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Maguire S, Kesby A, Brownlow R, Hunt GE, Kim M, McAulay C, Grisham JR, McGregor IS, Suraev A, Kevin RC, Russell J. A phase II randomised controlled trial of intranasal oxytocin in anorexia nervosa. Psychoneuroendocrinology 2024; 164:107032. [PMID: 38520886 DOI: 10.1016/j.psyneuen.2024.107032] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is an eating disorder (ED) with high mortality rates and limited response to existing treatments, prompting the need to identify effective agents and adjuncts. There is evidence for an emerging role for the neuropeptide oxytocin (OT) in the pathophysiology of AN, with studies showing a perturbed oxytocinergic system in patients with AN. Preliminary evidence has demonstrated that intranasal OT (IN-OT) can produce anxiolytic effects in AN, as well as reducing concern about eating, and dysfunctional attentional biases related to the disorder. IN-OT is a non-invasive treatment option for AN that requires investigation as an adjunct to nutritional rehabilitation. METHODS This multi-site study (Trial Registration:ACTRN1261000897460) sought to replicate and extend a previous randomised placebo-controlled pilot trial of repeated dose IN-OT in patients with AN hospitalised for nutritional rehabilitation. Patients with AN (N=61) received daily IN-OT (18 IU twice per day) or placebo for four weeks, whilst undergoing inpatient hospital treatment. Outcome measures included ED psychopathology (primary) as measured by the Eating Disorder Examination (EDE) and Body Mass Index (BMI; secondary). Participants were assessed pre- and post-treatment, and at six months following the intervention. The effects of the first and last doses of IN-OT on responses (anxiety ratings and salivary cortisol) to a high-energy snack were also examined. RESULTS Sixty-one female inpatients (Mage=24.36,SD=7.87) with an average BMI of 16.24 (range: 11.43-18.55), were recruited into the study. No significant differences were found between placebo and OT groups at any of the time points on the outcomes of interest, but significant improvements in almost all psychological parameters in both groups were evident over time. IN-OT did not significantly reduce anxiety nor salivary cortisol in response to a high-calorie snack. CONCLUSION This is the largest randomised placebo-controlled trial of repeated dose intranasal OT in people with AN, during refeeding. The therapeutically promising findings of the pilot study were not replicated. Limitations and reasons for the non-replication included relatively large variance, baseline psychopathology scores being higher in this patient group, potential ceiling effects in BMI and ED psychopathology as well as differing comorbidities.
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Affiliation(s)
- Sarah Maguire
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia.
| | - Alice Kesby
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia.
| | - Rachel Brownlow
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Glenn E Hunt
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia
| | - Marcellinus Kim
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Claire McAulay
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Jessica R Grisham
- UNSW Sydney, Faculty of Science, School of Psychology, Anzac Parade, Randwick, NSW 2031, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Anastasia Suraev
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Richard C Kevin
- Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Janice Russell
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Hemmings A, Gallop L, İnce B, Cutinha D, Kan C, Simic M, Zadeh E, Malvisi I, McKenzie K, Zocek L, Sharpe H, O'Daly O, Campbell IC, Schmidt U. A randomised controlled feasibility trial of intermittent theta burst stimulation with an open longer-term follow-up for young people with persistent anorexia nervosa (RaISE): Study protocol. Eur Eat Disord Rev 2024; 32:575-588. [PMID: 38303559 DOI: 10.1002/erv.3073] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE We present the protocol of a feasibility randomised controlled trial (RCT) of intermittent theta burst stimulation (iTBS) for young people with anorexia nervosa (AN). Effective first-line psychological therapies exist for young people with AN, but little is known about how to treat those who do not respond. Non-invasive neuromodulation, such as iTBS, could address unmet treatment needs by targeting neurocircuitry associated with the development and/or maintenance of AN. DESIGN Sixty-six young people (aged 13-30 years) with persistent AN will be randomly allocated to receive 20 sessions of real or sham iTBS over the left dorsolateral prefrontal cortex in addition to their usual treatment. Outcomes will be measured at baseline, post-treatment (1-month post-randomisation) and 4-months post-randomisation (when unblinding will occur). Additional open follow-ups will be conducted at 12- and 24-months post-randomisation. The primary feasibility outcome is the proportion of participants retained in the study at 4-months. Secondary outcomes include AN symptomatology, other psychopathology, quality of life, service utilisation, neurocognitive processes, and neuroimaging measures. DISCUSSION Findings will inform the development of a future large-scale RCT. They will also provide exploratory data on treatment efficacy, and neural and neurocognitive predictors and correlates of treatment response to iTBS in AN.
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Affiliation(s)
- Amelia Hemmings
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Lucy Gallop
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Başak İnce
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Darren Cutinha
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Carol Kan
- Central and North West London NHS Foundation Trust, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewa Zadeh
- South West London and St Georges Mental Health NHS Trust, London, UK
| | | | | | | | - Helen Sharpe
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Owen O'Daly
- Department of Neuroimaging, Centre for Neuroimaging Sciences, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Iain C Campbell
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Tomba E, Tecuta L, Gardini V, Tomei G, Lo Dato E. Staging models in eating disorders: A systematic scoping review of the literature. Compr Psychiatry 2024; 131:152468. [PMID: 38460478 DOI: 10.1016/j.comppsych.2024.152468] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024] Open
Abstract
Eating Disorders (ED) are characterized by low remission rates, treatment drop-out, and residual symptoms. To improve assessment and treatment of ED, the staging approach has been proposed. This systematic scoping review is aimed at mapping the existing staging models that explicitly propose stages of the progression of ED. A systematic search of PubMed, PsycINFO, Scopus was conducted with the terms staging, anorexia nervosa, bulimia nervosa, binge-eating disorders, eating disorders. Eleven studies met inclusion criteria presenting nine ED staging models, mostly for anorexia nervosa. Three were empirically tested, one of which was through an objective measure specifically developed to differentiate between stages. Most staging models featured early stages in which the exacerbation of EDs unfolds and acute phases are followed by chronic stages. Intermediate stages were not limited to acute stages, but also residual phases, remission, relapse, and recovery. The criteria for stage differentiation encompassed behavioral, psychological, cognitive, and physical features including body mass index and illness duration. One study recommended stage-oriented interventions. The current review underscores the need to empirically test the available staging models and to develop and test new proposals of staging models for other ED populations. The inclusion of criteria based on medical features and biomarkers is recommended. Staging models can potentially guide assessment and interventions in daily clinical settings.
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Affiliation(s)
- E Tomba
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - L Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | - V Gardini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - G Tomei
- Department of Psychology, University of Bologna, Bologna, Italy
| | - E Lo Dato
- Department of Psychology, University of Bologna, Bologna, Italy
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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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Bevione F, Martini M, Toppino F, Longo P, Abbate-Daga G, Brustolin A, Panero M. Cognitive Impulsivity in Anorexia Nervosa in Correlation with Eating and Obsessive Symptoms: A Comparison with Healthy Controls. Nutrients 2024; 16:1156. [PMID: 38674849 PMCID: PMC11054498 DOI: 10.3390/nu16081156] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Impulsivity in eating disorders (ED) has been historically focused on bingeing-purging symptoms, evidencing lower levels in restricting subtypes. In the recent literature, obsessive-compulsive disorder (OCD) has been described as characterized by high cognitive impulsivity. This specific impulsivity factor has been rarely studied in anorexia nervosa (AN). In this study, 53 inpatients with anorexia nervosa and 59 healthy controls completed the following questionnaires: the Barratt Impulsiveness Scale (BIS-11), the Obsessive-Compulsive Inventory (OCI), the Eating Disorders Inventory-2 (EDI-2), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). AN individuals showed significantly increased levels of cognitive instability but no difference in global score and other subscales of impulsivity compared to the healthy controls. Among AN individuals, cognitive instability emerged as being associated with the global score and obsession subscale of the OCI. It was also significantly associated with interoceptive awareness and impulse regulation. Cognitive instability was the main predictor of obsessive thoughts and behaviors in AN. Our study supports the hypothesis of AN as being characterized by high cognitive instability and adds the result that the cognitive domain of impulsivity may be associated with the presence of obsessive symptoms, specifically obsessive thoughts.
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Affiliation(s)
| | | | | | | | - Giovanni Abbate-Daga
- Eating Disorders Unit, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, via Cherasco 15, 10126 Turin, Italy; (F.B.); (M.M.); (F.T.); (P.L.); (A.B.); (M.P.)
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Himmerich H, Mirzaei K. Body Image, Nutrition, and Mental Health. Nutrients 2024; 16:1106. [PMID: 38674797 PMCID: PMC11054270 DOI: 10.3390/nu16081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Classical examples of disorders associated with body image disturbances are eating disorders (EDs) such as anorexia nervosa (AN) and bulimia nervosa (BN), as well as body dysmorphic disorder (BDD) [...].
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran;
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Forney KJ, Rezeppa TL, Hill NG, Bodell LP, Brown TA. Examining the placement of atypical anorexia nervosa in the eating disorder diagnostic hierarchy relative to bulimia nervosa and binge-eating disorder. Int J Eat Disord 2024; 57:839-847. [PMID: 38164071 DOI: 10.1002/eat.24122] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Some individuals meet the criteria for atypical anorexia nervosa and another eating disorder simultaneously. The current study evaluated whether allowing a diagnosis of atypical anorexia nervosa to supersede a diagnosis of bulimia nervosa (BN) or binge-eating disorder (BED) provided additional information on psychological functioning. METHODS Archival data from 650 university students (87.7% female, 69.4% white) who met Eating Disorder Diagnostic Survey for DSM-5 eating disorder criteria and completed questionnaires assessing quality of life, eating disorder-related impairment, and/or eating pathology at a single time point. Separate regression models used diagnostic category to predict quality of life and impairment. Two diagnostic schemes were used: the DSM-5 diagnostic scheme and an alternative scheme where atypical anorexia nervosa superseded all diagnoses except anorexia nervosa. Model fit was compared using the Davidson-Mackinnon J test. Analyses were pre-registered (https://osf.io/2ejcd). RESULTS Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided better fit to the data for eating disorder-related impairment (p = .02; n = 271), but not physical, psychological, or social quality of life (p's ≥ .33; n = 306). Allowing an atypical anorexia nervosa diagnosis to supersede a BN or BED diagnosis provided a better fit in cross-sectional models predicting purging (p = .02; n = 638), but not body dissatisfaction, binge eating, restricting, or excessive exercise (p's ≥ .08; n's = 633-647). DISCUSSION The current data support retaining the DSM-5 diagnostic scheme. More longitudinal work is needed to understand the predictive validity of the atypical anorexia nervosa diagnosis. PUBLIC SIGNIFICANCE The current study examined how changes to the diagnostic categories for eating disorders may change how diagnoses are associated with quality of life and impairment. Overall, findings suggest that the diagnostic hierarchy should be maintained.
