Social cognition in anorexia nervosa: evidence of preserved theory of mind and impaired emotional functioning

BACKGROUND

The findings of the few studies that have to date investigated the way in which individuals with Anorexia Nervosa (AN) navigate their social environment are somewhat contradictory. We undertook this study to shed new light on the social-cognitive profile of patients with AN, analysing Theory of Mind and emotional functioning. Starting from previous evidence on the role of the amygdala in the neurobiology of AN and in the social cognition, we hypothesise preserved Theory of Mind and impaired emotional functioning in patients with AN.

METHODOLOGY

Thirty women diagnosed with AN and thirty-two women matched for education and age were involved in the study. Theory of Mind and emotional functioning were assessed with a set of validated experimental tasks. A measure of perceived social support was also used to test the correlations between this dimension and the social-cognitive profile of AN patients.

PRINCIPAL FINDINGS

The performance of patients with AN is significantly worse than that of healthy controls on tasks assessing emotional functioning, whereas patients' performance is comparable to that of healthy controls on the Theory of Mind task. Correlation analyses showed no relationship between scores on any of the social-cognition tasks and either age of onset or duration of illness. A correlation between social support and emotional functioning was found. This latter result seems to suggest a potential role of social support in the treatment and recovery of AN.

CONCLUSIONS

The pattern of results followed the experimental hypothesis. They may be useful to help us better understand the social-cognitive profile of patients with AN and to contribute to the development of effective interventions based on the ways in which patients with AN actually perceive their social environment.

Persistent amenorrhoea in weight-recovered anorexics: psychological and biological aspects

Demographic, psychopathological and hormonal parameters of 22 women with previous anorexia nervosa (AN) presently recovered, in a state of stabilized nutritional normalization for 3 months to 2 years but with persistent amenorrhoea, and of 20 psychophysically healthy age- and sex-matched normally menstruating controls were studied. Body mass index (BMI) values did not differ in patients and controls. Psychological examination, monitored by Eating Disorder Inventory 1, Bulimic Investigation Test Edinburgh, Yale-Brown-Cornell Eating Disorder Scale, and Tridimensional Personality Questionnaire rating scales, showed the persistence of some of the psychopathological symptoms of AN. Hormonal examinations included basal plasma concentrations of follicle stimulating hormone, luteotropic hormone, estrogens (E), progesterone, thyrotropic hormone, FT(3), FT(4) (immunoradiometric assays), leptin (LEP) (enzymatic-linked-immunosorbent assay) and 24 h urinary free cortisol (immunoradiometric assay). Hormone values were the same in patients and controls, except for E and LEP levels, which were significantly lower in patients than in controls. The concentrations of the two hormones were not correlated with the BMI of the patients, but LEP values were correlated negatively with the difference between the present BMI and the preanorexic one. The values of both hormones correlated negatively with some of the psychopathological aspects typical of AN, in particular with high 'body dissatisfaction', 'ineffectiveness', and 'interpersonal distrust' and with low 'interoceptive awareness'.

A consensus document on definition and diagnostic criteria for orthorexia nervosa

PURPOSE

Since the term orthorexia nervosa (ON) was coined from the Greek (ὀρθός, right and ὄρεξις, appetite) in 1997 to describe an obsession with "correct" eating, it has been used worldwide without a consistent definition. Although multiple authors have proposed diagnostic criteria, and many theoretical papers have been published, no consensus definition of ON exists, empirical primary evidence is limited, and ON is not a standardized diagnosis. These gaps prevent research to identify risk and protective factors, pathophysiology, functional consequences, and evidence-based therapeutic treatments. The aims of the current study are to categorize the common observations and presentations of ON pathology among experts in the eating disorder field, propose tentative diagnostic criteria, and consider which DSM chapter and category would be most appropriate for ON should it be included.

