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Oliverio S, Steiger H, St-Hilaire A, Paquin-Hodge C, Leloup AG, Israel M, Thaler L. Barriers and facilitators to providing autonomy supportive counselling to individuals seeking treatment for an eating disorder. Eat Weight Disord 2022; 27:2919-2929. [PMID: 35366169 DOI: 10.1007/s40519-022-01395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Self-determination theory suggests that autonomous motivation for change (i.e., motivation that is internal and self-endorsed) can be enhanced in therapeutic contexts by clinicians acting in an autonomy supportive manner. While previous research has established a link between autonomy support (AS) and autonomous motivation in enhancing outcomes in eating disorder (ED) treatment, few studies have examined factors that support or hinder therapists' ability to be autonomy supportive in the context of an ED therapeutic encounter. The goal of the present study was to conduct a qualitative analysis of personal and contextual factors that facilitated or hindered therapists' ability to provide autonomy supportive interventions. METHODS Semi-structured interviews were conducted with 10 therapists conducting outpatient psychotherapy at a specialized eating disorders treatment program. Data were analyzed using thematic analysis. RESULTS The most frequently noted facilitators were organizational support of AS interventions and patients' engagement and motivation for treatment. The most frequently noted barriers were patients' personality variables such as patients that exhibit passive and help-rejecting behaviours, as well as therapists feeling overwhelmed due to a high workload. CONCLUSION Our results provide insight into the factors that facilitate and impede the utilization of an autonomy supportive approach in specialized ED treatment and can be used to inform future quantitative research on such factors. LEVEL OF EVIDENCE Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Stephanie Oliverio
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada. .,Research Centre, Douglas University Institute, Montreal, Canada.
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada.,Department of Psychology, McGill University, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Anne-Gaëlle Leloup
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Clinique Baca, Montreal, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, Canada
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2
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Thaler L, Paquin-Hodge C, Leloup AG, Wallace A, Oliverio S, Freiwald S, Israel M, Steiger H. Barriers and Facilitators to the Implementation of an Eating Disorders Knowledge Exchange Program for Non-specialist Professionals. J Behav Health Serv Res 2022; 50:365-380. [PMID: 36180648 PMCID: PMC9524729 DOI: 10.1007/s11414-022-09822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
Despite availability of evidence-based treatments for eating disorders (EDs), individuals with EDs often do not receive informed treatment. Training of non-specialized clinicians by experienced professionals through knowledge exchange (KE) programs is an effective way to enhance accessibility to evidence-based treatments for EDs. The authors conducted a qualitative analysis of factors that facilitated or impeded the uptake of an ED-focused KE program. Semi-structured interviews were conducted with mental health professionals (n = 43) and managers (n = 11) at 13 community mental-health sites at which the KE program was offered. Data were analyzed using a qualitative content analysis. Key facilitators identified were management support for the program and building competence through ongoing supervision of clinicians. Main barriers were limited access to ED patients to treat and having insufficient time to apply ED interventions in front-line settings. The results provide insights into the practical imperatives involved in implementing a KE initiative for ED treatment.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada. .,Psychiatry Department, McGill University, Montreal, QC, Canada.
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | | | - Aimée Wallace
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal, QC, Canada
| | - Shiri Freiwald
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal West Island Integrated Health and Social Services Centre, 6603-05 LaSalle BlvdH4H 1R3, QC, Verdun, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada
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3
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Steiger H, Booij L, Crescenzi O, Oliverio S, Singer I, Thaler L, St-Hilaire A, Israel M. In-person versus virtual therapy in outpatient eating-disorder treatment: A COVID-19 inspired study. Int J Eat Disord 2022; 55:145-150. [PMID: 34904742 DOI: 10.1002/eat.23655] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Findings show virtual therapy (conducted using internet-based videoconferencing techniques) to be a viable alternative to in-person therapy for a variety of mental-health problems. COVID-19 social-distancing imperatives required us to substitute virtual interventions for in-person sessions routinely offered in our outpatient eating disorder (ED) program-and afforded us an opportunity to compare the two treatment formats for clinical efficacy. METHODS Using self-report assessments, we compared outcomes in a historical sample of 49 adults with heterogeneous EDs (treated in-person over 10-14 weeks in individual and group therapies) to those of 76 patients receiving comparable virtual treatments, at distance, during the COVID-19 outbreak. Linear mixed models were used to study symptom changes over time and to test for differential effects of treatment modality. RESULTS Participants in both groups showed similar improvements on eating symptoms, levels of weight gain (in individuals in whom gain was indicated), and satisfaction with services. DISCUSSION Our results suggest that short-term clinical outcomes with virtual and in-person ED therapies are comparable, and point to potentials of virtual therapy for situations in which geographical distance or other barriers impede physical access to trained therapists or specialized treatments.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Psychiatry Department, McGill University, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Psychiatry Department, McGill University, Montreal, Québec, Canada.,Department of Psychology, Concordia University, Montreal, Québec, Canada.,Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Québec, Canada
| | - Olivia Crescenzi
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
| | - Ilana Singer
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Psychiatry Department, McGill University, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Psychiatry Department, McGill University, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Institute, Montreal, Québec, Canada.,Psychiatry Department, McGill University, Montreal, Québec, Canada.,Research Centre, Douglas Institute, Montreal, Québec, Canada
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4
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Thaler L, Booij L, Burnham N, Kenny S, Oliverio S, Israel M, Steiger H. Predictors of non-completion of a day treatment program for adults with eating disorders. Eur Eat Disord Rev 2021; 30:146-155. [PMID: 34971014 DOI: 10.1002/erv.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non-completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge-eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating-disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff-initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff-initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi-diagnostic day treatment programs.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Nuala Burnham
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Samantha Kenny
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada
| | - Stephanie Oliverio
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Research Centre, Douglas Institute, Montreal, Quebec, Canada.,Department of Psychology, McGill University, Montreal, Quebec, Canada
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5
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Busoni S, Bock M, Chmelik M, Colgan N, De Bondt T, Hanson LG, Israel M, Kugel H, Maieron M, Mazzoni LN, Seimenis I, Vestergaard P. ADDENDUM to EFOMP Policy statement No.14 "The role of the Medical Physicist in the management of safety within the magnetic resonance imaging environment: EFOMP recommendations". Phys Med 2021; 89:303-305. [PMID: 34492497 DOI: 10.1016/j.ejmp.2021.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- S Busoni
- Medical Physics Department, Firenze University Hospital - AOU Careggi, Firenze, Italy.
| | - M Bock
- Radiology - Medical Physics Dpt., University Medical Center Freiburg, Freiburg, Germany
| | - M Chmelik
- Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - N Colgan
- Galway University Hospital, National University of Ireland Galway, Galway, Ireland
| | - T De Bondt
- Vinçotte - Controlatom, Vilvoorde, Belgium; De Bondt Consulting BV, Antwerp, Belgium
| | - L G Hanson
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark; Section for Magnetic Resonance, DTU Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - M Israel
- Department of Hygiene, Medical Ecology and Professional Diseases, Medical University - Pleven, Bulgaria; Department of Physical Factors, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | - H Kugel
- University Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - M Maieron
- Health Physics Department, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - L N Mazzoni
- Health Physics Unit, AUSL Toscana Centro, Pistoia, Italy
| | - I Seimenis
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - P Vestergaard
- Indkøb & Medicoteknik, Region Midtjylland, Aarhus, Denmark
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Davis K, Tan L, Miller J, Israel M. Seeking Approval: International Higher Education Students' Experiences of Applying for Human Research Ethics Clearance in Australia. J Acad Ethics 2021; 20:421-436. [PMID: 34131418 PMCID: PMC8193590 DOI: 10.1007/s10805-021-09425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/24/2022]
Abstract
University human research ethics application procedures can be complicated and daunting, especially for international students unfamiliar with the process and the language. We conducted focus groups and interviews with four research higher degree and 21 Master’s coursework international students at an Australian university to gain their views on the human ethics application process. We found the most important influences on their experience were: the time it took to do an application; support from supervisors, peers and others; their own language skills; and their lack of familiarity with research ethics procedures. To improve the experience of international students undertaking research involving human research ethics applications, we recommend universities provide guidance on institutional ethics review processes, concepts and terminology, with translations in a range of languages, together with guidance on how to conduct research ethically within and outside the students’ own countries. We also recommend curricula be developed to further students’ understanding of the importance of ethical research practice, and that these curricula be embedded in undergraduate and postgraduate degree programs and reflected in course learning outcomes.