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Affiliation(s)
- K Jean Forney
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | | | - Naomi G Hill
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Lindsay P Bodell
- Department of Psychology, Western University, London, Ontario, Canada
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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Biçaker E, Trolio V, Miller AE, Zhu LY, White C, Racine SE. Affective processes underlying restrictive eating in atypical anorexia nervosa: Comparisons to anorexia nervosa and bulimia nervosa using ecological momentary assessment. Int J Eat Disord 2024; 57:879-891. [PMID: 38192012 DOI: 10.1002/eat.24134] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE Certain symptom and risk/maintenance factor similarities between individuals with atypical anorexia nervosa (AN) and 'typical' AN have been documented, but few studies have investigated how atypical AN compares to bulimia nervosa (BN). Further, the role of affective mechanisms in maintaining restrictive eating in atypical AN has not been examined. The current study investigated whether atypical AN resembles AN and/or BN on affect-related processes using questionnaires and ecological momentary assessment (EMA). METHOD Women with atypical AN (n = 24), AN-restrictive subtype, (n = 27), AN-binge eating/purging subtype (n = 34), and BN (n = 58) completed questionnaires measuring depressive symptoms and emotion regulation difficulties. They also completed a 14-day EMA protocol during which they reported negative and positive affect and skipped meals five times/day (signal-contingent surveys) and restrictive eating after meals/snacks (event-contingent surveys). RESULTS Diagnostic groups generally did not differ on questionnaire measures nor affective patterns surrounding restrictive eating behaviors. Momentary changes in affect did not predict or follow restriction at meals/snacks, though higher momentary negative affect ratings predicted skipped meals, and higher positive affect was reported after skipped meals. Greater average negative affect and lower average positive affect predicted both restrictive eating behaviors. DISCUSSION Across diagnoses, reductions in food intake do not appear to be influenced by momentary changes in affect, though skipping meals may serve an emotion regulation function. Atypical AN seems to resemble AN and BN on affective processes underlying restrictive eating, raising further questions regarding the unique diagnosis of atypical AN. PUBLIC SIGNIFICANCE Though atypical anorexia appears to strongly resemble anorexia nervosa, it is less clear how this disorder relates to bulimia nervosa. It is further unknown whether affective-related processes underlie restrictive eating in atypical anorexia nervosa, and how these processes compare to those in anorexia nervosa and bulimia nervosa. Results suggest that atypical anorexia does not differ from anorexia nervosa or bulimia nervosa on emotion-related measures, nor in affective patterns surrounding restrictive eating behaviors.
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Affiliation(s)
- Ege Biçaker
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Vittoria Trolio
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Lisa Y Zhu
- Department of Psychology, University of Western Ontario, Social Science Centre, London, Ontario, Canada
| | - Chloe White
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Billman Miller MG, Gioia AN, Essayli JH, Forrest LN. Few differences in psychiatric comorbidities and treatment response among people with anorexia nervosa and atypical anorexia nervosa. Int J Eat Disord 2024; 57:809-818. [PMID: 37737487 DOI: 10.1002/eat.24046] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Little is known about how individuals with atypical anorexia nervosa (AN) respond to eating disorder (ED) treatment in a partial hospitalization program (PHP), nor how certain factors such as trauma, childhood abuse, psychiatric comorbidity, and suicidal thoughts and behaviors might contribute to poor treatment outcomes. Thus, the current study (1) compares prevalence of these factors between individuals with AN and atypical AN upon admission to an ED PHP, (2) compares PHP treatment response between groups, and (3) investigates whether experiencing these factors impacts treatment outcomes. METHOD We conducted a retrospective chart review of young adults admitted to a PHP with AN (n = 95) and atypical AN (n = 59). Histories of psychiatric comorbidities and adverse childhood experiences were obtained from initial psychiatric evaluations. ED symptoms were assessed at intake and discharge with the Eating Disorder Examination-Questionnaire (EDE-Q). RESULTS No significant differences were found at intake in ED symptom severity or prevalence of lifetime trauma, childhood abuse, number of psychiatric diagnoses, or suicidal thoughts and behavior. Symptomatology at discharge also did not differ between groups. Emotional abuse was significantly related to discharge shape and weight overvaluation. No other intake characteristics were significantly related to discharge symptomatology. DISCUSSION To our knowledge, this is the first study to compare the prevalence of comorbidities for both AN and atypical AN, as well as differential treatment outcomes for these individuals in a PHP. Results add to growing literature suggesting that, other than weight, AN and atypical AN have few properties that reliably distinguish them from one another. PUBLIC SIGNIFICANCE This study adds to a growing body of literature that raises questions about whether anorexia nervosa (AN) and atypical AN are truly different diagnoses. Our findings suggest these two groups present to treatment in a partial hospitalization program (PHP) with similar ED symptoms, as well as prevalence of lifetime trauma, childhood abuse, suicidal thoughts and behavior, and number of psychiatric comorbidities, and demonstrate similar treatment trajectories in PHP.
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Affiliation(s)
| | - Ayla N Gioia
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Jamal H Essayli
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Keegan E, Wade TD. The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa. Int J Eat Disord 2024; 57:1020-1025. [PMID: 36840352 DOI: 10.1002/eat.23918] [Citation(s) in RCA: 1] [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: 11/14/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10-session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. METHODS Participants (n = 67; 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. RESULTS People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. DISCUSSION This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little-understood population. PUBLIC SIGNIFICANCE STATEMENT People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these individuals.
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Affiliation(s)
- Ella Keegan
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Golden NH, Kapphahn CJ, Cheng J, Kreiter A, Downey AE, Accurso EC, Machen VI, Adams SH, Buckelew SM, Moscicki AB, Le Grange D, Garber AK. Course and outcome in individuals with atypical anorexia nervosa: Findings from the Study of Refeeding to Optimize iNpatient Gains (StRONG). Int J Eat Disord 2024; 57:799-808. [PMID: 37507351 PMCID: PMC10822019 DOI: 10.1002/eat.24029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVE We previously reported that participants with atypical anorexia nervosa (atypical AN) had higher historical and admission weights, greater eating disorder psychopathology, but similar rates of amenorrhea and weight suppression at baseline as compared to anorexia nervosa (AN); here, we compare 1-year outcomes. METHOD Weight, % median body mass index (%mBMI), Eating Disorder Examination Questionnaire (EDE-Q) scores, resumption of menses, and rehospitalizations were examined at 3, 6, and 12 months post-discharge. Analyses (N = 111) compared changes in %mBMI, weight suppression, and EDE-Q scores over time between atypical AN and AN. RESULTS Among the participants (48 atypical AN, 63 AN), both groups gained weight but those with atypical AN had lower gains than those with AN in %mBMI (p = .02) and greater weight suppression (p = .002) over time. EDE-Q scores improved over time, independent of weight suppression, with no significant difference between atypical AN and AN. Groups did not differ by rates of resumption of menses (80% atypical AN, 76.9% AN) or rehospitalization (29.2% atypical AN, 37.9% AN). Greater weight suppression predicted longer time to restore menses and more days of rehospitalization. DISCUSSION Individuals with atypical AN regained a smaller proportion of body mass and were more weight suppressed over time. Change in eating disorder cognitions, resumption of menses, and rehospitalization rates at 1-year follow-up did not differ between groups. There was no significant difference in weight suppression between groups for those who were psychologically improved at 12 months. Findings highlight limitations in our understanding of weight recovery in atypical AN. New metrics for recovery are urgently needed. PUBLIC SIGNIFICANCE Little is known about outcome in atypical anorexia nervosa (atypical AN). We examined recovery metrics in young people with atypical AN and anorexia nervosa (AN) 1 year after medical hospitalization. Individuals with atypical AN showed slower weight gain and remained further from their pre-illness weight. There were no differences in the rates of psychological recovery, resumption of menses, or rehospitalization. New metrics are needed to assess recovery in atypical AN.
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Affiliation(s)
- Neville H Golden
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Cynthia J Kapphahn
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Jing Cheng
- Department of Preventive & Restorative Dental Sciences, University of California, San Francisco, California, USA
| | - Anna Kreiter
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - Amanda E Downey
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Vanessa I Machen
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Sally H Adams
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Sara M Buckelew
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
| | - Anna-Barbara Moscicki
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | - Andrea K Garber
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA
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Fitterman-Harris HF, Han Y, Osborn KD, Faulkner LM, Williams BM, Pennesi JL, Levinson CA. Comparisons between atypical anorexia nervosa and anorexia nervosa: Psychological and comorbidity patterns. Int J Eat Disord 2024; 57:903-915. [PMID: 38288579 PMCID: PMC11018480 DOI: 10.1002/eat.24147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Literature comparing "atypical" anorexia nervosa (atypical AN) and anorexia nervosa (AN) suggests these diagnoses share significant similarities in eating disorder (ED) pathology and psychiatric comorbidities. This study evaluated potential differences in ED pathology, psychiatric comorbidity, associated mechanisms (i.e., ED fears and perfectionism), and demographic factors (i.e., ethnicity and age) between individuals with atypical AN and AN. METHOD Data from seven protocols were combined for a total 464 individuals diagnosed with atypical AN (n = 215) or AN (n = 249). Between-group differences in ED severity and behaviors, psychiatric comorbidities, ED fears, perfectionism, and demographic factors were assessed using t-tests, Wilcoxon rank-sum tests, and Fisher's exact test. RESULTS Participants with atypical AN reported higher levels of overvaluation of weight and shape than those with AN. Participants with AN scored higher on food-related fears (anxiety about eating, food avoidance behaviors, and feared concerns) and fears of social eating, as well as obsessive-compulsive symptoms. Participants with AN were more likely to identify as Asian or Pacific Islander. No other statistically significant differences were found between groups for overall ED severity, ED behaviors, psychiatric comorbidities, general ED fears, perfectionism, or demographic factors. DISCUSSION Overall, results support previous literature indicating limited differences between individuals with atypical AN and AN, though individuals with atypical AN reported more overvaluation of weight and shape and those with AN reported higher food and social eating fears and obsessive-compulsive symptoms. Relatively few overall differences between atypical AN and AN highlight the importance of exploring dimensional conceptualizations of AN as an alternative to the current categorical conceptualization. PUBLIC SIGNIFICANCE This study assessed differences among individuals with atypical anorexia nervosa and anorexia nervosa in eating disorder severity and behaviors, comorbid psychiatric diagnoses, associated mechanisms, and demographic factors. Few differences emerged, though participants with atypical anorexia nervosa reported more overvaluation of weight and shape, while those with anorexia nervosa reported more food and social eating fears and higher obsessive-compulsive symptoms. Results support exploration of these diagnoses as a spectrum disorder.