METHODS

47 eating disorder researchers and multidisciplinary treatment specialists from 14 different countries across four continents completed a three-phase modified Delphi process, with 75% agreement determined as the threshold for a statement to be included in the final consensus document. In phase I, participants were asked via online survey to agree or disagree with 67 statements about ON in four categories: A-Definition, Clinical Aspects, Duration; B-Consequences; C-Onset; D-Exclusion Criteria, and comment on their rationale. Responses were used to modify the statements which were then provided to the same participants for phase II, a second round of feedback, again in online survey form. Responses to phase II were used to modify and improve the statements for phase III, in which statements that met the predetermined 75% of agreement threshold were provided for review and commentary by all participants.

RESULTS

27 statements met or exceeded the consensus threshold and were compiled into proposed diagnostic criteria for ON.

CONCLUSIONS

This is the first time a standardized definition of ON has been developed from a worldwide, multidisciplinary cohort of experts. It represents a summary of observations, clinical expertise, and research findings from a wide base of knowledge. It may be used as a base for diagnosis, treatment protocols, and further research to answer the open questions that remain, particularly the functional consequences of ON and how it might be prevented or identified and intervened upon in its early stages. Although the participants encompass many countries and disciplines, further research will be needed to determine if these diagnostic criteria are applicable to the experience of ON in geographic areas not represented in the current expert panel.

LEVEL OF EVIDENCE

Level V: opinions of expert committees.

Risk and resilience factors for specific and general psychopathology worsening in people with Eating Disorders during COVID-19 pandemic: a retrospective Italian multicentre study

PURPOSE

The COVID-19 pandemic restrictions had negative impact on the psychopathology of people with Eating Disorders (EDs). Factors involved in the vulnerability to stressful events have been under-investigated in this population. We aimed to assess which factors contributed to COVID-19-induced worsening in both general and specific psychopathology.

METHODS

Three-hundred and twelve people with a clinically defined diagnosis of an ED and undergoing a specialist ED treatment in different Italian ED services before the spreading of COVID-19 pandemic filled in an online survey. ED specific and general psychopathology changes after COVID-19 quarantine were retrospectively evaluated. Factors related to COVID-19 concerns (financial condition, fear of contagion, perceived social isolation/support, satisfaction in peer, family or sentimental relationships), illness duration and treatment-related variables (type of treatment provided, type of access to care, satisfaction with therapeutic relationships) were included as predicting factors in a structural equational model, which included latent variables consisting of general and ED psychopathology items as outcomes.

RESULTS

A perceived low quality of therapeutic relationships, fear of contagion and increased isolation were positively associated with psychopathology worsening. Reduced satisfaction with family and with friends' relationships and reduced perceived social support were associated with ED and general symptoms deterioration, respectively. No significant effect emerged for intimate relationships, illness duration, economic condition and type of treatment.

CONCLUSIONS

This study provides a comprehensive evaluation of clinical variables associated with psychopathological changes during the COVID-19 lockdown period highlighting potential risk and resilience factors and, possibly, informing treatment as well as prevention strategies for EDs.

LEVEL OF EVIDENCE IV

Evidence obtained from multiple time series analysis such as case studies.

Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology.

Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators.

Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology.

Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.

Body fat distribution before and after weight gain in anorexia nervosa

OBJECTIVE

To study abdominal fat distribution in anorexia nervosa subjects and to assess the effects of initial weight regain on abdominal fat distribution.

DESIGN

Longitudinal, clinical study. The baseline measurement was acquired within four days of admission to the eating disorders clinic. All patients were treated by re-feeding, reinforced by psychotherapy. Following weight regain of at least 5 kg, a second body fat distribution evaluation was performed. Of the 21 subjects evaluated at baseline, 14 achieved the goal of body weight regain and were retested.

PATIENTS

Fourteen subjects (age: 18-38 y; body mass index: 11.5-18.3; relative body weight: 54.9-88.3%).

MEASUREMENTS

Total, subcutaneous and visceral abdominal adipose tissue areas at the L4-L5 level were evaluated by computed tomography.