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Affiliation(s)
- K Davis
- School of Education, The University of Adelaide, Adelaide, Australia
| | - L Tan
- School of Education, The University of Adelaide, Adelaide, Australia
| | - J Miller
- School of Education, The University of Adelaide, Adelaide, Australia
| | - M Israel
- Australasian Human Research Ethics Consultancy Services, University of Western Australia, Perth, Australia
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Thaler L, Brassard S, Booij L, Kahan E, McGregor K, Labbe A, Israel M, Steiger H. Methylation of the OXTR gene in women with anorexia nervosa: Relationship to social behavior. Eur Eat Disord Rev 2019; 28:79-86. [PMID: 31823473 DOI: 10.1002/erv.2703] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 11/09/2022]
Abstract
DNA methylation allows for the environmental regulation of gene expression and is believed to link environmental stressors to psychiatric disorder phenotypes, such as anorexia nervosa (AN). The oxytocin receptor (OXTR) gene is epigenetically regulated, and studies have shown associations between OXTR and social behaviours in various samples, including women with AN. The present study examined differential levels of methylation at various CG sites of the OXTR gene in 69 women with active AN (AN-Active), 21 in whom AN was in remission (AN-Rem) and 35 with no eating disorder (NED). Within each group, we explored the correlation between methylation and measures of social behaviour such as insecure attachment and social avoidance. Hypermethylation of a number of CG sites was seen in AN-Active participants as compared with AN-Rem and NED participants. In the AN-Rem sample, methylation at CG27501759 was significantly positively correlated with insecure attachment (r = .614, p = .003, permutation Q = 0.008) and social avoidance (r = .588, p = .005, permutation Q = 0.0184). Our results highlight differential methylation of the OXTR gene among women with AN, those in remission from AN, and those who never had AN and provide some evidence of associations between OXTR methylation and social behaviour in women remitted from AN.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Sarah Brassard
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada
| | - Linda Booij
- Psychology Department, Concordia University, Montreal, Quebec, Canada.,CHU Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada
| | - Kevin McGregor
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Aurelie Labbe
- CHU Sainte-Justine Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada.,Research Centre, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health & Social Service Centre (IUHSSC), Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Psychology Department, McGill University, Montreal, Quebec, Canada
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Paquin Hodge C, Gauvin L, St-Hilaire A, Israel M, Azzi M, Kahan E, Thaler L, Dansereau E, Steiger H. A naturalistic comparison of two inpatient treatment protocols for adults with anorexia nervosa: Does reducing duration of treatment and external controls compromise outcome? Int J Eat Disord 2019; 52:1015-1023. [PMID: 31408212 DOI: 10.1002/eat.23150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Although hospitalization is sometimes necessary when treating individuals with anorexia nervosa, the available literature provides limited guidance to inform decisions surrounding optimal components or duration of inpatient treatments. We report observational data comparing outcomes of two inpatient treatments. The first was longer and more strictly structured around a Contingency Management Protocol (CMP) emphasizing external incentives for achieving weight-restoration goals; the second was a shorter Autonomy Support Protocol (ASP) that progressively increased patient autonomy around meal management without external incentives. METHOD We compared data from 41 patients who participated in the ASP to a historical sample of 41 patients treated using the CMP. At admission, discharge, and post-treatment follow-up, participants completed the Eating Disorder Examination Questionnaire and the Behavior and Symptom Identification Scale-32, and we measured height and weight to compute body mass index. RESULTS Multilevel modeling analyses that controlled for time in treatment and time in follow-up indicated the two protocols yielded equivalent in-treatment gains and post-treatment loss of gains. DISCUSSION Our results indicate that shorter inpatient stays emphasizing autonomous control over eating behavior may yield outcomes that are equivalent to those of lengthier, more stringent, and more costly approaches implicating external incentives and controls.
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Affiliation(s)
- Chloé Paquin Hodge
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Lise Gauvin
- Centre de Recherche du Centre Hospitalier, de l'Université de Montréal and École de santé publique de l'Université de Montréal, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Michelle Azzi
- Psychiatry Department, McGill University, Montreal, Canada.,Psychology Department, McGill University, Montreal, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
| | - Eve Dansereau
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Montreal, Canada.,Psychiatry Department, McGill University, Montreal, Canada.,Research Centre, Douglas University Institute, Montreal
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Sansfaçon J, Fletcher É, Zuroff DC, Schmitz N, Miller A, Israel M, Steiger H. Psychometric properties of the "Autonomous and Controlled Motivation for Treatment Questionnaire" in women with eating disorders. Eur Eat Disord Rev 2018; 27:306-314. [PMID: 30417472 DOI: 10.1002/erv.2656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/26/2018] [Accepted: 10/07/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To validate the Autonomous and Controlled Motivation for Treatment Questionnaire (ACMTQ) for use in women with an eating disorder (ED). METHOD Data were available for 463 individuals. We assessed factor structure, internal reliability, test-retest reliability, convergent/divergent validity, and incremental predictive validity. RESULTS Our data showed acceptable fit to our hypothesized model (comparative fit index = 0.92, root mean square error of approximation = 0.09, standardized root mean square residual = 0.09). We found test-retest reliability of 0.73 for both the autonomous (α = 0.85) and controlled (α = 0.80) subscales. Autonomous scores were more strongly associated with motivation measures (β = 0.37; 0.46) than with ED severity measures (β = -0.10; -0.18). Associations between autonomous motivation and symptom improvement over time supported predictive validity. Controlled motivation was associated with lower motivation (β = 0.02; -0.31) and with higher ED severity (β = 0.12; 0.47). CONCLUSION Our results suggest that the ACMTQ is valid for use in women with EDs and lend support to the validity of findings from previous ED studies that have used the ACMTQ.
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Affiliation(s)
- Jeanne Sansfaçon
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Émilie Fletcher
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - David C Zuroff
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Alexia Miller
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health Institute, Montreal, Quebec, Canada
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10
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Thaler L, Freiwald S, Paquin Hodge C, Fletcher É, Cottier D, Kahan E, Rossi E, Piat M, Lal S, Israel M, Steiger H. A Tertiary-Care/Primary-Care Partnership Aimed at Improving Care for People with Eating Disorders. Community Ment Health J 2018; 54:1154-1161. [PMID: 29948625 DOI: 10.1007/s10597-018-0290-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 06/05/2018] [Indexed: 11/29/2022]
Abstract
We describe the implementation and impact of a province-wide program of knowledge exchange (KE), aimed at developing capacity for the treatment of people with eating disorders (EDs). The program is designed to equip clinicians working in nonspecialized health-care installations with skills to evaluate and treat people with EDs. Trainings were conducted at 21 institutions. The majority of clinicians reported satisfaction with the KE program and indicated that the trainings enhanced their confidence and ability to treat patients with EDs. A subset of clinicians received case supervision with a specialist ED therapist and followed patients with EDs (n = 119). Treated patients showed significant improvements on eating and depressive symptoms, and reported satisfaction with the treatments they received.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada. .,Psychiatry Department, McGill University, Montreal, QC, Canada. .,Eating Disorders Continuum, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Shiri Freiwald
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Chloe Paquin Hodge
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Émilie Fletcher
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Danaelle Cottier
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Erika Rossi
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychology Department, Université du Québec à Montréal, Montreal, QC, Canada
| | - Myra Piat
- Psychiatry Department, McGill University, Montreal, QC, Canada.,Douglas Institute Clinical Activities, Knowledge Transfer and Teaching Directorate, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,School of Social Work, McGill University, Montreal, QC, Canada
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.,PEPP-Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre (IUHSSC), Montreal, QC, Canada.,Psychiatry Department, McGill University, Montreal, QC, Canada.,Psychology Department, McGill University, Montreal, QC, Canada