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Affiliation(s)
| | - Yuchen Han
- Department of Bioinformatics and Biostatistics, University of Louisville
| | - Kimberly D. Osborn
- Department of Psychological and Brain Sciences, University of Louisville
- School of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University
| | - Loie M. Faulkner
- Department of Psychological and Brain Sciences, University of Louisville
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville
| | - Jamie-Lee Pennesi
- Department of Psychological and Brain Sciences, University of Louisville
| | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville
- Department of Pediatrics – Division of Child and Adolescent Psychiatry, University of Louisville
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13
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Silbiger K. Mental health providers' perceptions of restrictive eating disorders: Relationship with client body weight. Int J Eat Disord 2024; 57:916-923. [PMID: 38291927 DOI: 10.1002/eat.24154] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study investigated whether mental health providers have different diagnostic impressions and treatment recommendations for patients with restrictive eating disorders, depending on the patient's body weight. METHOD Participants were given one of three versions of a vignette depicting a patient who meets DSM-5 criteria for anorexia nervosa (AN) or atypical AN with the patient's weight described as either below, within, or above the average range for her age and height. Participants were then asked to respond to a series of questions about diagnosis, symptoms, and treatment recommendations. Results were compared between the three weight conditions with the goal of better understanding how a patient's body weight may influence different aspects of participants' clinical impressions. RESULTS Participants given the low weight version of the vignette were more likely to identify the presenting problem as an eating disorder and to agree that the patient experienced dietary restriction and weight loss, weight gain avoidance, and body image concerns. Participants given the low weight description were also more likely to recommend specialized eating disorder treatment and medical follow-up. DISCUSSION Findings suggest that mental health providers were generally more responsive to restrictive eating disorder symptoms when the patient was at a lower body weight. These results are concerning because they suggest patients with atypical AN may be less likely to receive an accurate diagnosis or adequate treatment compared to underweight patients with AN, despite experiencing the same symptoms. PUBLIC SIGNIFICANCE Restrictive eating disorders like AN and atypical AN can cause comparable physical and psychological symptoms in people of any body weight. Despite having the same symptoms, people with a higher body weight are less likely to receive a diagnosis or treatment. This study compared mental health providers' reactions to a description of a patient with an eating disorder at different body weights and found differences in diagnosis, detection of symptoms, and treatment recommendations.
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14
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Kons K, Essayli J, Shook J. Comparing the knowledge, attitudes, and practices of pediatric and family medicine clinicians toward atypical anorexia nervosa versus anorexia nervosa. Int J Eat Disord 2024; 57:993-1001. [PMID: 38082458 PMCID: PMC11018502 DOI: 10.1002/eat.24095] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To investigate the knowledge, attitudes, and current practices of adolescent primary care providers regarding the epidemiology, clinical features, and diagnosis of atypical anorexia nervosa (AN) compared to AN. METHODS An online survey was sent to the Pediatric and Family Medicine clinicians who provide medical care to adolescents. Statistical analyses compared differences in responses to questions about atypical AN versus AN. RESULTS Relative to AN, participants (n = 67) were significantly less familiar with atypical AN, less likely to consider a diagnosis of atypical AN, less comfortable identifying atypical AN, less likely to counsel patients with atypical AN on health risks, less likely to refer patients with atypical AN to a specialist, and less likely to correctly identify atypical AN. Clinicians with more years in medical practice reported a significantly larger gap in familiarity between AN and atypical AN than clinicians with less than 5 years of practice. CONCLUSIONS Providers who care for adolescents appear to be less familiar with and less likely to identify atypical AN compared to AN. This knowledge gap may be more pronounced among clinicians with more years practicing medicine due to the novelty of atypical AN as a diagnosis. Lack of knowledge surrounding atypical AN risk factors may result in delayed diagnosis and associated poor health outcomes. Future research should investigate strategies that improve knowledge and screening of atypical AN in medical and other settings. PUBLIC SIGNIFICANCE Pediatric and Family Medicine clinicians are less familiar with atypical anorexia nervosa (AN) and less likely to diagnose a patient with atypical AN relative to AN. Insufficient knowledge about atypical AN may place these individuals at increased risk for worsening restrictive eating and the physical and psychological consequences of malnutrition.
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Affiliation(s)
- Kelly Kons
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jamal Essayli
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jennifer Shook
- Department of Pediatrics, Division of Adolescent Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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15
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Hebebrand J, Seitz J, Föcker M, Viersen HPV, Huss M, Bühren K, Dahmen B, Becker K, Weber L, Correll CU, Jaite C, Egberts K, Romanos M, Ehrlich S, Seidel M, Roessner V, Fleischhaker C, Möhler E, Hahn F, Kaess M, Legenbauer T, Hagmann D, Renner TJ, Schulze UME, Thiemann U, Wessing I, Antony G, Herpertz-Dahlmann B, Matthews A, Peters T. Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder. Int J Eat Disord 2024; 57:967-982. [PMID: 38528714 DOI: 10.1002/eat.24189] [Citation(s) in RCA: 1] [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: 08/23/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE For adolescents, DSM-5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI-centile-for-age. We hypothesized that the diagnostic weight cut-off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN. METHOD Based on admission BMI-centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t-tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders. RESULTS Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI-standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN. DISCUSSION Whereas the weight cut-off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight-specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity. PUBLIC SIGNIFICANCE Because body weights of patients with AN must drop below the 5th BMI-centile per DSM-5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Manuel Föcker
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University-Bochum, Hamm, Germany
| | - Hanna Preuss-van Viersen
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Katharina Bühren
- kbo-Heckscher Klinikum for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Academic Teaching Hospital, Ludwig Maximilian University, Munich, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Philipps-University and University Hospital Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany
| | - Linda Weber
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Philipps-University and University Hospital Marburg, Marburg, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany
- Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany
| | - Veit Roessner
- Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Freiburg, Germany
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Saarland University, Homburg, Germany
| | - Freia Hahn
- Department of Child & Adolescent Psychiatry and Psychotherapy, LVR-Klinik Viersen, Viersen, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University-Bochum, Hamm, Germany
| | - Daniela Hagmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Tobias J Renner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Ulrike M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Germany
| | - Ulf Thiemann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Hospital Bonn, Bonn, Germany
| | - Ida Wessing
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Gisela Antony
- Central Information Office, CIO Marburg GmbH, Fronhausen, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany
| | - Abigail Matthews
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Triinu Peters
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Johnson-Munguia S, Bottera AR, Vanzhula I, Forbush KT, Gould SR, Negi S, Thomeczek ML, L’Insalata AM, Like EE, Sharma AR, Morgan RW, Rasheed S. Understanding community provider practices in diagnosing and treating atypical anorexia nervosa: A mixed methods study. Int J Eat Disord 2024; 57:892-902. [PMID: 38239071 PMCID: PMC11018496 DOI: 10.1002/eat.24125] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is a lack of consensus in defining "significant weight loss" when diagnosing atypical anorexia nervosa (atypical AN) and no guidelines exist for setting target weight (TW). The current study aimed to identify community providers' practices related to the diagnosis of atypical AN and the determination of TW. A secondary aim was to evaluate whether professional discipline impacted "significant weight loss" definitions. METHOD A variety of providers (N = 141; 96.4% female) completed an online survey pertaining to diagnostic and treatment practices with atypical AN. Descriptive statistics were computed to characterize provider-based practices and Fisher's exact tests were used to test for differences in diagnostic practices by professional discipline. Thematic analysis was used to examine open-ended questions. RESULTS Most (63.97%) providers diagnosed atypical AN in the absence of any weight loss if other AN criteria were met, but doctoral-level psychologists and medical professionals were less likely to do so compared to nutritional or other mental health professionals. Most providers found weight gain was only sometimes necessary for atypical AN recovery. Qualitative responses revealed providers found atypical AN to be a stigmatizing label that was not taken seriously. Providers preferred to use an individualized approach focused on behaviors, rather than weight when diagnosing and treating atypical AN. DISCUSSION Lack of diagnostic clarity and concrete treatment guidelines for atypical AN may result in substantial deviations from the DSM-5-TR criteria in real-world practice. Clinically useful diagnostic definitions for restrictive eating disorders and evidence-based treatment guidelines for TW and/or other relevant recovery metrics are needed. PUBLIC SIGNIFICANCE The current study found variability in how community providers diagnose and determine target recovery weight for atypical anorexia nervosa (atypical AN). Many providers viewed the diagnosis of atypical AN as stigmatizing and preferred to focus on behaviors, rather than weight. This study underscores the importance of creating a clinically useful diagnostic definition and guidelines for recovery for atypical AN backed by empirical evidence that providers may implement in practice.
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Hagan KE, Johnson A, Venables K, Makara A, Haynos AF. Naturalistic symptom trajectories of atypical anorexia nervosa, anorexia nervosa, and bulimia nervosa in a prospective cohort study of United States college students. Int J Eat Disord 2024; 57:924-936. [PMID: 38303677 PMCID: PMC11018494 DOI: 10.1002/eat.24152] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Research on the natural course of symptoms of atypical anorexia nervosa (AN) relative to AN and bulimia nervosa (BN) is limited yet needed to inform nosology and improve understanding of atypical AN. This study aimed to 1) characterize trajectories of eating disorder and internalizing (anxiety, depression) symptoms in college students with and without a history of atypical AN, AN, and BN; and 2) compare sex and race/ethnicity distributions across groups. METHOD United States college students who participated in Spit for Science™, a prospective cohort study, were classified as having a history of atypical AN (n = 125), AN (n = 160), BN (n = 617), or as non-eating-disorder controls (NCs, n = 5876). Generalized and linear mixed-effects models assessed group differences in eating and internalizing symptom trajectories, and logistic regression compared groups on sex and race/ethnicity distributions. RESULTS Atypical AN participants demonstrated elevated eating disorder and internalizing symptoms compared to NCs during college, but less severe symptoms than AN and BN participants. Although all eating disorder groups showed signs of improvement in fasting and driven exercise, purging and depression remained elevated. Atypical AN participants showed increasing anxiety and stable binge-eating trajectories compared to AN and/or BN participants. The atypical AN group comprised significantly more people of color than the AN group. DISCUSSION Findings underscore that atypical AN is a severe psychiatric disorder. As atypical AN may present as less severe than AN and BN and disproportionately affects people of color, clinicians should be mindful of biases that could delay diagnosis and care. PUBLIC SIGNIFICANCE College students with histories of atypical AN, AN, and BN demonstrated improvements in fasting and driven exercise and stable purging and depression levels. Atypical AN students showed worsening anxiety and stable binge-eating trajectories compared to favorable changes among AN and BN students. A higher percentage of atypical AN (vs. AN) students were people of color. Findings may improve the detection of atypical AN in college students.
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Affiliation(s)
- Kelsey E. Hagan
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Adanya Johnson
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kira Venables
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Amanda Makara
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Ann F. Haynos
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, MN, USA
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18
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Himmerich H, Treasure J. Anorexia nervosa: diagnostic, therapeutic, and risk biomarkers in clinical practice. Trends Mol Med 2024; 30:350-360. [PMID: 38331700 DOI: 10.1016/j.molmed.2024.01.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 02/10/2024]
Abstract
In anorexia nervosa (AN), measurable biological parameters can inform the process of treating patients. Such biomarkers include established laboratory parameters as well as a range of potential future biomarkers, including genetic, metabolomic, microbiomic, endocrine, immunological, hematological, electrophysiological, and neuroimaging parameters. In this opinion article we discuss how these biomarkers can support diagnosic and therapeutic processes at specific steps during the AN treatment cycle, that is, the diagnosis, diagnostic specification, risk management, choice of therapy, therapy monitoring, and treatment review. History-taking, physical and neuropsychological examination, clinical observation, and judgment about treatment success by the patient, their carers, and members of the multidisciplinary team are essential to interpret laboratory and imaging data appropriately and to assess the full clinical picture.
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Affiliation(s)
- Hubertus Himmerich
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Centre for Research in Eating and Weight Disorders (CREW), Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
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Golden NH, Walsh BT. Time to revisit the definition of atypical anorexia nervosa. Int J Eat Disord 2024; 57:757-760. [PMID: 38390637 DOI: 10.1002/eat.24174] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
In this special issue, international researchers investigate how atypical anorexia nervosa (atypical AN) differs from anorexia nervosa (AN) and other eating disorders with respect to demographics, psychological and physiological morbidity, as well as treatment course and outcome. Manuscripts in this special issue report that atypical AN is associated with substantial medical and psychological morbidity, and the majority of studies find few differences between atypical AN and AN. While much remains to be learned about the long-term course and treatment response of individuals with atypical AN to psychological and pharmacological interventions, the evidence supports conceptualization of atypical AN as part of a spectrum-based restrictive eating disorder. These findings together with the potentially stigmatizing use of the term "atypical" suggest it may be time to revise the existing definition of atypical AN.