RESULTS

At baseline the subjects showed a higher proportion of visceral adipose tissue (% visceral adipose tissue = 55.3 +/- 26.1). A significant association was observed between body weight and both subcutaneous adipose tissue and total adipose tissue. A regain of body weight of 7.3 +/- 1.6 kg was accompanied by a significant increase in total adipose tissue, comprising both subcutaneous and visceral adipose tissue. The increase observed in subcutaneous adipose tissue, however, was significantly greater than for visceral adipose tissue (212.6% vs 116.8%, respectively, P < 0.01).

CONCLUSION

The results of the current study show a higher proportion of visceral adipose tissue than subcutaneous adipose tissue in anorexia nervosa subjects. With regain of body weight there is a preferential regain of subcutaneous adipose tissue. These data demonstrate a redistribution of abdominal adipose tissue with weight regain in anorexia nervosa subjects.

Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment

The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive–behavioural therapy and a flexible and personalized component implemented by third‐wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re‐evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.

Interoception and Autonomic Correlates during Social Interactions. Implications for Anorexia

The aim of this study is to investigate the bodily-self in Restrictive Anorexia, focusing on two basic aspects related to the bodily self: autonomic strategies in social behavior, in which others' social desirability features, and social cues (e.g., gaze) are modulated, and interoception (i.e., the sensitivity to stimuli originating inside the body). Furthermore, since previous studies carried out on healthy individuals found that interoception seems to contribute to the autonomic regulation of social behavior, as measured by Respiratory Sinus Arrhythmia (RSA), we aimed to explore this link in anorexia patients, whose ability to perceive their bodily signal seems to be impaired. To this purpose, we compared a group of anorexia patients (ANg; restrictive type) with a group of Healthy Controls (HCg) for RSA responses during both a resting state and a social proxemics task, for their explicit judgments of comfort in social distances during a behavioral proxemics task, and for their Interoceptive Accuracy (IA). The results showed that ANg displayed significantly lower social disposition and a flattened autonomic reactivity during the proxemics task, irrespective of the presence of others' socially desirable features or social cues. Moreover, unlike HCg, the autonomic arousal of ANg did not guide behavioral judgments of social distances. Finally, IA was strictly related to social disposition in both groups, but with opposite trends in ANg. We conclude that autonomic imbalance and its altered relationship with interoception might have a crucial role in anorexia disturbances.

Urinary free cortisol and childhood maltreatments in eating disorder patients: New evidence for an ecophenotype subgroup

Introduction

Increasing neurobiological evidence has suggested the presence of a specific ecophenotype in people with eating disorders (EDs) linked to early maltreatment. Urinary‐free cortisol could strengthen the data and show specific relationships between maltreated subtypes and the hormonal profiles of patients with EDs. This study aims to evaluate the presence of different urinary cortisol in drug‐free patients in the acute phase of the disorder and its relationship with childhood maltreatment.

Methods

A sample of 78 female patients with ED is included in the study. Childhood maltreatment history and 24‐h urinary free cortisol (24‐h UFC) are evaluated at a specialised ED ward admission.

Results

Patients with a maltreatment history show more blunted 24‐h UFC levels than peers without childhood maltreatment (p = 0.001). Regression analysis showed that child abuse is a predictor of the reduction of 24‐h UFC (p < 0.001), with physical abuse (p = 0.011) and sexual abuse (p = 0.050) that could have a more specific impact than other maltreatment subtypes.

Discussion

Childhood maltreatment should be evaluated in ED patients due to its biological impact on the hormonal stress axis, which could impair the ability of patients to respond to standardized ED treatment.

Eating disorder patients with history of maltreatment showed a reduced 24‐h urinary free cortisol.

New data support the evidence about the presence of an ecophenotype ED subgroup.

Reduced 24‐h urinary free cortisol is significantly correlated with child abuses.