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Avendaño-Badillo D, Israel M, Luis Guillermo I. Registry of the functioning of patients in the electronic clinical record at the national institute of rehabilitation of Mexico. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Wang X, Wang G, Ramos R, Wang X, Daszczuk P, Mazurek P, Yun K, Israel M, Plikus M, Kobielak K. 1392 Activation of Id2 gene regulatory network ruling quiescence of hair follicle stem cells. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Steiger H, Sansfaçon J, Thaler L, Leonard N, Cottier D, Kahan E, Fletcher E, Rossi E, Israel M, Gauvin L. Autonomy support and autonomous motivation in the outpatient treatment of adults with an eating disorder. Int J Eat Disord 2017; 50:1058-1066. [PMID: 28842966 DOI: 10.1002/eat.22734] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/18/2017] [Accepted: 05/08/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Across diverse clinical problems, therapists' autonomy support has been found to increase patients' autonomous motivation for change. Being self-motivated has, in turn, been linked to superior treatment response. In people undergoing outpatient eating disorder (ED) treatment, we examined associations among ratings of autonomy support received from therapists and other carers, self-reported engagement in therapy, and clinical outcomes. METHOD Ninety-seven women with anorexia nervosa, bulimia nervosa, or a related ED provided measures of motivational status and clinical symptoms at the beginning and end of time-limited (12-16 weeks) segments of specialized treatment. At mid-treatment, patients also rated the extent to which they perceived their individual therapists, group therapists, group-therapy peers, family members, friends, and romantic partners as being autonomy supportive. RESULTS Overall, multiple regression analyses indicated autonomy support to moderate (rather than mediate) the link between initial autonomous motivation and later change in autonomous motivation-with results indicating that, independently of ED diagnosis or treatment intensity, greater perceived autonomy support (from therapists and nontherapists alike) coincided with larger increases in autonomous motivation over the course of therapy. In turn, higher autonomous motivation at end-of-therapy coincided with larger reductions in eating symptoms. DISCUSSION Findings suggest that the experience of autonomy support (from therapists and nontherapists) is associated with increasing motivation in people undergoing ED treatment, and that becoming self-motivated is linked to better outcomes. Such results indicate that support from therapists, relatives, and peers can favorably influence personal engagement in individuals undergoing ED treatment.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Jeanne Sansfaçon
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Niamh Leonard
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Danaëlle Cottier
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Esther Kahan
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Emilie Fletcher
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Erika Rossi
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Continuum, Douglas University Institute, Verdun, Quebec, Canada.,Psychiatry Department, McGill University, Verdun, Quebec, Canada.,Research Centre, Douglas University institute, Verdun, Quebec, Canada
| | - Lise Gauvin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Verdun, Quebec, Canada
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Kobielak K, Wang X, Wang G, Kikulska A, Daszczuk P, Chen Y, Plikus M, Yun K, Israel M, Kandyba E. 879 Molecular network of Smads and Id2 genes in hair follicle stem cells regulation. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Savvidou LG, Fagundo AB, Fernández-Aranda F, Granero R, Claes L, Mallorquí-Baqué N, Verdejo-García A, Steiger H, Israel M, Moragas L, Del Pino-Gutiérrez A, Aymamí N, Gómez-Peña M, Agüera Z, Tolosa-Sola I, La Verde M, Aguglia E, Menchón JM, Jiménez-Murcia S. Is gambling disorder associated with impulsivity traits measured by the UPPS-P and is this association moderated by sex and age? Compr Psychiatry 2017; 72:106-113. [PMID: 27810546 DOI: 10.1016/j.comppsych.2016.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/29/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Impulsivity is a construct that is strongly associated with Gambling Disorder (GD). The main objectives in the present study are: 1) to explore the role of sex and age on impulsivity levels in GD patients; 2) to identify the relationship of the different impulsivity facets with comorbid psychopathology and other personality traits in GD patients; and (3) to assess whether impulsivity is a predictor for the severity of GD. METHOD The final sample consisted of 406 consecutive participants. All of them were seeking treatment for GD (88.4% male and 11.6% female) and completed the South Oaks Gambling Screen (SOGS), the UPPS-P Impulsive Behavior Scale, the Symptom Checklist (SCL-90-R), the Temperament and Character Inventory-R (TCI-R) as well as other clinical and psychopathological measures. RESULTS Results show a negative linear trend between age and lower sensation seeking levels as well as lack of premeditation (the higher the age the lower the UPPS-P scores), and a positive linear trend between age and positive urgency (UR) (the higher the age the higher the UPPS-P score). However, no sex differences were found for the assessed impulsivity dimensions. Lack of perseverance was positively associated with obsessive-compulsive symptoms and harm avoidance trait, and negatively related to persistence and self-directedness traits. Positive UR and negative UR were positively correlated with general psychopathology and the total number of DSM-IV criteria, and negatively associated to the following personality traits: self-directedness and cooperativeness. Finally, only the sensation seeking and negative UR of the UPPS-P showed predictive capacity on the severity of the disorder (the higher the impulsivity scores the higher the illness severity). CONCLUSIONS These findings highlight the association between impulsivity traits (measured by the UPPS-P) and GD in a large and consecutively recruited clinical sample with GD, taking into account the variables sex and age.
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Affiliation(s)
- Lamprini G Savvidou
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Ana B Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain; Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
| | - Laurence Claes
- Department of Psychology, Catholic University of Leuven, Leuven, Belgium
| | - Núria Mallorquí-Baqué
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Antonio Verdejo-García
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia; Institute of Neuroscience F. Oloriz, Universidad de Granada, Granada, Spain and Red de Trastornos Adictivos, Universidad de Granada, Granada, Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada
| | - Laura Moragas
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Amparo Del Pino-Gutiérrez
- Departament d'Infermeria de Salut Pública, Salut Mental i Maternoinfantil, Escola Universitària d'Infermeria, Universitat de Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain
| | - Iris Tolosa-Sola
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Melania La Verde
- University of Catania, Department of Psychiatry. A.O.U. "Policlinico-Vittorio Emanuele, Presidio Gaspare Rodolico", U.O.P.I. of Psychiatry, Catania, Italy
| | - Eugenio Aguglia
- University of Catania, Department of Psychiatry. A.O.U. "Policlinico-Vittorio Emanuele, Presidio Gaspare Rodolico", U.O.P.I. of Psychiatry, Catania, Italy
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain; Ciber Salud Mental (CIBERsam), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain.
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16
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Thaler L, Israel M, Antunes JM, Sarin S, Zuroff DC, Steiger H. An examination of the role of autonomous versus controlled motivation in predicting inpatient treatment outcome for anorexia nervosa. Int J Eat Disord 2016; 49:626-9. [PMID: 26841197 DOI: 10.1002/eat.22510] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We explored the effect of autonomous and controlled motivation on outcomes for patients undergoing inpatient treatment for Anorexia Nervosa (AN). METHOD Data on 80 patients with AN were available for the start of treatment, and for 49 at end of treatment. Patients completed measures of autonomous and controlled motivation, eating disorder symptoms and attitudes, and comorbid psychopathology at the start and end of treatment. RESULTS Patients showed significant improvements on eating symptoms and comorbid psychopathology over the course of treatment. Autonomous motivation was a significant predictor of change in severity of eating symptoms and attitudes such that patients with higher pre-treatment levels of autonomous motivation showed larger post-treatment reductions on these indices. No such effects were associated with controlled motivation. DISCUSSION This study highlights a relationship between autonomous motivation and outcome in an inpatient setting. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:626-629).
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | - Mimi Israel
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada
| | | | | | - David C Zuroff
- Psychology Department, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.,Psychiatry Department, McGill University, Montreal, Quebec, Canada.,Psychology Department, McGill University, Montreal, Quebec, Canada
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17
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Sauchelli S, Jiménez-Murcia S, Sánchez I, Riesco N, Custal N, Fernández-García JC, Garrido-Sánchez L, Tinahones FJ, Steiger H, Israel M, Baños RM, Botella C, de la Torre R, Fernández-Real JM, Ortega FJ, Frühbeck G, Granero R, Tárrega S, Crujeiras AB, Rodríguez A, Estivill X, Beckmann JS, Casanueva FF, Menchón JM, Fernández-Aranda F. Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome. Psychoneuroendocrinology 2016; 65:102-8. [PMID: 26741881 DOI: 10.1016/j.psyneuen.2015.12.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/29/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Orexins/hypocretins are orexigenic peptides implicated in the regulation of feeding behavior and the sleep/wake cycle. Little is known about the functioning of these peptides in anorexia nervosa (AN). The aims of the current study were to evaluate the extent to which orexin-A might be linked to sleep and treatment outcome in AN. METHOD Fasting plasma orexin-A concentrations were measured in 48 females with AN at the start of a day hospital treatment and in 98 normal-eater/healthy-weight controls. The Pittsburgh Sleep Quality Index was administered at the beginning of the treatment as a measure of sleep quality. Other psychopathological variables were evaluated with the Symptom Checklist-Revised (SCL90R) and the Eating Disorder Inventory-2 (EDI). Patients were assessed at the start and end of treatment by means of commonly used diagnostic criteria and clinical questionnaires. RESULTS The AN patients presented more sleep disturbances and poorer overall sleep quality than did the healthy controls (p=.026) but there were no global differences between groups in plasma orexin-A concentrations (p=.071). In the AN sample, orexin-A concentrations were associated with greater sleep disturbances (|r|=.30), sleep inefficiency (|r|=.22) and poorer overall sleep (|r|=.22). Structural Equation Modeling (SEM) showed that both elevated orexin-A concentrations and inadequate sleep predicted poorer treatment outcome. CONCLUSION Plasma orexin-A concentrations contribute to poor sleep quality in AN, and both of these variables are associated with therapy response.