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Affiliation(s)
- Neville H Golden
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA
| | - B Timothy Walsh
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
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Herb Neff KM, Buta E, Fenn LM, Ramsey CN, Snow JL, Haskell SG, Masheb RM. Distinguishing probable atypical anorexia nervosa from weight loss alone in a national sample of U.S. Military Veterans: Disentangling the roles of weight suppression and cognitive concerns. Int J Eat Disord 2024; 57:827-838. [PMID: 38129986 DOI: 10.1002/eat.24116] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Veterans are at high risk for eating disorders (EDs), and specifically for atypical anorexia nervosa (atypical AN). The current study aimed to better understand this under-studied disorder and how it differs from weight loss without ED cognitive features. METHOD Secondary analyses were conducted with data from a national study of Veterans (N = 882, 49.4% women). Participants were categorized into four mutually exclusive groups using the Eating Disorder Diagnostic Scale 5: probable atypical AN, a cognitive concerns group (Cog Only), a weight suppressed group (WS Only), and a no ED control group. Adjusted regression models were used to compare groups on measures of eating pathology and mental health. Three weight suppression thresholds (5%, 10%, and 15%) for probable atypical AN were also tested. RESULTS The sample was comprised of 12% probable atypical AN, 23.6% Cog Only, 16.3% WS Only, and 48.1% Control. The probable atypical AN group was most like the Cog Only group except for higher levels of dietary restraint. Atypical AN fared worse and was least like the Control group followed by the WS Only group. All weight suppression thresholds significantly predicted dietary restraint, with 5% being the best predictor. DISCUSSION Results found that probable atypical AN is a distinct clinical entity and that the exact weight suppression threshold associated with atypical AN is less important than having any weight suppression. Findings highlight the clinical significance of atypical AN and the importance of gaining a better understanding of how to address this clinical entity. PUBLIC SIGNIFICANCE Atypical anorexia nervosa is a relatively underexamined but highly prevalent eating disorder in the Veteran population. Results show that ED cognitive features are more closely linked to clinically significant eating pathology and poor mental health than weight suppression alone suggesting that negative thinking about weight gain and appearance, regardless of the presence or severity of weight loss, may signal the need for specialized intervention.
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Affiliation(s)
| | - Eugenia Buta
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Lindsay M Fenn
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Christine N Ramsey
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
- University of Texas at Austin, Austin, Texas, USA
| | - Jennifer L Snow
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Yale School of Medicine, New Haven, Connecticut, USA
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21
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Loizou P, Panagiotou G, Zanos P, Paraskevopoulos E. Exploring the neurofunctional impairments and cognitive biases concerning food and body related stimuli in anorexia nervosa: An integrated EEG and eye-tracking study protocol. PLoS One 2024; 19:e0299529. [PMID: 38547188 PMCID: PMC10977685 DOI: 10.1371/journal.pone.0299529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Patients with Anorexia Nervosa (AN) exhibit significant cognitive and neural disturbances compared to healthy individuals when processing food and body-related stimuli. These disturbances not only contribute to the manifestation and chronification of their pathological eating behaviour but also underscore the complex interplay of cognitive, emotional, and neurobiological factors in AN. However, the precise underlying cognitive and neural mechanisms of these disturbances remain a compelling area of investigation. METHODS This study presents a protocol developed for conducting a cross-sectional quasi-experimental study using a mixed model ANOVA approach with a crossover design. Our participants will consist of 20 patients with an active diagnosis of AN, 20 Overweight/obese individuals, and 20 Healthy Controls (HCs) with a normal BMI. An integrated eye-tracking and EEG methodology will be used in conjunction, with the primary aim of assessing participants' cognitive and neural processing towards high and low-calorie food stimuli. On an exploratory level, by utilizing the same methods, the present study will also investigate AN patients' responses towards high weight, normal weight, low weight, and self-body pictures, as well as towards images from the International Affective Picture System (IAPS) characterized by elevated valence and arousal levels. Additionally, behavioural methods such as yes or no questions, and self-reported questionnaires will be administered. The EEG and eye-tracking data will be analysed at early (50-300 ms) and late (350-500 ms) time intervals. DISCUSSION The investigation of the underlying cognitive and neural processes employed by patients with AN during the processing of food and body-related stimuli can help us develop a better understanding of the cognitive and neural mechanisms that contribute to the manifestation and maintenance of the disorder and assist in the development of more effective screening methods. ETHICAL APPROVAL AND CONSENT TO PARTICIPATE Ethical approval for the study has been obtained by the Cyprus National Bioethics Committee on 27.04.2023 (ΕΕΒΚ/ΕΠ/2023/19), and by the University of Cyprus (20.02.2023). Written informed consent will be obtained from all participants.
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Affiliation(s)
| | | | - Panos Zanos
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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Lucherini Angeletti L, Cassioli E, Tarchi L, Dani C, Faldi M, Martini R, Ricca V, Castellini G, Rossi E. From early relational experiences to non-suicidal self-injury in anorexia and bulimia nervosa: a structural equation model unraveling the role of impairments in interoception. Eat Weight Disord 2024; 29:22. [PMID: 38528258 DOI: 10.1007/s40519-024-01651-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) frequently exhibit Non-Suicidal Self-Injury (NSSI), yet their co-occurrence is still unclear. To address this issue, the aim of this study was to elucidate the role of impairments in interoception in explaining the NSSI phenomenon in AN and BN, providing an explanatory model that considers distal (insecure attachment/IA and traumatic childhood experiences/TCEs) and proximal (dissociation and emotional dysregulation) risk factors for NSSI. METHOD 130 patients with AN and BN were enrolled and administered self-report questionnaires to assess the intensity of NSSI behaviors, interoceptive deficits, IA, TCEs, emotional dysregulation and dissociative symptoms. RESULTS Results from structural equation modeling revealed that impairments in interoception acted as crucial mediators between early negative relational experiences and factors that contribute to NSSI in AN and BN, particularly emotional dysregulation and dissociation. Precisely, both aspects of IA (anxiety and avoidance) and various forms of TCEs significantly exacerbated interoceptive deficits, which in turn are associated to the emergence of NSSI behaviors through the increase in levels of dissociation and emotional dysregulation. CONCLUSIONS The proposed model provided a novel explanation of the occurrence of NSSIs in patients with AN and BN by accounting for the significance of interoception. LEVEL OF EVIDENCE Level V-Cross-sectional observational study.
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Affiliation(s)
- Lorenzo Lucherini Angeletti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
- The Royal's Institute of Mental Health Research & University of Ottawa, Ottawa, ON, Canada.
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Marco Faldi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Rachele Martini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
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Bohon C, Flanagan K, Welch H, Rienecke RD, Le Grange D, Lock J. Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa. Eat Disord 2024; 32:153-168. [PMID: 37942724 DOI: 10.1080/10640266.2023.2277054] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/10/2023]
Abstract
This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12-18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT). To examine the effects of different thresholds of EE, we used two different levels of EE in analyses. Results demonstrated that adolescents who had at least one parent with elevated EE indicated by a lower threshold (i.e. even mild levels) at baseline were less likely to achieve an early treatment response, suggesting that EE might interfere with treatment success from the start of treatment. When high EE was defined by a higher threshold, these effects were no longer significant, regardless of treatment type (FBT or AFT). These findings suggest that adolescents with AN may be more sensitive to EE than other mental illnesses, such that lower thresholds of EE impact the speed with which they are able to reduce symptoms and gain weight in treatment. It may be necessary to target parental EE prior to or early in treatment or pivot to parent-focused treatment to change the trajectory of treatment response. Future research is needed to explore ways parental EE can be reduced.
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Affiliation(s)
- Cara Bohon
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
- Clinical, Equip Health, Inc, Carlsbad, California, USA
| | - Katie Flanagan
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Hannah Welch
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Renee D Rienecke
- Research, Eating Recovery Center/Pathlight Mood & Anxiety Centers, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA (Emeritus)
| | - James Lock
- Eating Disorders Research Program, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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24
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Natali L, Meregalli V, Rowlands K, Di Pietro J, Treasure J, Collantoni E, Meneguzzo P, Tenconi E, Favaro A, Fontana F, Ceccato E, Sala A, Valmaggia L, Cardi V. Virtual food exposure with positive mood induction or social support to reduce food anxiety in anorexia nervosa: A feasibility study. Int J Eat Disord 2024; 57:703-715. [PMID: 38366755 DOI: 10.1002/eat.24155] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/20/2024] [Accepted: 01/20/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food-related anxiety in anorexia nervosa. METHOD One hundred and forty-five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self-report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure. RESULTS Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F(2,141) = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found. DISCUSSION Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa. PUBLIC SIGNIFICANCE This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.
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Affiliation(s)
- Ludovica Natali
- Department of General Psychology, University of Padova, Padova, Italy
| | - Valentina Meregalli
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jerome Di Pietro
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Department of Psychiatry, Eating Disorders Unit, Padova University Hospital, Padova, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Department of Psychiatry, Eating Disorders Unit, Padova University Hospital, Padova, Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Department of Psychiatry, Eating Disorders Unit, Padova University Hospital, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Department of Psychiatry, Eating Disorders Unit, Padova University Hospital, Padova, Italy
| | - Francesca Fontana
- Centro Provinciale di Treviso per i Disturbi del Comportamento Alimentare (Treviso Eating Disorders Unit), ULSS2 Marca Trevigiana, Treviso, Italy
| | - Enrico Ceccato
- Centro Provinciale di Vicenza per i Disturbi del Comportamento Alimentare (Vicenza Eating Disorders Unit), ULSS8 Berica, Vicenza, Italy
| | - Alessandra Sala
- Centro Provinciale di Vicenza per i Disturbi del Comportamento Alimentare (Vicenza Eating Disorders Unit), ULSS8 Berica, Vicenza, Italy
| | - Lucia Valmaggia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychiatry, KU Leuven, Leuven, Belgium
| | - Valentina Cardi
- Department of General Psychology, University of Padova, Padova, Italy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Department of Psychiatry, Eating Disorders Unit, Padova University Hospital, Padova, Italy
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Stonawski V, Mai-Lippold SA, Graap H, Moll GH, Kratz O, Van Doren J, Horndasch S. Processing of food stimuli in anorexia nervosa: An ERP-study comparing adolescents and adults. Eur Eat Disord Rev 2024; 32:281-297. [PMID: 37850962 DOI: 10.1002/erv.3040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/09/2023] [Accepted: 10/01/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with altered processing of disorder-relevant stimuli. Event-related potentials (ERP) - such as the Late Positive Potential (LPP) - give information about the underlying mechanisms of central nervous stimulus processing. METHODS Patients with AN (22 adolescents, 23 adults) and healthy controls (HCs; 17 adolescents, 24 adults) were included. Neutral, low, and high calorie food-images were rated for valence and arousal; EEG activity was recorded and LPPs (early: 350-700 ms; late: 800-1200 ms) were extracted. Effects of patient status, age group, and stimulus category were analyzed via mixed 2 × 2 × 3-AN(C)OVAs. RESULTS Patients with AN rated high calorie stimuli lower in valence and higher in arousal than HCs. Controlling for hunger, food stimuli elicited higher early LPPs than neutral ones in patients and HCs. For the late LPP, patients with AN showed larger amplitudes. CONCLUSION Results suggest a highly automatic attentional bias towards low-calorie foods. Patients with AN seem to have more intense cognitive processing independent of stimulus material. More research is needed to validate and clarify differences between early and late LPP measures as well as the operationalization and relevance of hunger status.