Correlation between psychometric and biological parameters in anorexic and bulimic patients during and after an intensive day hospital treatment

This study describes: 1. The therapeutic effects on anorexia nervosa (AN) and bulimia nervosa (BN) patients of a psycho-nutritional intensive day-hospital program; 2. The possible correlation between the changes observed in the psychometric tests and the variations of a number of biological parameters. Forty-six female patients (24 AN and 22 BN) were assessed through a semi-structured clinical interview based on DSM-IV criteria for Eating Disorders (ED) and a number of psychometric tests (SCL-90R, BDI, EDI-2, EAT-40, BITE, BAT) at the beginning and at the end of treatment, and after a 6-month follow-up. At these three times, we also assessed the plasma level of leptin, cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17beta-estradiol together with body mass index (BMI) and menstrual cycle. From beginning to discharge, the scores on all psychometric tests improved in the whole sample, except for the Perfectionism subscale of EDI-2 in both groups (AN and BN), the Anger-Hostility, Phobic Anxiety and Paranoid Ideation subscales of SCL-90 and the Interpersonal Distrust subscale of EDI-2 in the BN group. At follow-up, there was a worsening of the BITE scores and of a number of EDI-2 subscales, especially in the AN subgroup - with these changes correlating with the trend of BMI. In AN patients, plasma leptin levels changed from the beginning to the end of treatment and at follow-up according to BMI changes. The mean plasma leptin level in the BN subgroup was higher than in the AN one. We found a statistically significant correlation with the scores of BDI, SCL-90R Depression and Ineffectiveness subscales, EAT-40, BITE-Symptom subscale and the trend of menses dividing these patients into two subgroups (according to the plasma leptin concentration, higher or lower than the top leptin level in the anorexics). These data seem to confirm that leptin secretion doesn't correlate univocally to BMI.

Negative social emotions and cognition: Shame, guilt and working memory impairments

Negative emotions can have an impact on a variety of cognitive domains, including Working Memory (WM). The present work investigated whether shame and guilt modulate WM performance in a dual-task test both in a non-clinical and a clinical population. In Experiment 1, 76 non-clinical participants performed a dual-task before and after being randomly assigned to shame, guilt or neutral inductions elicited by the writing of autobiographical past experiences. Shame and guilt elicitations were related to impaired WM performances. In Experiment 2, 65 clinical inpatients with eating disorders were assigned to the same procedure. The negative relationship of self-conscious emotions and WM was confirmed. Taken together these results suggest that shame and guilt are related to impairments of WM in both clinical and non-clinical participants.

Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study

PURPOSE

The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs).

METHODS

320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient.

RESULTS

Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037).

DISCUSSION

Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings.

LEVEL OF EVIDENCE

III, cohort or case-control analytic studies.

Relation between vitamin D and impulse behaviours in patients with eating disorder: a pilot observational study

OBJECTIVE

There is growing evidence that vitamin D levels have a role not only in bone health and energy metabolism, but also for supporting nervous system and brain functions, including impulsivity. Impulsive behaviours are considered characteristics of great relevance in patients with Eating Disorders (ED) both for the course of the illness and for the treatment. The aim of this study is to examine the relationship between impulsive behaviours and vitamin D in patients with ED.

METHOD

236 patients with a diagnosis of ED, consecutively recruited at an ED ward between 2014 and 2018, were enrolled. Patients were classified as impulsive or non-impulsive based on the presence of clinically relevant impulsive behaviours.

RESULTS

Impulsive patients were found to have statistically significant lower levels of vitamin D than non-impulsive (p = .007). A threshold value of 20.4 ng/ml for discriminating impulsive from non-impulsive patients was found.

DISCUSSION

This hypothesis generating study partially confirmed a relationship between vitamin D deficiency and impulsive behaviours in ED spectrum mediated by body weight, even if results were not confirmed after corrected by obesity. No definitive conclusion may be taken on whether the effect is reduced due to the loss of power. Future directions are discussed.

Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders (EDs) may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs.