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Affiliation(s)
- Sarah Sauchelli
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nadine Riesco
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Nuria Custal
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Jose C Fernández-García
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Lourdes Garrido-Sánchez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada
| | - Rosa M Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychological, Personality, Evaluation and Treatment of the University of Valencia, Valencia, Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Basic Psychology, Clinic and Psychobiology of the University Jaume I, Castelló, Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health and Experimental Sciences, Universitat Pompeu Fabra Barcelona, Spain
| | - Jose M Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta, Girona, Spain
| | - Francisco J Ortega
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta, Girona, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Salome Tárrega
- Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Ana B Crujeiras
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Medicine, Endocrinology Division, Santiago de Compostela University, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Amaia Rodríguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Xavier Estivill
- Center for Genomic Regulation (CRG), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), ISCIII, Barcelona, Spain
| | | | - Felipe F Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Medicine, Endocrinology Division, Santiago de Compostela University, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), ISCIII, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
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18
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Islam MA, Steiger H, Jimenez-Murcia S, Israel M, Granero R, Agüera Z, Castro R, Sánchez I, Riesco N, Menchón JM, Fernández-Aranda F. Non-suicidal Self-injury in Different Eating Disorder Types: Relevance of Personality Traits and Gender. Eur Eat Disorders Rev 2015; 23:553-60. [DOI: 10.1002/erv.2374] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/12/2015] [Accepted: 05/13/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mohammed A. Islam
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Howard Steiger
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Susana Jimenez-Murcia
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
| | - Mimi Israel
- Douglas University Institute in Mental Health & Psychiatry Department; McGill University; Montreal Canada
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Departament de Psicobiologia i Metodologia; Universitat Autònoma de Barcelona; Spain
| | - Zaida Agüera
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
| | - Rita Castro
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
- Ciber Salud Mental (CIBERSAM); Instituto Salud Carlos III; Barcelona Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL; Barcelona Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN); Instituto Salud Carlos III; Barcelona Spain
- Clinical Sciences Department, School of Medicine; University of Barcelona; Spain
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19
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Israel M, Klein M, Pruessner J, Thaler L, Spilka M, Efanov S, Ouellette AS, Berlim M, Ali N, Beaudry T, Van den Eynde F, Walker CD, Steiger H. n-back task performance and corresponding brain-activation patterns in women with restrictive and bulimic eating-disorder variants: preliminary findings. Psychiatry Res 2015; 232:84-91. [PMID: 25707581 DOI: 10.1016/j.pscychresns.2015.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 09/28/2014] [Accepted: 01/27/2015] [Indexed: 01/08/2023]
Abstract
Eating disorder (ED) variants characterized by "binge-eating/purging" symptoms differ from "restricting-only" variants along diverse clinical dimensions, but few studies have compared people with these different eating-disorder phenotypes on measures of neurocognitive function and brain activation. We tested the performances of 19 women with "restricting-only" eating syndromes and 27 with "binge-eating/purging" variants on a modified n-back task, and used functional magnetic resonance imaging (fMRI) to examine task-induced brain activations in frontal regions of interest. When compared with "binge-eating/purging" participants, "restricting-only" participants showed superior performance. Furthermore, in an intermediate-demand condition, "binge-eating/purging" participants showed significantly less event-related activation than did "restricting-only" participants in a right posterior prefrontal region spanning Brodmann areas 6-8-a region that has been linked to planning of motor responses, working memory for sequential information, and management of uncertainty. Our findings suggest that working memory is poorer in eating-disordered individuals with binge-eating/purging behaviors than in those who solely restrict food intake, and that observed performance differences coincide with interpretable group-based activation differences in a frontal region thought to subserve planning and decision making.
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Affiliation(s)
- Mimi Israel
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada.
| | - Michael Klein
- McGill University, Department of Psychology, Montreal, Quebec, Canada; Montreal Neurological Institute, Cognitive Neuroscience Unit, Montreal, Quebec, Canada
| | - Jens Pruessner
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Michael Spilka
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Simona Efanov
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Anne-Sophie Ouellette
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Marcelo Berlim
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Nida Ali
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Thomas Beaudry
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Frederique Van den Eynde
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Claire-Dominique Walker
- McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
| | - Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; McGill University, Psychiatry Department, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada
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Piat M, Pearson A, Sabetti J, Steiger H, Israel M, Lal S. International training programs on eating disorders for professionals, caregivers, and the general public: A scoping review. J Eat Disord 2015; 3:28. [PMID: 26279836 PMCID: PMC4536892 DOI: 10.1186/s40337-015-0066-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022] Open
Abstract
This review identified and synthesized published training programs on eating disorders (ED) (anorexia nervosa or bulimia nervosa) for professionals, natural supporters of people with ED, or the public. A scoping review using the Arksey and O'Malley (2005) framework was conducted. Four data bases were searched, for all years, and manual searches from three additional sources were also conducted. Experts on ED were consulted for validation of the identified studies. A narrative synthesis was performed. A total of 20 evaluation studies from five countries were identified, and reviewed in relation to 14 ED training programs. Characteristics of the training programs, and study characteristics, were highly diverse, as shown on Table 1 which compiles results from the charted data. Evaluations were equally divided between training for healthcare and education professionals (9), and training for families or other carers of people with ED (10). One study evaluated ED training for the general public. We found that training orientation varies with the interests and needs of different trainee groups. While most studies assessed trainee outcomes, future research needs to give greater consideration to patient perspectives, and to the relationship between training and evaluation approaches, improved knowledge, and better care.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Alexis Pearson
- Douglas Mental Health University Institute, Montreal, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, Canada
| | - Howard Steiger
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Mimi Israel
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Montreal, Québec, H4H 1R3 Canada
| | - Shalini Lal
- École de Réadaptation, Université de Montréal, Montréal, Canada
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Jiménez-Murcia S, Granero R, Moragas L, Steiger H, Israel M, Aymamí N, Gómez-Peña M, Sauchelli S, Agüera Z, Sánchez I, Riesco N, Penelo E, Menchón JM, Fernández-Aranda F. Differences and Similarities Between Bulimia Nervosa, Compulsive Buying and Gambling Disorder. Eur Eat Disorders Rev 2014; 23:111-8. [DOI: 10.1002/erv.2340] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
| | - Roser Granero
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut; Universitat Autònoma de Barcelona; Barcelona Spain
| | - Laura Moragas
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Howard Steiger
- Douglas Mental Health University Institute; Montreal Canada
| | - Mimi Israel
- Douglas Mental Health University Institute; Montreal Canada
| | - Neus Aymamí
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Sarah Sauchelli
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Zaida Agüera
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Isabel Sánchez
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Nadine Riesco
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
| | - Eva Penelo
- Departament de Psicobiologia i Metodologia de les Ciències de la Salut; Universitat Autònoma de Barcelona; Barcelona Spain
| | - José M. Menchón
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber de Salud Mental (CIBERSAM); Instituto Salud Carlos III; Madrid Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry; Bellvitge University Hospital-IDIBELL; Barcelona Spain
- Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN); Instituto de Salud Carlos III; Madrid Spain
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Israel M, Cohen A. Spatial attention across perception and action. J Vis 2014. [DOI: 10.1167/14.10.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Thaler L, Wilson S, Coelho JS, Mazanek Antunes J, Israel M, Steiger H. Mandating weekly weight gain in a day treatment program for eating disorders. Int J Eat Disord 2014; 47:500-6. [PMID: 24431323 DOI: 10.1002/eat.22246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/20/2013] [Accepted: 12/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined differences in treatment outcome associated with a "self-directed"- versus "external-incentive"-based day treatment protocol for individuals with eating disorders (EDs) with below normal body mass index. The self-directed protocol recommended a weekly 500 g weight gain, but allowed participants freedom to gain weight at their own rate; the "external-incentive" protocol required a minimum weight gain of 500 g/week as a requirement for staying in the program. METHOD Weight outcome was available for 49 individuals who were treated with the recommended weight gain protocol, and 40 individuals who were treated with the required weight gain protocol. RESULTS Post-treatment weight was significantly higher in patients treated in the required weight gain protocol compared to those treated in the recommended weight gain protocol. All patients, regardless of which program they completed, showed improvements in the measures of eating-disorder and comorbid-psychiatric symptoms. DISCUSSION This study demonstrated the benefits of an alteration in protocol that required no additional financial or human resources. Further studies are needed to validate the effectiveness of various day treatment protocol parameters.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Psychiatry Department, McGill University, Montreal, Quebec, Canada
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Abstract
There are a variety of definitions for "non-thermal effects" included in different international standards. They start by the simple description that they are "effects of electromagnetic energy on a body that are not heat-related effects", passing through the very general definition related to low-level effects: "biological effects ascribed to exposure to low-level electric, magnetic and electromagnetic fields, i.e. at or below the corresponding dosimetric reference levels in the frequency range covered in this standard (0 Hz-300 GHz)", and going to the concrete definition of "the stimulation of muscles, nerves, or sensory organs, vertigo or phosfenes". Here, we discuss what kind of effect does the non-thermal one has on human body and give data of measurements in different occupations with low-frequency sources of electromagnetic field such as electric power distribution systems, transformers, MRI systems and : video display units (VDUs), whereas thermal effects should not be expected. In some of these workplaces, values above the exposure limits could be found, nevertheless that they are in the term "non-thermal effects" on human body. Examples are workplaces in MRI, also in some power plants. Here, we will not comment on non-thermal effects as a result of RF or microwave exposure because there are not proven evidence about the existance of such effects and mechanisms for them are not clear.
