventory-2, State-Trait Anxiety Inventory, and Beck Depression Inventory. RESULTS All affective temperaments but the hyperthymic one were involved in the relationship with DT and BD. Only the anxious temperament had a significant unmediated direct effect on DT after the strictest correction for multiple comparisons, while the depressive temperament had a significant direct effect on DT at a less strict significance level. State anxiety was the strongest mediator of the link between affective temperament and core AN body-related psychopathology. Depression showed intermediate results while trait anxiety was not a significant mediator at all. CONCLUSION Affective temperaments had a relevant impact on body-related core components of AN; however, a clear direct effect could be identified only for the anxious and depressive temperaments. Also, state anxiety was the strongest mediator thus entailing interesting implications in clinical practice. LEVEL OF EVIDENCE V, cross-sectional study.
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Affiliation(s)
- Allan Jérolon
- CNRS, MAP5 UMR 8145, Université de Paris, F-75006 Paris, France
| | | | - Nadia Delsedime
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center, Department of Neuroscience, Rita Levi Montalcini”, Hospital “Città della Salute e Della Scienza”, University of Turin, Via Cherasco 11, 10126 Turin, Italy
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