Method: A sample of patients with eating disorders (N = 157) completed a battery of measures assessing mentalization and related variables, including the Reflective Functioning Questionnaire (RFQ), the Difficulties in Emotion Regulation Strategies (DERS), the Interpersonal Reactivity Index (IRI). Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale (MMS), and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation (DERS), empathy (IRI), and adequate and impairments in mentalizing (MMS and RFQ).

Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: (1) affective/self/automatic imbalances, (2) external imbalance, (3) cognitive/self/automatic imbalances, and (4) cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients.

Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis.

Altered orienting of attention in anorexia nervosa

The study of cognitive processes in anorexia nervosa (AN) is largely unexplored, although recent evidence suggests the presence of impairments in both social cognition and attention processing. Here we investigated AN patients' ability to orient attention in response to social and symbolic visual stimuli. AN patients and matched controls performed a task in which gaze and pointing gestures acted as social directional cues for spatial attention. Arrows were also included as symbolic cue. On each trial, a centrally-placed cue appeared oriented rightwards or leftwards. After either 200 or 700ms, a lateralized neutral target (a letter) requiring a discrimination response appeared in a location either spatially congruent or incongruent with the directional cue. Controls showed a reliable orienting irrespective of both temporal interval and cue type. AN patients showed a reliable orienting at both temporal intervals only in response to pointing gestures. Both gaze and arrow cues failed to orient attention at the short temporal interval, that is when attention is under reflexive control, whereas a reliable orienting emerged at the long temporal interval. These results provide preliminary evidence of altered reflexive orienting of attention in AN patients that does not extend to body-related cues such as pointing gestures.

The Anticipation and Perception of Affective Touch in Women with and Recovered from Anorexia Nervosa

Disruptions in reward processing and anhedonia have long been observed in Anorexia Nervosa (AN). Interoceptive deficits have also been observed in AN, including reduced tactile pleasure. However, the extent to which this tactile anhedonia is specifically liked to an impairment in a specialised, interoceptive C-tactile system originating at the periphery, or a more top-down mechanism in the processing of tactile pleasantness remains debated. Here, we investigated differences between patients with and recovered from AN (RAN) and healthy controls (HC) in the perception of pleasantness of touch delivered in a CT-optimal versus a CT-non-optimal manner, and in their top-down, anticipatory beliefs about the perceived pleasantness of touch. To this end, we measured the anticipated pleasantness of various materials touching the skin and the perceived pleasantness of light, dynamic touch applied to the forearm of 27 women with AN, 24 women who have recovered and 30 HCs using C Tactile (CT) afferents-optimal (slow) and non-optimal (fast) velocities. Our results showed that both clinical groups anticipated tactile experiences and rated delivered tactile stimuli as less pleasant than HCs, but the latter difference was not related to the CT optimality of the stimulation. Instead, differences in the perception of CT-optimal touch were predicted by differences in top-down beliefs, alexithymia and interoceptive sensibility. Thus, tactile anhedonia in AN might persist as a trait even after otherwise successful recovery of AN and it is not linked to a bottom-up interoceptive deficit in the CT system, but rather to a learned, defective top-down anticipation of tactile pleasantness.

Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit

Objective

Cognitive remediation therapy (CRT) has been proposed as an add‐on treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit.

Methods

A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8‐weeks protocol. To evaluate the treatment implementation effect, different self‐administered questionnaires were used.

Results

The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self‐confidence about the ability to change (p < 0.001), and less short‐term focus (p < 0.001), with no differences between restrictive and binge‐purging patients.

Conclusion

This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge‐purge type.

Cognitive remediation therapy (CRT) could be implemented in an inpatient setting with a rolling protocol

CRT improves flexibility, drive to change, and therapy engagement

No differences between restrictive or binge/purge subgroups

Both adolescent and adult patients improved their cognitive styles

Health-related quality of life assessment in eating disorders: adjustment and validation of a specific scale with the inclusion of an interpersonal domain

PURPOSE

Quality of life is a fundamental aspect of both clinical practice and research on eating disorders (ED) due to the significant impacts these disorders have on everyday life. Disorder-specific scales can improve the quality of research and findings and offer greater sensitivity and responsiveness. However, no specific instrument is available in Italian for ED. The aim of this paper is to adjust and to validate a reliable scale with specific items regarding physical and interpersonal well-being.