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Affiliation(s)
- Valeska Stonawski
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sandra A Mai-Lippold
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Holmer Graap
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Oliver Kratz
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jessica Van Doren
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefanie Horndasch
- Department of Child and Adolescent Mental Health, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Rennick A, Papastavrou Brooks C, Singh Basra R, Startup H, Lavender T, Oldershaw A. Acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS): A novel intervention for anorexia nervosa. Int J Eat Disord 2024; 57:611-623. [PMID: 38258350 DOI: 10.1002/eat.24139] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Investigate the acceptability of Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS), a novel intervention for anorexia nervosa (AN), conducted as a feasibility trial to provide an initial test of the intervention. METHODS SPEAKS therapy lasting 9-12 months was provided to 34 people with AN or atypical AN by eight specialist eating disorder therapists trained in the model across two NHS Trusts in the UK (Kent and Sussex) during a feasibility trial. All participants were offered a post-therapy interview; sixteen patients and six therapists agreed. All patient participants were adult females. Interviews were semi-structured and asked questions around individuals' experience of SPEAKS, the acceptability of the intervention and of the research methods. Interviews were analyzed using thematic analysis. RESULTS Key areas explored in line with research questions led to 5 overarching themes and 14 subthemes: (1) shift in treatment focus and experience, (2) balancing resources and treatment outcomes, (3) navigating the online treatment environment, (4) therapist adaptation and professional development, and (5) research processes. DISCUSSION SPEAKS was found to be an acceptable intervention for treating AN from the perspective of patients and therapists. The findings provide strong support for delivery of a larger scale randomized control trial. Recommendations for future improvements, particularly pertaining to therapist understanding of the treatment model are detailed, alongside broader clinical implications. PUBLIC SIGNIFICANCE We aimed to evaluate the acceptability of a new anorexia nervosa treatment called SPEAKS. Interviews were conducted with patients and therapists involved in the pilot study and responses were analyzed. Results showed that both patients and therapists found SPEAKS to be an acceptable treatment for anorexia nervosa. The study suggests that SPEAKS meets the criteria for moving forward with a larger trial to assess its effectiveness.
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Affiliation(s)
- Abigail Rennick
- All Age Eating Disorder Service, North East London NHS Foundation Trust, Maidstone, UK
| | - Cat Papastavrou Brooks
- SPIRED Clinic, Sussex Partnership NHS Foundation Trust and Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Helen Startup
- Schema Therapy School, Brighton Psychology Service, Brighton, Sussex, UK
| | - Tony Lavender
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK
| | - Anna Oldershaw
- Canterbury Christ Church University, Salomons Institute for Applied Psychology, Tunbridge Wells, UK
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Aarnio-Peterson CM, Grange DL, Mara CA, Modi AC, North EO, Zegarac M, Stevens K, Matthews A, Mitan L, Shaffer A. Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion. Int J Eat Disord 2024; 57:682-694. [PMID: 38318997 PMCID: PMC10947854 DOI: 10.1002/eat.24149] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. METHOD In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). RESULTS Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. DISCUSSION Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. PUBLIC SIGNIFICANCE Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.
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Affiliation(s)
- Claire M. Aarnio-Peterson
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Psychiatry and Neurosciences, The University of Chicago, Chicago, IL, USA (Emeritus)
| | - Constance A. Mara
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Avani C. Modi
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Emily Offenbacker North
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
| | - Miriam Zegarac
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Kimberly Stevens
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Abigail Matthews
- Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
| | - Laurie Mitan
- University of Cincinnati College of Medicine, Department of Pediatrics, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Division of Adolescent Medicine, Cincinnati, OH USA
| | - Anne Shaffer
- Department of Psychology, University of Georgia, Athens, GA, USA
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28
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Oldershaw A, Basra RS, Lavender T, Startup H. Specialist psychotherapy with emotion for anorexia in Kent and Sussex: An intervention development and non-randomised single arm feasibility trial. Eur Eat Disord Rev 2024; 32:215-229. [PMID: 37815048 DOI: 10.1002/erv.3034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a serious eating disorder treated using psychological interventions, yet outcomes remain limited. Emotional difficulties are recognised as a treatment target. This research programme developed and evaluated feasibility of an emotion-focused therapy for adults with AN. METHODS Phase One intervention development utilised 'intervention mapping'. Qualitative research drew on lived experience highlighting objectives for change. Empirical evidence was synthesised into hypotheses of core emotional difficulties and an associated model of change. Relevant psychotherapeutic theory-based change methods were integrated to form the Specialist Psychotherapy with Emotion for Anorexia in Kent and Sussex (SPEAKS) intervention, guidebook and clinician training package. Phase Two tested SPEAKS in a single-arm, multisite feasibility trial across two specialist services, utilising prespecified progression criteria, and embedded process evaluation. RESULTS SPEAKS was 9-12 months (40 sessions) of weekly individual psychotherapy, drawing on a range of psychotherapeutic modalities, predominantly Emotion Focused Therapy and Schema Therapy. Forty-six participants consented to feasibility trial participation; 42 entered the trial and 34 completed. Thirteen of 16 feasibility criteria were met at green level and three at amber, highlighting areas for improving model adherence. CONCLUSIONS A randomised controlled trial is indicated. Therapist training and guidebook adjustments to improve model adherence are suggested.
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Affiliation(s)
- Anna Oldershaw
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
- Kent and Medway All Age Eating Disorders Service, North East London NHS Foundation Trust (NELFT), Maidstone, UK
| | - Randeep Singh Basra
- Kent and Medway All Age Eating Disorders Service, North East London NHS Foundation Trust (NELFT), Maidstone, UK
| | - Tony Lavender
- Salomons Institute for Applied Psychology, Tunbridge Wells, UK
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Giles S, Hughes EK, Castle D, Jenkins Z, Phillipou A, Rossell S, Urbini G, Fuller-Tyszkiewicz M, Krug I. A new network analysis model in anorexia nervosa patients based on self-reported eating disorder symptoms, psychological distress, and cognitive flexibility. Br J Clin Psychol 2024; 63:118-134. [PMID: 38071465 DOI: 10.1111/bjc.12451] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample. METHODS One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence. RESULTS The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress. CONCLUSIONS The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence.
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Affiliation(s)
- Sarah Giles
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth K Hughes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Castle
- Centre for Mental Health Service Innovation, University of Tasmania, Hobart, Tasmania, Australia
| | - Zoe Jenkins
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Iverson Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea Phillipou
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Orygen, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Susan Rossell
- Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Gemma Urbini
- Body Image & Eating Disorders Treatment & Recovery Service, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Melbourne, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Sternheim LC, Bijsterbosch JM, Wever MCM, van Elburg AA, Frank GKW. Examining anxious temperament in anorexia nervosa: Behavioural inhibition and intolerance of uncertainty and their contribution to trait anxiety in adolescents with anorexia nervosa. J Affect Disord 2024; 348:116-123. [PMID: 38110154 DOI: 10.1016/j.jad.2023.12.035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious and complex psychiatric disorder yet treatment results are suboptimal. Insight into the etiology of this illness is much needed. Research highlights the implication of anxiety-related traits in the development and maintenance of AN. This study investigates firstly, behavioural inhibition and intolerance for uncertainty (IU) in adolescents with and without AN, and secondly relations between these traits. METHODS In a cross-sectional study, 165 adolescent girls (AN = 94, HC = 71) completed questionnaires measuring behavioural inhibition, IU and trait anxiety. ANOVAs tested differences between AN and HC groups, and mediation models with IU as a mediator between behavioural inhibition and trait anxiety were run. RESULTS AN adolescents reported significantly higher levels of behavioural inhibition, IU and trait anxiety compared to their peers. In both AN and HC, a direct and a total effect of behavioural inhibition on trait anxiety was found. However, only in the AN group IU partially mediated the relation between behavioural inhibition and trait anxiety. LIMITATIONS Data is cross-sectional and longitudinal studies are required. A mean illness duration of nearly 2 years may mean early effects of malnourishment and habituation and future studies should include patients with shorter illness duration. CONCLUSIONS Results highlight that behavioural inhibition and IU may contribute to anxiety in AN whilst their peers may have developed better executive and social-emotional skills to manage uncertainty. Adolescents with AN may benefit from interventions targeting behavioural inhibition and IU.
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Affiliation(s)
- Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, the Netherlands.
| | | | - Mirjam C M Wever
- Department of Clinical Psychology, Leiden University, the Netherlands
| | | | - Guido K W Frank
- Department of Psychiatry, University of California San Diego, USA
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31
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Kinnaird E, Cooper M. Exploring the relationship between clinical and personal models of recovery in anorexia nervosa: A mixed methods study. Eur Eat Disord Rev 2024; 32:244-256. [PMID: 37840375 DOI: 10.1002/erv.3037] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE There is increasing interest around the relationship between clinically defined recovery from Anorexia nervosa (AN), based on a reduction of symptoms and weight normalisation, and personal models of recovery which emphasise factors such as personal growth. The purpose of this mixed methods study was to evaluate the hypothesis that these two approaches are complimentary, with reduced symptoms associated with higher achievement in personal domains. METHODS Eighty-one adults who self-defined as fully or partially recovered from AN were recruited into an online study and completed self-report measures of clinical and personal recovery. Participants were also asked questions about their views on the clinical criteria, and this data was analysed using thematic analysis. RESULTS People who were clinically defined as fully recovered scored significantly higher on measures of personal recovery compared to those defined as not recovered, and there were strong positive associations between lower behavioural and cognitive symptoms, and personal recovery. There was a weaker relationship between personal recovery measures and BMI. Qualitative data indicated that most participants felt that the clinical criteria were not a sufficient definition of recovery. CONCLUSIONS Implications for the usage of clinical criteria for recovery from AN in research trials and clinical practice are discussed.
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Affiliation(s)
- Emma Kinnaird
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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Campos Del Portillo R, Palma Milla S, Matía Martín P, Loria-Kohen V, Martínez Olmos MÁ, Mories Álvarez MT, Castro Alija MJ, Martín Palmero MÁ, Carrillo Lozano E, Valero-Pérez M, Campos Del Portillo MI, Sirvent Segovia AE, Plaza Blázquez P, de la Cruz López DM, Pita F. [Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023]. NUTR HOSP 2024. [PMID: 38466575 DOI: 10.20960/nh.05175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.