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Affiliation(s)
- M Israel
- National Centre of Public Health and Analysis, Sofia, Bulgaria.
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Groleau P, Joober R, Israel M, Zeramdini N, DeGuzman R, Steiger H. Methylation of the dopamine D2 receptor (DRD2) gene promoter in women with a bulimia-spectrum disorder: associations with borderline personality disorder and exposure to childhood abuse. J Psychiatr Res 2014; 48:121-7. [PMID: 24157248 DOI: 10.1016/j.jpsychires.2013.10.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/04/2013] [Accepted: 10/04/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Previous findings indicate that women with Bulimia Nervosa (BN), when compared to women with no eating disorder (NED), tend to display elevated methylation in the promoter region of the DRD2 gene. The preceding would be compatible with evidence of generally reduced dopamine activity in people with BN. However, altered DNA methylation has also been associated with adverse environmental exposures (such as to childhood abuse) and with psychiatric disturbances (such as Borderline Personality Disorder: BPD). In this study, we examined the extent to which DRD2 methylation was associated with the presence or absence of a bulimic eating disorder, to childhood abuse exposure, or to comorbid BPD. METHOD Women with a bulimia-spectrum disorder (BSD) and women with NED were assessed for childhood traumata, eating-disorder symptoms and BPD, and provided blood samples for methylation analyzes. RESULTS BSD and NED groups did not differ as to mean percent DRD2 promoter methylation. However, among the women with a BSD, those with BPD showed small, but significant increases in DRD2 methylation levels compared to women with NED (as indicated by Hochberg's post-hoc tests). Similarly, women with a BSD who reported a history of childhood sexual abuse showed a trend-level elevation of DRD2 methylation compared to our NED group. DISCUSSION Our findings imply that, in people with a BSD, increased methylation of the DRD2 gene promoter may be more strongly characteristic of comorbid psychopathology than it is a global correlate of the eating disorder per se. We discuss theoretical implications of our findings.
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Affiliation(s)
- Patricia Groleau
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada; Psychology Department, McGill University, Montreal, Quebec, Canada; Research Centre, Douglas University Institute, Montreal, Quebec, Canada.
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Steiger H, Labonté B, Groleau P, Turecki G, Israel M. Methylation of the glucocorticoid receptor gene promoter in bulimic women: associations with borderline personality disorder, suicidality, and exposure to childhood abuse. Int J Eat Disord 2013; 46:246-55. [PMID: 23417893 DOI: 10.1002/eat.22113] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare levels of methylation of the glucocorticoid receptor (GR) gene (NR3C1) promoter between women with bulimia nervosa (BN) and women with no eating disorder (ED), and also to explore, in women with BN, the extent to which methylation of the GR gene promoter corresponds to childhood abuse, suicidality, or borderline personality disorder (BPD). METHOD We measured methylation levels in selected NR3C1 promoter regions using DNA obtained from lymphocytes in 64 women with BN (32 selected as having a history of severe childhood abuse and 32 selected as having no such history) and 32 comparison women with no ED or history of childhood abuse. RESULTS Compared to noneating disordered women, women with BN and comorbid BPD (or BN with a history of suicidality) showed significantly more methylation of specific exon 1C sites. There was also a (nonsignificant) result indicative of greater methylation in some 1C sites among women with BN, when compared (as a group) to women with no ED. No parallel effects owing to childhood abuse were observed. DISCUSSION Our findings associate BN (when accompanied by BPD or suicidality) with hypermethylation of certain GR exon 1C promoter sites. We discuss theoretical and clinical implications of our findings.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute, Quebec, Canada.
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Thaler L, Groleau P, Badawi G, Sycz L, Zeramdini N, Too A, Israel M, Joober R, Bruce KR, Steiger H. Epistatic interactions implicating dopaminergic genes in bulimia nervosa (BN): relationships to eating- and personality-related psychopathology. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:120-8. [PMID: 22683321 DOI: 10.1016/j.pnpbp.2012.05.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/16/2012] [Accepted: 05/26/2012] [Indexed: 10/28/2022]
Abstract
We explored the influence of interactions between polymorphisms acting upon postsynaptic receptors (DRD2 TaqA1 rs1800497 and DRD4 7R) and dopamine regulators (COMT rs4680 and DAT1) on the expression of eating symptoms and personality traits in women with bulimia-spectrum eating disorders. We had 269 bulimic women provide blood for genetic assays, and measured eating-disorder symptoms and psychopathological traits using structured interviews and self-report questionnaires. We observed two epistatic interactions on symptom indices: interactions (in predicted directions) of DRD2 by DAT were seen on Body Mass Index (p=.023), and of DRD4 by COMT on self-harming behaviors (p=.014)--with genetic effects that would correspond to reduced dopamine transmission coinciding with more-pathological scores. Our findings suggest that genes acting in the dopamine system interact to influence both eating-related and personality psychopathology, with the result that lower levels of dopamine neuro-transmission correspond to increased psychopathology and body mass in women with bulimia-spectrum disorders. We discuss the implications of our observations.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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Groleau P, Steiger H, Joober R, Bruce KR, Israel M, Badawi G, Zeramdini N, Sycz L. Dopamine-system genes, childhood abuse, and clinical manifestations in women with Bulimia-Spectrum Disorders. J Psychiatr Res 2012; 46:1139-45. [PMID: 22733030 DOI: 10.1016/j.jpsychires.2012.05.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We explored interaction effects involving polymorphisms of targeted dopamine system genes and selected forms of childhood abuse (sexual, physical and emotional) acting upon severity of binge-eating and psychopathological symptoms in women with Bulimia-Spectrum Disorders (BSDs). METHODS Women diagnosed with a BSD (n = 216) were assessed for childhood traumata, eating-disorder (ED) symptoms, and selected psychopathological features (sensation seeking, impulsivity, compulsivity and affective instability), and then provided blood samples for genotyping of main polymorphisms of dopamine-2 receptor (DRD2), dopamine transporter (DAT1) and catechol o-methyltransferase (COMT) genes. RESULTS Sensation Seeking was elevated in carriers of the low-function allele of the DRD2 Taq1A polymorphism who also reported childhood sexual abuse, relative to that in individuals showing other combinations of alleles and abuse exposures. In addition, carriers of a low-function allele of COMT scored higher on compulsivity, lower on impulsivity, and marginally lower on frequency of binge-eating than did individuals in whom the allele was absent. DISCUSSION Our results suggest that genes acting within the dopamine system may contribute, either directly or indirectly (i.e., in interaction with traumatic childhood experiences), to variations in the presentation of comorbid traits and, possibly, of bulimic symptoms.