METHODS

The Italian version of the Eating Disorder Quality of Life (IEDQOL) scale was developed, on the basis of the original English scale, with the addition of items pertaining to physical well-being and interpersonal interactions. In this study, 180 ED patients and 190 healthy controls from the community were enrolled both from inpatient units and outpatient services. A statistical analysis with an exploratory factorial approach was performed in order to validate the tool.

RESULTS

The results showed that the IEDQOL has very good psychometric properties with test-retest validity and sensitivity between patients and controls (d = 2.17 for total score). Moreover, the interpersonal domain showed excellent psychometric values (Cronbach's α > 0.70 in all the subgroups) and a robust correlation with other quality of life constructs.

CONCLUSION

Future studies on the Italian population should use IEDQOL as outcome element that can be useful also with other disorder-specific psychopathological constructs and corroborate the reliability of the data. Future research in the ED field should only use this specific tool.

LEVEL OF EVIDENCE

Case-control analytic study, Level III.

Altered social attention in anorexia nervosa during real social interaction

The capacity to devote attentional resources in response to body-related signals provided by others is still largely unexplored in individuals with Anorexia Nervosa (AN). Here, we tested this capacity through a novel paradigm that mimics a social interaction with a real partner. Healthy individuals (Experiment 1) and individuals with AN (Experiment 2) completed a task with another person which consisted in performing, alternatively, rapid aiming movements to lateralised targets. Generally, this task leads to a form of Inhibition of Return (IOR), which consists of longer reaction times when an individual has to respond to a location previously searched by either himself (individual IOR) or by the partner (social IOR) as compared to previously unexplored locations. IOR is considered as an important attentional mechanism that promotes an effective exploration of the environment during social interaction. Here, healthy individuals displayed both individual and social IOR that were both reliable and of the same magnitude. Individuals with AN displayed a non-significant individual IOR but a reliable social IOR that was also significantly stronger than individual IOR. These results suggest the presence of a reduced sensitivity in processing body-related stimuli conveyed by oneself in individuals with AN which is reflected in action-based attentional processes.

Visual evaluation of food amount in patients affected by Anorexia Nervosa

OBJECTIVE

The study compares visual evaluation of an amount of food and an amount of nonedible objects in patients affected by Anorexia Nervosa and control subjects.

METHOD

59 anorexic subjects were asked to evaluate an amount of candies and plastic bricks shown to them. Their answers were compared to both the real number of objects and the parallel evaluations given by 56 control subjects.

RESULTS

There were no significant differences in stimuli evaluation between patients affected by AN and control subjects. Both groups reported a significantly lower number of both candies and bricks in comparison to their real number.

DISCUSSION

In an experimental condition not related with food intake there is the same under-evaluation of the amount of presented food and nonedible objects among patients affected by AN and Control Subjects. The clinical finding of overestimation of food intake among patients affected by AN seems not to be due to a perceptive bias.

Family backgrounds and eating disorders

The aim of this study was to assess the possible relationship between the presence of a pathological family background and various eating disorders subgroups. A semi-structured interview was used to assess the socio-demographic and clinical characteristics and the presence of psychological complaints among family members of 79 subjects with anorexia nervosa (AN) and 34 subjects with bulimia nervosa (BN). The subjects were also administered the following self-assessment questionnaires: BITE, EDI, and HSCL-90. There were nonsignificant differences between AN and BN in terms of parental mental disorders. A further subdivision of the patients (as indicated in DSM-IV) revealed significant differences in the distribution of psychiatric family history. In particular, it seems that the presence of purgative behavior is associated with a higher incidence of a pathological family background. These results suggest that pathological family histories are not responsible for the development of ED, but they are an aggravating factor both in AN and BN.