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Affiliation(s)
| | - Samara Palma Milla
- Servicio de Endocrinología y Nutrición. Unidad de Nutrición Clínica y Dietética. Hospital Universitario La Paz
| | - Pilar Matía Martín
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Universidad Complutense. Madrid
| | - Viviana Loria-Kohen
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030)
| | | | | | | | | | | | - Marlhyn Valero-Pérez
- Servicio de Endocrinología y Nutrición. Unidad de Nutrición Clínica y Dietética. Hospital Universitario La Paz
| | | | | | - Pilar Plaza Blázquez
- Servicio de Endocrinología y Nutrición. Hospital Universitario Puerta de Hierro Majadahonda
| | | | - Francisco Pita
- Servicio de Endocrinología y Nutrición. Complexo Hospitalario Universitario de A Coruña
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Haas V, Wechsung K, Kaiser V, Schmidt J, Raile K, Busjahn A, Le Grange D, Correll CU. Comparing family-based treatment with inpatient treatment in youth with anorexia nervosa eligible for hospitalization: A 12-month feasibility study. Int J Eat Disord 2024; 57:388-399. [PMID: 38082440 DOI: 10.1002/eat.24098] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Family-based treatment (FBT) for youth with anorexia nervosa (AN), has not been compared to inpatient, multimodal treatment (IMT). METHOD Prospective, non-randomized pilot feasibility study of adolescents with AN receiving FBT (n = 31), and as a reference point for exploratory outcome comparisons IMT (n = 31), matched for baseline age and percent median BMI (%mBMI). Feasibility of FBT in youth fulfilling criteria for IMT was assessed via study recruitment and retention rates; acceptability via drop-out and caregiver strain; safety via adverse events; preliminary treatment effectiveness between groups was assessed via a change in %mBMI, AN psychopathology (Eating Disorder Examination-Questionnaire, EDE-Q), and hospital days, over 12 months with intent-to-treat, mixed models repeated measures analyses covering post-intervention usual care until 12 months. RESULTS Taking into account that 8 FBT patients (25.8%) crossed over to IMT due to lack of weight gain or psychiatric concerns, FBT and IMT were similarly feasible, acceptable, and safe, apart from more physical antagonism toward others in FBT (p = .010). FBT lasted longer (median [interquartile range, IQR]; 33.6 [17.4, 49.9] vs. 17.3 [14.4, 24] weeks, p < .001), but required fewer hospital days than IMT (median, [IQR], FBT = 1 [0, 16] vs. IMT = 123 [101, 180], p < .001). Baseline comorbidity-adjusted changes over 12 months did not differ between groups in %mBMI (FBT = 12.6 ± 11.9 vs. IMT = 13.7 ± 9.1; p = .702) and EDE-Q global score (median, [IQR]; FBT = -1.2 [-2.3, 0.2] vs. IMT = -1.3 [-2.8, -0.4]; p = .733). DISCUSSION Implementing FBT in this pilot study was feasible, acceptable, and safe for youth eligible for IMT according to German S3 guidelines. Non-inferiority of FBT versus IMT requires confirmation in a sufficiently large multicenter RCT. PUBLIC SIGNIFICANCE This pilot study with 62 adolescent patients with anorexia nervosa demonstrated that for 2/3rd of patients eligible for a long hospitalization in the German health care system, outpatient, Family-based treatment (FBT) was a safe and feasible treatment alternative. Over 12 months, FBT lead to similar weight gain and reduction in eating disorder cognitions as inpatient treatment with fewer hospital days. This pilot study needs to be followed up by a larger, multicenter trial.
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Affiliation(s)
- Verena Haas
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Katja Wechsung
- Center for Social-Pediatric Care/Paediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Vivien Kaiser
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Janine Schmidt
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago (Emeritus), Chicago, USA
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and HumboldtUniversität zu Berlin, Berlin, Germany
- Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- German Center for Mental Health (DZPG), Berlin, Germany
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Manaboriboon B, In-Iw S, Bongsebandhu-Phubhakdi C, Arunakul J, Kamol N, Areekul W, Thunyapipat C, Leelathipkul L, Areemit R. Feeding and eating disorders among hospitalized children and adolescents in Thailand: A 5-year secondary national database analysis. Int J Nurs Pract 2024; 30:e13189. [PMID: 37591310 DOI: 10.1111/ijn.13189] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 06/26/2023] [Accepted: 07/28/2023] [Indexed: 08/19/2023]
Abstract
AIMS This study aimed to present national data for children and adolescents requiring hospitalization in Thailand. BACKGROUND Feeding and eating disorders can cause life-threatening and negative health impacts. In Asia, the prevalence is rising. Data from children and adolescents in Thailand are limited. DESIGN This study is a retrospective study of the national database. METHODS Data from the National Health Security Office database on Universal Health Insurance Coverage (2015-2019) of 0-17-year-olds were analysed by diagnosis (anorexia nervosa, bulimia nervosa, vomiting associated with psychological disturbances, other eating disorders and unspecified eating disorders). Descriptive statistics, chi-square test and multinomial logistic regression were used. RESULTS There were 163 patients, averaging 9.4 ± 5.2 years old, requiring 205 admissions. Most diagnoses showed stable trends, except for a slight decrease in anorexia and unspecified eating disorders. Most admissions were due to unspecified eating disorders and psychogenic vomiting, followed by anorexia nervosa. The overall prevalence was 3.86 per 100 000 admissions. Anorexia had the highest hospital costs and re-admission rates. Anorexia nervosa was most prevalent in early adolescence and females, while bulimia nervosa was most prominent in middle adolescence and had a male predominance. CONCLUSION Early recognition in clinical practice could increase early detection and improve outcomes.
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Affiliation(s)
| | - Supinya In-Iw
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chansuda Bongsebandhu-Phubhakdi
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jiraporn Arunakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Napapailin Kamol
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wirote Areekul
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Lalit Leelathipkul
- Department of Pediatrics, Faculty of Medicine, Thammasat Hospital, Thammasat University, Khlong Nueng, Thailand
| | - Rosawan Areemit
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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35
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Dougherty EN, Bottera AR, Forester G, Schaefer LM, Forbes EE, Wildes JE. Prospective associations between cognitive flexibility and eating disorder symptoms in anorexia nervosa and bulimia nervosa. Psychiatry Res 2024; 332:115717. [PMID: 38183925 PMCID: PMC10872327 DOI: 10.1016/j.psychres.2024.115717] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
This study investigated concurrent and prospective associations between measures of reversal learning and attentional set-shifting and eating disorder symptoms at baseline, 3 months, and 6 months among individuals with anorexia nervosa restricting subtype (AN-R, n = 26), AN binge eating/purging subtype (AN-BP, n = 22), bulimia nervosa (BN, n = 35), and healthy controls (n = 27), and explored whether these associations differed by diagnosis. At baseline, participants completed diagnostic interviews, height/weight measurements, and measures of set-shifting (the Intradimensional/Extradimensional shift task) and reversal learning (a probabilistic reversal learning task). At 3- and 6-month follow-up, participants with eating disorders completed assessments of weight and eating disorder symptoms. A one-way analysis of variance found no evidence that baseline reversal learning and attentional set-shifting differed across diagnostic groups. Multilevel modeling analyses indicated that perseverative errors (an index of reversal learning) predicted an increase in purging over time for individuals with AN-BP and BN. Set-shifting errors differentially predicted frequency of loss of control eating for individuals with AN-BP and BN; however, set-shifting was not related to loss of control eating when examined separately in AN-BP and BN. These findings suggest that disentangling facets of cognitive flexibility may help understand change in eating disorder symptoms.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States
| | - Angeline R Bottera
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., Lawrence, KS 66045, United States
| | - Glen Forester
- Center for Biobehavioral Research, Sanford Research, 120 8th St. S, Fargo, ND 48103, United States
| | - Lauren M Schaefer
- Center for Biobehavioral Research, Sanford Research, 120 8th St. S, Fargo, ND 48103, United States; Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd Stop 9037, Grand Forks, ND 58202, United States
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, United States
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, United States.
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Purvis F, Snowden J. Psychologically informed care of patients with anorexia nervosa on an acute medical ward. Nurs Stand 2024; 39:38-43. [PMID: 38152022 DOI: 10.7748/ns.2023.e12199] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/29/2023]
Abstract
Anorexia nervosa is a challenging and highly distressing illness associated with significant and often debilitating symptoms that affect the person's physical and mental well-being, as well as their wider social networks. Although some patients can make important steps in their recovery in the community, many will become significantly unwell and require medical stabilisation and refeeding in an acute medical ward as a result of significant weight loss. This article describes some of the challenges experienced by adult nurses when caring for patients with anorexia nervosa on acute medical wards and explores how the patient's distress may manifest and complicate the recovery process. The article also discusses the principles of psychologically informed care and therapeutic interactions that nurses can use to promote recovery and ensure optimal practice.
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Affiliation(s)
- Francesca Purvis
- Department of Nursing, Midwifery and Health, School of Health Sciences, University of Southampton, Hampshire, England
| | - Jasmine Snowden
- Department of Nursing, Midwifery and Health, School of Health Sciences, University of Southampton, Hampshire, England
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Matheson BE, Bohon C, Le Grange D, Lock JD. Family-based treatment (FBT) for loss of control (LOC) eating in youth: Current knowledge and future directions. Eat Disord 2024; 32:1-12. [PMID: 38149636 PMCID: PMC10753090 DOI: 10.1080/10640266.2023.2229091] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
Loss of control (LOC) eating in youth is a common disordered eating behavior and associated with negative health and psychological sequalae. Family-based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa and bulimia nervosa (BN) but has not been formally evaluated for adolescents with LOC eating. This study is a secondary data analysis from a randomized controlled clinical trial (NCT00879151) testing FBT for 12-18-year-olds with BN. Data were reanalyzed to examine outcomes for LOC eating episodes, regardless of episode size. Abstinence rates, defined as zero LOC eating episodes (objective or subjective binge episodes) in the previous month, were calculated at the end-of-treatment (EOT), 6-month, and 12-month follow-up time points. Among 51 adolescent participants (M + SD: 15.94 + 1.53 y; 92% female; 23.5% Hispanic; 76.5% Caucasian), FBT significantly reduced LOC eating episodes, with 49% achieving LOC eating abstinence at EOT. At 6-month follow-up, 41% achieved LOC eating abstinence. Of those providing 12-month follow-up data, 73% achieved abstinence. This preliminary exploration suggests that FBT may be effective for youth with LOC eating, regardless of episode size. Additional research is needed to replicate these findings and extend treatments with developmental adaptations for younger children with LOC eating.
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Affiliation(s)
- Brittany E. Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Equip Health, Inc., Carlsbad, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago (Emeritus)
| | - James D. Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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38
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Yim SH, White S. Service evaluation of multi-family therapy for anorexia groups between 2013-2021 in a specialist child and adolescent eating disorders service. Clin Child Psychol Psychiatry 2024; 29:63-75. [PMID: 37501085 DOI: 10.1177/13591045231193249] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
The aims of the service evaluation were to examine the effectiveness of multi-family therapy for anorexia nervosa (MFT-AN) on family relationships, as well as to understand families' experiences of MFT in a specialist child and adolescent eating disorders service between 2013-2021. Mixed-methods were used (t-tests and reflexive thematic analysis). Delivery was in-person in 2013-2019, and moved online from 2020 due to COVID-19. Responses from a total of 57 families and 190 people were analysed. MFT improved family functioning from pre-to post MFT as measured by the Systemic Clinical Observation in Routine Evaluation (SCORE-15). Sub-group analysis by family roles showed that at four-month follow-up, the effects were no longer significant among parents. On the contrary, preliminary analysis showed that although young people did not report any improvement at post-intervention, family functioning was reported to increase at follow-up. Four themes were constructed: being together as a family and as a group; individuality: everyone's recovery is different; MFT as an emotion 'hotpot', and in-person versus virtual groups: not a one-size-fits-all. More robust follow-up data are needed to ascertain the effects of online MFT-AN.