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Affiliation(s)
- Patricia Groleau
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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Nguyen TV, McCracken J, Ducharme S, Botteron KN, Mahabir M, Johnson W, Israel M, Evans AC, Karama S. Testosterone-related cortical maturation across childhood and adolescence. Cereb Cortex 2012; 23:1424-32. [PMID: 22617851 DOI: 10.1093/cercor/bhs125] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuroendocrine theories of brain development hold testosterone as the predominant factor mediating sex-specific cortical growth and the ensuing lateralization of hemispheric function. However, studies to date have focussed on prenatal testosterone rather than pubertal changes in testosterone. Yet, animal studies have shown a high density of androgen-sensitive receptors in multiple key cortical areas, and puberty is known to coincide with both a significant rise in testosterone and the emergence of behavioral sex differences, suggesting peripubertal influences of testosterone on brain development. Here, we used linear mixed models to examine sex-specific cortical maturation associated with changes in testosterone levels in a longitudinal sample of developmentally healthy children and adolescents. A significant "sex by age by testosterone" interaction on cortical thickness (CTh) involving widespread areas of the developing brain was found. Testosterone levels were associated with CTh changes in regions of the left hemisphere in males and of the right hemisphere in females. In both sexes, the relationship between testosterone and CTh varied across the age span. These findings show the association between testosterone and CTh to be complex, highly dynamic, and to vary, depending on sex and age; they also suggest sex-related hemispheric lateralization effects of testosterone in humans.
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Affiliation(s)
- Tuong-Vi Nguyen
- McConnell Brain Imaging Center, Montreal Neurological Institute, Montreal, Québec, Canada H3A 2B4
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Groleau P, Steiger H, Bruce K, Israel M, Sycz L, Ouellette AS, Badawi G. Childhood emotional abuse and eating symptoms in bulimic disorders: an examination of possible mediating variables. Int J Eat Disord 2012; 45:326-32. [PMID: 21656539 DOI: 10.1002/eat.20939] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We sought to estimate prevalences of childhood emotional abuse (CEA) in bulimic and normal-eater control groups, and to replicate previous findings linking CEA to severity of eating symptoms in BN. We also examined potential mediators of the link between CEA and disordered eating. METHOD Women diagnosed with a bulimic disorder (n = 176) and normal-eater women (n = 139) were assessed for childhood traumata, eating-disorder (ED) symptoms and psychopathological characteristics (ineffectiveness, perfectionism, depression, and affective instability) thought to be potential mediators of interest. RESULTS CEA was more prevalent in the bulimic than in the nonbulimic group, and predicted severity of some eating-symptom indices. Ineffectiveness and affective instability both mediated relationships between CEA and selected ED symptoms. DISCUSSION We found CEA to predict eating pathology through mediating effects of ineffectiveness and affective instability. CEA might influence severity of ED symptoms by impacting an individual's self-esteem and capacity for affect regulation.
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Affiliation(s)
- Patricia Groleau
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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Steiger H, Gauvin L, Joober R, Israel M, Badawi G, Groleau P, Bruce KR, Yin Kin NMKN, Sycz L, Ouelette AS. Interaction of the BcII glucocorticoid receptor polymorphism and childhood abuse in Bulimia Nervosa (BN): relationship to BN and to associated trait manifestations. J Psychiatr Res 2012; 46:152-8. [PMID: 22088926 DOI: 10.1016/j.jpsychires.2011.10.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 10/13/2011] [Accepted: 10/13/2011] [Indexed: 01/09/2023]
Abstract
We recently documented a gene-environment interaction suggesting that individuals with Bulimia Nervosa (BN) differed from normal eaters as to the combined presence of the low-function allele of the glucocorticoid receptor polymorphism, BcII, and childhood abuse. The present study examined the extent to which any such interaction effect may have been attributable to behavioral impulsivity, sensation seeking, affective instability or depression. We had 174 bulimic and 130 nonbulimic women provide blood for genetic assays, and measured psychopathological traits and childhood abuse using structured interviews and self-report questionnaires. As expected, we observed a significant BcII × abuse interaction indicating genetic and environmental susceptibilities to co-occur significantly more often in bulimic than in nonbulimic individuals. The BcII × abuse interaction was attenuated when levels of depression were accounted for, but was surprisingly unaffected by controls for motoric impulsivity, sensation seeking or affective instability. Our findings suggest that stress-induced alterations in glucocorticoid sensitivity contribute to BN and depressive disturbances--without being associated with the behavioral/affective dysregulation seen in many BN sufferers. We discuss theoretical and clinical implications of these observations.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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Jiménez-Murcia S, Bove FI, Israel M, Steiger H, Fernández-Aranda F, Alvarez-Moya E, Granero R, Penelo E, Vergé B, Aymamí MN, Santamaría JJ, Gómez-Peña M, Moragas L, Savvidou LG, Menchón JM. Cognitive-behavioral therapy for pathological gambling in Parkinson's disease: a pilot controlled study. Eur Addict Res 2012; 18:265-74. [PMID: 22760081 DOI: 10.1159/000337442] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 02/06/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The main objective of this study was to compare the clinical characteristics and differences in response to treatment of two groups of pathological gamblers: with comorbid Parkinson's disease (PG + PD) and without (PG - PD). METHODS Clinical and psychopathological profiles and response to cognitive-behavioral treatment were assessed in 15 PG + PD and 45 PG - PD individuals consulting a specialized hospital Unit. RESULTS Statistically significant differences were observed between the two groups on a series of clinical variables. PG + PD patients were older and presented later onset of problematic gambling behaviors, lower alcohol consumption and higher bingo playing than PG - PD patients. No significant differences were noted in psychopathology except for lower measures of hostility in the PG + PD group. No statistical differences were detected between groups in terms of response to treatment. CONCLUSION These results may provide guidance for obtaining accurate diagnostic information in pathological gamblers by properly identifying patients with specific needs that may be targeted with treatment.
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Affiliation(s)
- Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
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Van den Eynde F, Suda M, Broadbent H, Guillaume S, Van den Eynde M, Steiger H, Israel M, Berlim M, Giampietro V, Simmons A, Treasure J, Campbell I, Schmidt U. Structural magnetic resonance imaging in eating disorders: a systematic review of voxel-based morphometry studies. Eur Eat Disord Rev 2011; 20:94-105. [PMID: 22052722 DOI: 10.1002/erv.1163] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/22/2011] [Accepted: 09/25/2011] [Indexed: 12/23/2022]
Abstract
This systematic review summarises and critically appraises the literature on structural magnetic resonance imaging in people with a current or past eating disorder. Studies using voxel-based morphometry image analysis were included. Ten studies reported on a total of 236 people with a current or past eating disorder and 257 healthy controls. Sample heterogeneity prohibited a meta-analytic approach. The findings do not unequivocally indicate grey or white matter volume abnormalities in people with an eating disorder. Nevertheless, these preliminary data suggest that, compared with healthy controls, people with anorexia nervosa have decreased grey matter in a range of brain regions and that those with bulimia nervosa have increased grey matter volumes in frontal and ventral striatal areas. Research in the recovery phase and longitudinal studies suggest that potential brain tissue abnormalities may recover with clinical improvement. Overall, as the available data are inconclusive, further efforts in this field are warranted.
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Affiliation(s)
- Frederique Van den Eynde
- King's College London, Institute of Psychiatry, Department of Psychological Medicine, Section of Eating Disorders, London, UK.
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Bruce KR, Steiger H, Israel M, Kin NMKNY, Hakim J, Schwartz D, Richardson J, Mansour SA. Effects of acute alcohol intoxication on eating-related urges among women with bulimia nervosa. Int J Eat Disord 2011; 44:333-9. [PMID: 21472752 DOI: 10.1002/eat.20834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the effects of acute alcohol intoxication on eating-related urges among women with bulimia nervosa (BN). METHOD Participants included women with BN or normal-weight eating disorder NOS with regular binge/purge symptoms (N = 13), and normal-eater control women (N = 17). Tested individually, the women reported on their mood state as well as on urges to binge eat and engage in various compensatory behaviors, prior to consuming alcohol, and again at 60 and 180 min following the consumption of 1.0 ml kg(-1) alcohol. RESULTS Both groups reported feeling less clearheaded after drinking, as well as initial subjective mood stimulation followed by subsequent mood lowering. In addition, BN participants reported reductions in their urges to binge eat, exercise compulsively, and restrict food intake following alcohol consumption-the urge to purge was not significantly affected. DISCUSSION Among women with BN, alcohol consumption appeared to reduce select eating-related urges with concomitant reductions in attention or concentration.
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Affiliation(s)
- Kenneth R Bruce
- Eating Disorders Program, Douglas Institute, Montreal, Quebec, Canada; Research Centre, Douglas Institute, Montreal, Quebec, Canada.