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Affiliation(s)
- See Heng Yim
- Central and Northwest London NHS Foundation Trust, UK
| | - Sam White
- Oxford Health NHS Foundation Trust, UK
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Ayton A, Ibrahim A, Downs J, Baker S, Kumar A, Virgo H, Breen G. From awareness to action: an urgent call to reduce mortality and improve outcomes in eating disorders. Br J Psychiatry 2024; 224:3-5. [PMID: 37850424 DOI: 10.1192/bjp.2023.133] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
High mortality rates and poor outcomes from eating disorders, especially anorexia nervosa, are largely preventable and require urgent action. A national strategy to address this should include prevention; early detection; timely access to integrated physical and psychological treatments; safe management of emergencies; suicide prevention; and investment in training, services and research.
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Affiliation(s)
- Agnes Ayton
- Faculty of Eating Disorders, Royal College of Psychiatrists, London, UK; Cotswold House, Oxford Health NHS Foundation Trust, Oxford, UK; and University of Oxford, Oxford, UK
| | - Ali Ibrahim
- Acorn Lodge, South London and Maudsley NHS Foundation Trust, London, UK
| | - James Downs
- Faculty of Eating Disorders, Royal College of Psychiatrists, London, UK
| | - Suzanne Baker
- Faculty of Eating Disorders, Royal College of Psychiatrists, London, UK; F.E.A.S.T. (Families Empowered and Supporting Treatment for Eating Disorders), London, UK
| | - Ashish Kumar
- Faculty of Eating Disorders, Royal College of Psychiatrists, London, UK; Child and Adolescent Mental Health Services, Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Hope Virgo
- Health and Social Campaigners' Network International, Llandrindod Wells, UK
| | - Gerome Breen
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London, UK
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Dikmeer N, Ersöz Alan B, Foto Özdemir D. The role of mindfulness on the psychological aspects of anorexia nervosa. Clin Child Psychol Psychiatry 2024; 29:15-29. [PMID: 37667411 PMCID: PMC10748460 DOI: 10.1177/13591045231190675] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Emotion regulation, perfectionism, and rumination are perpetuating factors in anorexia nervosa (AN). Mindfulness can be protective and therapeutic. We aimed to understand the relationship between these factors and mindfulness in AN. METHODS 20 adolescent girls in the acute phase of the AN, 16 in remission, and 40 in the control group were evaluated. RESULTS Mindfulness was lowest in the acute AN group. The difference in the acute AN group regarding body dissatisfaction, emotion dysregulation, perfectionism, and mindfulness disappeared after controlling for the effects of depression and anxiety. The predictors of disordered eating in the entire study population were body dissatisfaction and depressive symptoms. Emotion regulation and perfectionism were the predictors of mindfulness in the acute AN group and the entire study population. When mindfulness decreased, concerns about body shape increased in both acute AN and remission groups, while dietary restriction and disordered eating behaviors increased only in the remission group. DISCUSSION Emotion regulation difficulties in acute AN could be related to depression and anxiety. Mindfulness interventions for emotion regulation could be used for depression during the acute phase while for perfectionism in remission. Early intervention for depression and body dissatisfaction seems protective, and mindfulness could be an appropriate intervention.
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Affiliation(s)
| | - Burcu Ersöz Alan
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilşad Foto Özdemir
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Hübel C, Abdulkadir M, Herle M, Palmos AB, Loos RJF, Breen G, Micali N, Bulik CM. Persistent thinness and anorexia nervosa differ on a genomic level. Eur J Hum Genet 2024; 32:117-124. [PMID: 37474786 PMCID: PMC10772076 DOI: 10.1038/s41431-023-01431-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 06/15/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
Thinness and anorexia nervosa are both characterised by persistent low weight. Individuals with anorexia nervosa concurrently report distorted perceptions of their body and engage in weight-loss behaviours, whereas individuals with thinness often wish to gain weight. Both conditions are heritable and share genomics with BMI, but are not genetically correlated with each other. Based on their pattern of genetic associations with other traits, we explored differences between thinness and anorexia nervosa on a genomic level. In Part 1, using publicly available data, we compared genetic correlations of persistent thinness/anorexia nervosa with eleven psychiatric disorders. In Part 2, we identified individuals with adolescent persistent thinness in the Avon Longitudinal Study of Parents and Children (ALSPAC) by latent class growth analysis of measured BMI from 10 to 24 years (n = 6594) and evaluated associations with psychiatric and anthropometric polygenic scores. In Part 1, in contrast to the positive genetic correlations of anorexia nervosa with various psychiatric disorders, persistent thinness showed negative genetic correlations with attention deficit hyperactivity disorder (rgAN = 0.08 vs. rgPT = -0.30), alcohol dependence (rgAN = 0.07 vs. rgPT = -0.44), major depressive disorder (rgAN = 0.27 vs. rgPT = -0.18) and post-traumatic stress disorder (rgAN = 0.26 vs. rgPT = -0.20). In Part 2, individuals with adolescent persistent thinness in the ALSPAC had lower borderline personality disorder polygenic scores (OR = 0.77; Q = 0.01). Overall, results suggest that genetic variants associated with thinness are negatively associated with psychiatric disorders and therefore thinness may be differentiable from anorexia nervosa on a genomic level.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK.
- National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Mohamed Abdulkadir
- National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Moritz Herle
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alish B Palmos
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Ruth J F Loos
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, London, UK
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Centre Ballerup, Ballerup, Denmark
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Nuding L, Lukas L, Platt B, Schulte-Körne G, Sfärlea A. Look me in the eyes! A preliminary study on eye-contact in adolescents with anorexia nervosa. Eur Eat Disord Rev 2024; 32:13-19. [PMID: 37525386 DOI: 10.1002/erv.3016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/16/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often associated with impairments in the socio-emotional domain. Avoidance of eye-contact may underlie some of these difficulties and has been found in adults with AN in several studies. This study aimed to clarify whether adolescents with AN also show reduced eye-contact when viewing social stimuli, that is, faces. METHODS In this cross-sectional study, girls aged 12-18 years with AN (n = 38) were compared with a clinical (girls with depression and/or anxiety disorders; n = 30) and a healthy (n = 36) control group. Eye-contact was operationalised as maintenance of visual attention to the eye-area of faces showing different emotional expressions (happy, angry, afraid, sad, neutral), recorded via eye-tracking. RESULTS Contrary to our expectations, we did not find adolescents with AN to dwell less on the eye-area than control groups; instead, we found preliminary evidence for increased attention to the eye-area in the AN group compared to the healthy control group. CONCLUSIONS The results suggest that reduced eye-contact found in adult AN samples is not (yet) present in adolescents with AN but may develop with the prolonged duration of the disorder. However, replication and longitudinal studies are needed to confirm this assumption.
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Affiliation(s)
- Laura Nuding
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Borghesi F, Mancuso V, Bruni F, Cremascoli R, Bianchi L, Mendolicchio L, Cattaldo S, Chirico A, Mauro A, Pedroli E, Cipresso P. Mental flexibility assessment: A research protocol for patients with Parkinson's Disease and Anorexia Nervosa. PLoS One 2023; 18:e0293921. [PMID: 38117804 PMCID: PMC10732438 DOI: 10.1371/journal.pone.0293921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/22/2023] [Indexed: 12/22/2023] Open
Abstract
Mental Flexibility oscillates between adaptive variability in behavior and the capacity to restore homeostasis, linked to mental health. It has recently been one of the most investigated abilities in mental and neurological diseases such as Anorexia nervosa and Parkinson's disease, studied for rigidity or cognitive inflexibility. Patients with anorexia nervosa have rigid cognitive processes about food and weight, which leads to restrictive eating and excessive exercise. People who struggle to adapt their cognitive processes and actions to change their diet and exercise habits may have a harder time recovering from the disorder. On the other hand, research suggests that Parkinson's disease patients may have cognitive flexibility impairments that impair their ability to perform daily tasks and adapt to new environments. Although of clinical interest, mental flexibility lacks theoretical liberalization and unified assessment. This study introduces "IntellEGO" a protocol for a new, multidimensional psychometric assessment of flexibility. This assessment evaluates a person's authentic ability to handle daily challenges using cognitive, emotional, and behavioral factors. Since traditional assessments often focus on one domain, we aim to examine flexibility from multiple angles, acknowledging the importance of viewing people as whole beings with mental and physical aspects. The study protocol includes two assessment phases separated by a rehabilitation period. T0, the acute phase upon admission, and T1, the post-rehabilitation phase lasting 15 days for Parkinson's patients and 4 weeks for eating disorder patients, will be assessed. Neuropsychological performance, self-report questionnaires, psychophysiological measures, and neuroendocrine measures will be collected from Anorexia Nervosa and Parkinson's Disease patients during each study phase. The objective of this procedure is to provide clinicians with a comprehensive framework for conducting meticulous assessments of mental flexibility. This framework considers emotional, cognitive, and behavioral factors, and is applicable to various patient populations.
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Affiliation(s)
| | | | | | - Riccardo Cremascoli
- Istituto Auxologico Italiano, IRCCS, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital Piancavallo, Verbania, Italy
| | - Laura Bianchi
- Istituto Auxologico Italiano, IRCCS, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital Piancavallo, Verbania, Italy
| | - Leonardo Mendolicchio
- Istituto Auxologico Italiano, IRCCS, Unity of Eating Disorders, San Giuseppe Hospital Piancavallo, Verbania, Italy
| | - Stefania Cattaldo
- Istituto Auxologico Italiano, IRCCS, Laboratory of Clinical Neurobiology, San Giuseppe Hospital Piancavallo, Verbania, Italy
| | - Alice Chirico
- Department of Psychology, Research Center in Communication Psychology, Universitá Cattolica del Sacro Cuore, Milan, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital Piancavallo, Verbania, Italy
- Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Elisa Pedroli
- Faculty of Psychology, eCampus University, Novedrate, Italy
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Pietro Cipresso
- Department of Psychology, University of Turin, Turin, Italy
- Istituto Auxologico Italiano, IRCCS, Unit of Neurology and Neurorehabilitation, San Giuseppe Hospital Piancavallo, Verbania, Italy
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Korczynski S, Khiar Zerrouk A, Revah-Levy A, Sibeoni J, Lachal J. Issues around food in mixed families of adolescent girls with bulimia nervosa: A qualitative study with photo-elicitation. Encephale 2023; 49:606-611. [PMID: 36253177 DOI: 10.1016/j.encep.2022.08.019] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Bulimia nervosa (BN) is a common psychiatric disorder among adolescent girls with potentially significant complications. Family relationships play a major role in the development and progression of this disorder. Studies in migrant populations suffering from eating disorders show contrasting results depending on the generation of migrants: first generation migrants have fewer eating disorders than the native population, while the prevalence of this disorder is more important than the latter among second and third generation migrants. In our clinical experience, we have frequently encountered so-called "mixed" families, which are families composed of one migrant parent and one non-migrant parent. Research focusing on this kind of family is scarce which is why we chose to explore their dynamic. METHODS This study explored the issues around food and family relationships of adolescent girls suffering from BN, a topic that, to date, has not yet been studied. Ten interviews were conducted with five adolescent girls with BN between the ages of 16 and 20 and their parents, using photo-elicitation to enrich the collected data. RESULTS The results were organized around two axes: (1) identity issues around food, that is the assimilation process described by both parents and adolescents concerning family meals and food habits, and how the adolescents struggle to manage this interbreeding; and (2) transmission issues with the consequences the migrant parent has to deal with to transmit his/her cultural identity with food while being far away from the homeland, and the difficulties between this parent and his/her child to share this heritage. Both issues, identity and transmission, appear to be central among these families. CONCLUSIONS Our results suggest a difficulty in mentalizing identity issues in adolescent girls; the function of appeasement around non-mentalized tensions was highlighted. In our opinion, in this particular context, BN acts as a means of expressing the difficulty of their mixed culture. This enables it to draw some clinical implications, especially using mentalization-based therapy which has already shown efficacy in adolescents with borderline personality disorder and ED.