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Israel M, Döbbel S, Joraschky P, Pöhlmann K. Interpersonelle Problembelastung bei Sozialer Phobie vs. Agoraphobie. Psychother Psychosom Med Psychol 2011. [DOI: 10.1055/s-0031-1272391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE In participants with eating disorders (EDs), prior physical or sexual abuse has been associated with increased likelihood of impulsivity and affective instability. However, previous studies among participants with eating disorders have not systematically explored relationships between empirically derived, personality-trait-based classes, on the one hand, and likelihood of exposure to either childhood sexual or physical abuse, on the other. METHOD We assessed multiple psychopathological traits, eating symptoms, and history of abuse in 185 women with an ED and 93 with no ED. RESULTS A latent class analysis, conducted using psychopathological-trait measures, yielded latent classes of participants with eating disorders fitting the descriptors "dissocial/impulsive," "inhibited/compulsive," and "low psychopathology." ED was generally associated with increased risk of childhood sexual abuse, but the dissocial/impulsive characteristic corresponded with a unique likelihood of physical abuse and especially high rates of sexual abuse. DISCUSSION Observed associations between different forms of childhood abuse and trait-defined ED variants help inform models on the development of eating disorders and of psychopathological traits that often accompany them.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute, Montreal, Quebec, Canada.
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Steiger H, Richardson J, Schmitz N, Joober R, Israel M, Bruce KR, Gauvin L, Dandurand C, Anestin A. Association of trait-defined, eating-disorder sub-phenotypes with (biallelic and triallelic) 5HTTLPR variations. J Psychiatr Res 2009; 43:1086-94. [PMID: 19383563 DOI: 10.1016/j.jpsychires.2009.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/12/2009] [Accepted: 03/17/2009] [Indexed: 12/16/2022]
Abstract
CONTEXT Efforts to classify eating-disordered individuals based on concurrent personality traits have consistently converged on a typology encompassing "over-regulated", "dysregulated", and "low psychopathology" subgroups. In various populations, evidence has associated personality variations of an "over-regulated/dysregulated" type with differences on serotonin-system indices, and specifically, with different loadings of serotonin transporter promoter regulatory region polymorphism (5HTTLPR) genotypes and alleles. We explored the extent to which an empirical, trait-defined typology of eating-disordered individuals coincided systematically with variations in 5HTTLPR, assayed using biallelic and triallelic models. METHOD We tested 185 women with a DSM-IV eating disorder (108 with Bulimia Nervosa, 17 Anorexia Nervosa, and 60 an Eating Disorder Not Otherwise Specified) and 93 with no eating disorder on measures reflecting psychopathological traits and 5HTTLPR (biallelic and triallelic) genotypes and alleles. RESULTS The highest-function, triallelic (L(A)/L(A)) genotype occurred significantly more frequently among eating-disordered individuals than among controls. However, a more fine-grained analysis suggested that this association was attributable to the fact that, among eating-disordered participants, those displaying an "Inhibited/Compulsive" profile (derived using latent class analysis) were more likely than those of a "Dissocial/Impulsive" or a "Low Psychopathology" group to carry the triallelic 5HTTLPR gain-of-function L(A) allele and to be L(A)/L(A) homozygotes. DISCUSSION This study's empirically derived classes coincide with interpretable differences on genetic indices-associating an "Inhibited/Compulsive" group with 5HTTLPR gain-of-function genotypes (and alleles) that have elsewhere been linked to trait compulsivity. The findings, furthermore, suggest that 5HTTLPR, by influencing personality-trait manifestations may, in turn, influence eating-disorder risk and symptom expression.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas University Institute in Mental Health, Quebec, Canada.
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Pöhlmann K, Eismann E, Döbbel S, Israel M, Joraschky P. Wie wirksam ist stationäre Psychotherapie bei der Behandlung sozialer Ängste? Aktuelle Ergebnisse und zukünftige Herausforderungen. Psychother Psychosom Med Psychol 2009. [DOI: 10.1055/s-0029-1208228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Steiger H, Joober R, Gauvin L, Bruce KR, Richardson J, Israel M, Anestin AS, Groleau P. Serotonin-system polymorphisms (5-HTTLPR and -1438G/A) and responses of patients with bulimic syndromes to multimodal treatments. J Clin Psychiatry 2008; 69:1565-71. [PMID: 19192439 DOI: 10.4088/jcp.v69n1006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 02/22/2008] [Indexed: 10/20/2022]
Abstract
BACKGROUND We tested the hypothesis that individuals carrying low-function alleles of the serotonin transporter (5-HTTLPR) and 5-HT(2A) receptor gene (-1438G/A) promoter polymorphisms would show relatively poor treatment responses on indices of bulimic and concurrent symptoms. METHOD Participants included 111 women with bulimia-spectrum eating disorders (DSM-IV-TR criteria), 98 of whom were followed through 4- to 8-month spans of specialized multimodal treatment to enable examination of relationships between genotypes and prospective changes in eating and general psychiatric symptoms. Given a hierarchically structured dataset and a desire to control for effects of variations in adjunctive pharmacotherapy, individual therapy, group therapy, or day treatment, we used multilevel modeling techniques. The study was conducted between October 2001 and May 2007. RESULTS After effects of treatments were removed, 5-HTTLPR low-function allele carriers showed smaller treatment reductions in binge eating (p < .01) and in anxiety and depression (p < .05), whereas low-function -1438G/A G carriers showed smaller reductions in binge eating (p < .01) and impulsivity (p < .05). CONCLUSIONS This study documents an expected association between poorer bulimia-treatment response and low-function alleles of 5-HTTLPR and -1438G/A--and suggests that such effects cannot be attributed to mediating influences of medication or psychotherapy responsiveness alone. A better understanding of hereditary, serotonin-mediated factors affecting bulimic individuals' progress during therapy may facilitate the development of more effective treatments.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, Quebec, Canada H4H 1R3.
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Richardson J, Steiger H, Schmitz N, Joober R, Bruce KR, Israel M, Gauvin L, Anestin AS, Dandurand C, Howard H, de Guzman R. Relevance of the 5-HTTLPR polymorphism and childhood abuse to increased psychiatric comorbidity in women with bulimia-spectrum disorders. J Clin Psychiatry 2008; 69:981-90. [PMID: 18505306 DOI: 10.4088/jcp.v69n0615] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Individuals with bulimia nervosa have been shown to display heterogeneous profiles of comorbid psychiatric disturbance, possibly due to varying degrees of genetic and environmental vulnerability. Using information about comorbid psychiatric disturbances, we developed an empirically based classification of individuals with bulimia-spectrum disorders, and then explored whether or not the resulting phenotypes corresponded to variations in the serotonin transporter promoter polymorphism (5-HTTLPR) and exposure to childhood abuse. METHOD Eighty-nine women aged 17 to 49 years with DSM-IV bulimia-spectrum disorders completed questionnaires assessing eating and general psychopathologic symptoms, participated in interviews assessing Axis I disorders and childhood abuse, and provided blood samples for genotyping. Data on lifetime Axis I disorders were analyzed using latent class analysis, and resulting classes were compared on eating and psychopathologic symptoms, 5-HTTLPR genotype, and childhood abuse. The study was conducted from June 2002 to October 2006. RESULTS The analysis yielded a model with 2 classes: a first class labeled low comorbidity (N = 59, 66%), characterized by a high likelihood of major depressive disorder, and another class labeled high comorbidity (N = 30, 34%), characterized by a high likelihood of major depressive disorder, anxiety disorder, and substance-use disorders. The high-comorbidity class displayed significantly higher dieting preoccupations and conduct problems, and showed a greater likelihood of carrying the 5-HTTLPR S allele and of childhood abuse than did the low-comorbidity class. CONCLUSIONS The present results are consistent with previous findings identifying a subgroup of individuals with bulimia characterized by high psychiatric comorbidity and suggest that the 5-HTTLPR polymorphism and childhood trauma may both be pertinent to explaining the presence of greater psychiatric comorbidity in bulimia-spectrum disorders.
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Affiliation(s)
- Jodie Richardson
- Eating Disorders Program, Douglas Mental Health University Institute, Montreal, Quebec, Canada.
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Pöhlmann K, Altmann U, Butter A, Israel M, Keller A, Schellong J, Simmich T, Petrowski K, Joraschky P. Differenzielle Therapieverläufe in der stationären Psychotherapie: Eine störungsübergreifende Differenzierung von Verlaufstypen. Psychother Psychosom Med Psychol 2008. [DOI: 10.1055/s-2008-1061574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Döbbel S, Israel M, Pöhlmann K, Joraschky P. Interpersonale Probleme bei Sozialer Phobie und Agoraphobie: Veränderung störungsspezifischer Muster im Therapieverlauf. Psychother Psych Med 2008. [DOI: 10.1055/s-2008-1061509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Israel M, Döbbel C, Schönberg C, Herbst K, Pöhlmann K, Joraschky P. Stationäre Psychotherapie von sozialen Ängsten–Wirksamkeit und Prognose unter Berücksichtigung des Selbstwerts. Psychother Psych Med 2008. [DOI: 10.1055/s-2008-1061510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Steiger H, Richardson J, Joober R, Israel M, Bruce KR, Ng Ying Kin NMK, Howard H, Anestin A, Dandurand C, Gauvin L. Dissocial behavior, the 5HTTLPR polymorphism, and maltreatment in women with bulimic syndromes. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:128-30. [PMID: 17722012 DOI: 10.1002/ajmg.b.30579] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We recently reported that, among bulimic women, previously abused carriers of the 5HTTLPR S allele showed special propensities towards novelty seeking (implying recklessness or impulsivity) and interpersonal insecurity. We subsequently re-analyzed our data, to examine the bearing of the 5HTTLPR polymorphism and prior sexual or physical maltreatment upon validated, higher-order personality-traits. Ninety women with bulimic syndromes were genotyped for 5HTTLPR "short" (S) and "long" (L(G) and L(A)) alleles, and then assessed for eating symptoms, history of sexual or physical abuse, and the higher-order personality traits Emotional Dysregulation, Dissocial Behavior, Inhibition, and Compulsivity. With a classification based on a biallelic model of 5HTTLPR (i.e., presence or absence of at least one S-allele copy), multiple regression indicated a significant proportion of variance in Dissocial Behavior to be explained by an abuse x genotype interaction-greater psychopathology occurring in abused S-allele carriers. A parallel analysis applying a triallelic model of 5HTTLPR (i.e., presence or absence of at least one copy of presumably low-function S or L(G) alleles) produced a similar pattern, but no statistically significant effect. The finding that bulimic 5HTTLPR S-allele carriers who are previously abused display elevations on Dissocial Behavior corroborates previous observations concerning phenomenological correlates of traumatic stress in 5HTTLPR S allele carriers. (c) 2007 Wiley-Liss, Inc.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Institute, Montreal, Quebec, Canada.
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Steiger H, Richardson J, Joober R, Gauvin L, Israel M, Bruce KR, Ying Kin NMKN, Howard H, Young SN. The 5HTTLPR polymorphism, prior maltreatment and dramatic-erratic personality manifestations in women with bulimic syndromes. J Psychiatry Neurosci 2007; 32:354-62. [PMID: 17823651 PMCID: PMC1963352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Low-function alleles of the serotonin transporter promoter polymorphism (5HTTLPR) have been linked to various psychopathological entities, especially in individuals exposed to prior stressors. In women with bulimic syndromes, we explored associations with personality pathology of 5HTTLPR and prior sexual or physical maltreatment. METHODS Ninety-two women with bulimic syndromes were genotyped for 5HTTLPR short (S) and long (L(G) and L(A)) alleles and were then assessed for eating symptoms, dimensional personality disturbances, history of sexual or physical abuse and borderline personality disorder (BPD). RESULTS With a classification based on a biallelic model of 5HTTLPR (i.e., presence or absence of at least 1 S-allele copy), multiple regression analyses indicated significant proportions of variance in stimulus seeking and insecure attachment to be explained by abuse x genotype interaction effects, with greater psychopathology always occurring in S-allele carriers who had been abused. Likewise, a logistic regression analysis linked BPD to significant main effects of genotype and abuse. Analyses that aggregated carriers according to a triallelic model of 5HTTLPR (i.e., presence or absence of at least 1 copy of a presumably low-function S or LG allele) produced similar patterns but no statistically significant effects. CONCLUSIONS Traits such as sensation seeking and insecure attachment are, on average, elevated in 5HTTLPR S-allele carriers with bulimic syndromes who report prior physical or sexual maltreatment. These results add to the literature associating pronounced psychopathological manifestations, with conjoint effects of stress and the 5HTTLPR polymorphism.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Hospital, 6875 LaSalle Blvd., Montréal QC H4H 1R3, Canada.
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Herbst K, Israel M, Keller A, Schellong J, Simmich T, Petrowski K, Joraschky P, Pöhlmann K. Wirksamkeit stationärer Psychotherapie und Stabilität der Behandlungsergebnisse bei acht verschiedenen Störungsbildern. Psychother Psych Med 2007. [DOI: 10.1055/s-2007-970653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Israel M, Pöhlmann K, Schönberg C, Herbst K, Herbst K, Döbbel S, Joraschky P. Stationäre Psychotherapie bei Patienten mit sozialen Ängsten – Therapieverlauf und Stabilität der Behandlungsergebnisse. Psychother Psych Med 2007. [DOI: 10.1055/s-2007-970657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Steiger H, Gauvin L, Joober R, Israel M, Ng Ying Kin NMK, Bruce KR, Richardson J, Young SN, Hakim J. Intrafamilial correspondences on platelet [3H-]paroxetine-binding indices in bulimic probands and their unaffected first-degree relatives. Neuropsychopharmacology 2006; 31:1785-92. [PMID: 16407896 DOI: 10.1038/sj.npp.1301011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Reduced brain serotonin (5-hydroxytryptamine: 5-HT) transporter activity has been associated with susceptibility to various forms of psychopathology, including bulimia nervosa (BN) and related syndromes characterized by appetitive or behavioural dysregulation. We applied density (Bmax) of platelet [3H-]paroxetine binding as a proxy for central 5-HT reuptake activity in two groups of women (33 with BN-spectrum disorders and 19 with no apparent eating or psychiatric disorders), most of these individuals' mothers (31 and 18, respectively), and a small sampling of their sisters (seven and eight, respectively). Hierarchical linear modeling techniques were used to account for nesting of individuals within families and diagnostic groupings. Bulimic probands, their mothers, and their sisters all displayed significantly lower density (Bmax) of platelet-paroxetine binding than did 'control' probands, mothers, or sisters-even when relatives showing apparent eating or psychiatric disturbances were excluded. In addition, in bulimic probands and mothers, significant within-family correlations were obtained on Bmax. These findings imply a heritable trait (or endophenotype), linked to 5-HT activity, and carried by BN sufferers and their first-degree relatives (even when asymptomatic). We propose that, under conducive circumstances, such a trait may increase risk of binge-eating behavior, or associated symptoms of affective or behavioral dysregulation.
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Affiliation(s)
- Howard Steiger
- Eating Disorders Program, Douglas Hospital, Montreal, QC, Canada.
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Bruce KR, Steiger H, Ng Ying Kin NMK, Israel M. Reduced platelet [3H]paroxetine binding in anorexia nervosa: relationship to eating symptoms and personality pathology. Psychiatry Res 2006; 142:225-32. [PMID: 16697471 DOI: 10.1016/j.psychres.2005.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2005] [Revised: 07/19/2005] [Accepted: 08/03/2005] [Indexed: 10/24/2022]
Abstract
Alterations in serotonin function have been implicated in both anorexia and bulimia nervosa, and previous studies suggest associations between serotonin function and variations in pathological personality traits. Women meeting DSM-IV criteria for anorexia nervosa (AN, 16 with the restricting subtype and 14 with the binge-purge subtype) and 49 healthy control women (CW) provided blood samples for analyses of platelet [(3)H]paroxetine binding. Participants also filled out questionnaires tapping eating disorder symptoms, depression, and personality pathology. Compared with CW, women with restricting and binge-purge AN had significantly lower levels of paroxetine binding (respectively: 1012 + 487 vs. 560 + 253 vs. 618 + 217 fmol/mg protein). Simple correlation analyses showed that, within AN but not within controls, paroxetine binding was inversely related to dieting preoccupations, affective instability, anxiousness, compulsivity, restricted expression and social avoidance but independent of age, body mass index, depression, and other eating symptoms. Findings suggest that reduced peripheral serotonin transporter density in AN relates to increased dieting preoccupations, affective instability and anxiousness-fearfulness.
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Affiliation(s)
- Kenneth R Bruce
- Eating Disorders Program, Douglas Hospital, Montreal, Quebec, Canada.
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Schönberg C, Pöhlmann K, Döbbel S, Joraschky P, Israel M. Die Veränderung des Selbstkonzepts von Sozialphobikern im Verlauf stationärer Psychotherapie. Psychother Psych Med 2006. [DOI: 10.1055/s-2006-934306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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