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Affiliation(s)
- S Korczynski
- University of Lorraine, 54000 Nancy, France; Service of Adolescent Psychiatry, Hospital Center of Jury, Maison des Adolescents de Metz, 57000 Metz, France.
| | - A Khiar Zerrouk
- University of Lorraine, 54000 Nancy, France; Service of Adolescent Psychiatry, Hospital Center of Jury, Maison des Adolescents de Metz, 57000 Metz, France; Université de Lorraine, Laboratoire INTERPSY, UR 4432, Team PRISME, F- 54000 Nancy, France
| | - A Revah-Levy
- University Service of Adolescent Psychiatry, Argenteuil Hospital Centre, 69, rue du Lieutenant-Colonel Prud'hon, 95107 Argenteuil Cedex, France; ECSTRRA Team, UMR-1153, Inserm, université de Paris, 75010 Paris, France
| | - J Sibeoni
- University Service of Adolescent Psychiatry, Argenteuil Hospital Centre, 69, rue du Lieutenant-Colonel Prud'hon, 95107 Argenteuil Cedex, France; ECSTRRA Team, UMR-1153, Inserm, université de Paris, 75010 Paris, France
| | - J Lachal
- Child and Adolescent Psychiatry Service, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; University of Clermont Auvergne, 63000 Clermont-Ferrand, France; University Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
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Guérin AC, Lemonnier S, Keribin T, Lavrilloux M, Jacob Alby V. [Anorexia nervosa and the perinatal period]. Soins 2023; 68:34-36. [PMID: 38070980 DOI: 10.1016/j.soin.2023.10.009] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.
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Affiliation(s)
| | - Sylvie Lemonnier
- Université catholique de l'Ouest, Bretagne Nord, 37 rue du Maréchal-Foch, 22200 Guingamp, France
| | - Titouan Keribin
- Université catholique de l'Ouest, place André-Leroy, 49100 Angers, France
| | - Mathilde Lavrilloux
- Université catholique de l'Ouest, Bretagne Nord, 37 rue du Maréchal-Foch, 22200 Guingamp, France
| | - Virginie Jacob Alby
- Université catholique de l'Ouest, Bretagne Nord, 37 rue du Maréchal-Foch, 22200 Guingamp, France.
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Muroni O, Sudres JL. [Unconditional self-acceptance and self-compassion: another clinic for anorexia nervosa?]. Soins 2023; 68:41-44. [PMID: 38070982 DOI: 10.1016/j.soin.2023.10.011] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
People suffering from anorexia have a particular emotional and cognitive profile (altered body and self-perception, emotional dysregulation, perfectionism, obsessive traits), which the disorder can compensate for through emotional distancing strategies. Self-compassion and unconditional self-acceptance have been shown to have therapeutic effects on the barriers to recovery associated with this profile.
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Affiliation(s)
- Océane Muroni
- Laboratoire CERPPS EA 7411 (Centre d'études et de recherches en psychopathologie et psychologie de la santé), Université Toulouse 2 Jean-Jaurès, 5 allée Antonio-Machado, 31058 Toulouse, France
| | - Jean-Luc Sudres
- Laboratoire CERPPS EA 7411 (Centre d'études et de recherches en psychopathologie et psychologie de la santé), Université Toulouse 2 Jean-Jaurès, 5 allée Antonio-Machado, 31058 Toulouse, France; Clinique Castelviel, Hôpital de jour L'Oasis, chemin des Affieux, 31180 Castelmaurou, France.
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Palmer S, Brockmeyer T, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. Words count in psychotherapy: Differentiating language characteristics of cognitive behavioral therapy and focal psychodynamic therapy for anorexia nervosa. Psychotherapy (Chic) 2023; 60:488-496. [PMID: 37824236 DOI: 10.1037/pst0000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
It is generally assumed that psychodynamic therapy and cognitive behavioral therapy (CBT) differ in terms of applied techniques and processes. To date, however, little is known about whether and how such differences can actually be observed at a basic linguistic level and in what the two treatment approaches differ most strongly (i.e., how psychodynamic and CBT therapists differ in what they actually say word-by-word in therapy sessions). Building on theoretical models and previous research that used observer ratings, we formulated specific hypotheses regarding which word categories psychodynamic and CBT therapists who treat patients with an eating disorder should differ in. To investigate these hypotheses, we used verbatim transcripts from 297 therapy sessions of a randomized controlled trial in which patients with anorexia nervosa (n = 88) received either focal psychodynamic therapy (FPT) or CBT. These transcripts were then examined using computerized quantitative text analysis. In line with our hypotheses, we found that CBT therapists overall spoke more than their FPT counterparts and that they used more words related to eating. Also in line with our hypotheses, FPT therapists used more words related to social processes. Contrary to our expectations, CBT therapists did not show a stronger focus on the future but talked more about emotions than FPT therapists. The latter effect, however, appears to be driven by a stronger focus on positive emotions. These findings suggest that computerized quantitative text analysis can differentiate meaningful language characteristics of CBT and FPT on spoken-word level and that it holds potential as a tool for researchers and therapists. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Simon Palmer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen
| | - Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, Center of Excellence in Eating Disorders, University Hospital Tuebingen
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School
| | - Andreas Dinkel
- Department of PsychosomaticMedicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf
| | - Sefik Tagay
- Faculty of Social Sciences, TH Koln-University of Applied Sciences
| | - Eva Rothermund
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital
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Sader M, Waiter GD, Williams JHG. The cerebellum plays more than one role in the dysregulation of appetite: Review of structural evidence from typical and eating disorder populations. Brain Behav 2023; 13:e3286. [PMID: 37830247 PMCID: PMC10726807 DOI: 10.1002/brb3.3286] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 09/14/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Dysregulated appetite control is characteristic of anorexia nervosa (AN), bulimia nervosa (BN), and obesity (OB). Studies using a broad range of methods suggest the cerebellum plays an important role in aspects of weight and appetite control, and is implicated in both AN and OB by reports of aberrant gray matter volume (GMV) compared to nonclinical populations. As functions of the cerebellum are anatomically segregated, specific localization of aberrant anatomy may indicate the mechanisms of its relationship with weight and appetite in different states. We sought to determine if there were consistencies in regions of cerebellar GMV changes in AN/BN and OB, as well as across normative (NOR) variation. METHOD Systematic review and meta-analysis using GingerALE. RESULTS Twenty-six publications were identified as either case-control studies (nOB = 277; nAN/BN = 510) or regressed weight from NOR data against brain volume (total n = 3830). AN/BN and OB analyses both showed consistently decreased GMV within Crus I and Lobule VI, but volume reduction was bilateral for AN/BN and unilateral for OB. Analysis of the NOR data set identified a cluster in right posterior lobe that overlapped with AN/BN cerebellar reduction. Sensitivity analyses indicated robust repeatability for NOR and AN/BN cohorts, but found OB-specific heterogeneity. DISCUSSION Findings suggest that more than one area of the cerebellum is involved in control of eating behavior and may be differentially affected in normal variation and pathological conditions. Specifically, we hypothesize an association with sensorimotor and emotional learning via Lobule VI in AN/BN, and executive function via Crus I in OB.
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Affiliation(s)
- Michelle Sader
- Biomedical Imaging CentreUniversity of AberdeenAberdeenUK
| | | | - Justin H. G. Williams
- Biomedical Imaging CentreUniversity of AberdeenAberdeenUK
- School of MedicineGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast Mental Health and Specialist ServicesGold CoastQueenslandAustralia
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Sorel O, Saint-Jammes JT. [From diagnosis to symptoms]. Soins 2023; 68:30-33. [PMID: 38070979 DOI: 10.1016/j.soin.2023.10.008] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The diagnosis of anorexia nervosa is one of the easiest to make in that it is a positive diagnosis, not a differential diagnosis. It is defined by a few criteria which together become almost pathognomonic: excessive restriction of energy intake combined with an irrational fear of weight and an altered body image. Even if weight is at the heart of the medical team's concerns, it is important to question the pathology in its history, in order to put it in to context, and sometimes to understand the para-logic and its function in the patient's life history. It is necessary to work on emotions and cognitions in addition to behaviour.
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Affiliation(s)
- Olivier Sorel
- IOS-psychothérapie et formation, 3 bis rue de la Tuilerie, 37550 Saint-Avertin, France; Cellule d'urgence médico-psychologique, Zone sud-ouest, 121 rue de la Bechade, CS 81285, 33076 Bordeaux cedex, France.
| | - Juliane Tortes Saint-Jammes
- Cellule d'urgence médico-psychologique, Zone sud-ouest, 121 rue de la Bechade, CS 81285, 33076 Bordeaux cedex, France; Camea, 1 rue Saint-François-Xavier, 33170 Gradignan, France; Équipe AHeaD, Inserm U1219, Université de Bordeaux-Isped, 146 rue Léo-Saignat, 33076 Bordeaux cedex, France
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Delepaut Gautrin A, Lesteven M, Lossouarn J, Taourirt N. [Clinical management of anorexia nervosa in a hospital ward]. Soins 2023; 68:27-29. [PMID: 38070978 DOI: 10.1016/j.soin.2023.10.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The Lou-Andréas-Salomé unit, which specializes in behavioral addictions, is part of the addictology department of the Nantes university hospital center, and offers inpatient care for people suffering from eating disorders. It manages, prevents or limits the consequences of this addictive pathology, based on the work carried out by a multi-professional team focusing on different areas: somatic, psychological, cognitive, social and family.
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Affiliation(s)
- Annaïck Delepaut Gautrin
- Unité Lou-Andréas-Salomé, service d'addictologie, CHU de Nantes, 85 rue Saint-Jacques, 44093 Nantes cedex 1, France.
| | - Marine Lesteven
- Unité Lou-Andréas-Salomé, service d'addictologie, CHU de Nantes, 85 rue Saint-Jacques, 44093 Nantes cedex 1, France
| | - Julie Lossouarn
- Unité Lou-Andréas-Salomé, service d'addictologie, CHU de Nantes, 85 rue Saint-Jacques, 44093 Nantes cedex 1, France
| | - Nadia Taourirt
- Unité Lou-Andréas-Salomé, service d'addictologie, CHU de Nantes, 85 rue Saint-Jacques, 44093 Nantes cedex 1, France
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