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Anić P, Mohorić T, Pokrajac-Bulian A. Self-Esteem and Anxiety as Mediators in the Relationship Between Emotional Intelligence and Eating Disorder Symptoms. Psychol Rep 2024:332941241269451. [PMID: 39096186 DOI: 10.1177/00332941241269451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
This study investigated the relationship between emotional intelligence (EI) and eating disorder symptoms (EDS) by testing the serial mediation model, with self-esteem and anxiety as mediators. A total of 923 participants (61.9% female) aged 15-60 years completed questionnaires assessing their EI, self-esteem, anxiety, and EDS. Correlational analyses were conducted to assess the relationship between the study variables, and a serial mediation analysis was conducted to test the possible mediating role of self-esteem and anxiety in the relationship between EI and EDS. Correlation analyses revealed significant bivariate relationships between EI, self-esteem, and anxiety, but no significant correlation between EI and EDS. The relationship between EI and EDS was serially mediated by self-esteem and anxiety. High levels of EI were associated with higher self-esteem, which, in turn, was associated with lower anxiety and less EDS. The results offer potential mechanisms that could explain the relationship between EI and EDS and highlight the importance of EI in regulating eating behavior through self-esteem and anxiety.
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Affiliation(s)
- Petra Anić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Rijeka, Croatia
| | - Tamara Mohorić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Rijeka, Croatia
| | - Alessandra Pokrajac-Bulian
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Rijeka, Croatia
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Bazo Perez M, Frazier LD. Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors. J Eat Disord 2024; 12:62. [PMID: 38773646 PMCID: PMC11110273 DOI: 10.1186/s40337-024-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/15/2024] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs. METHODS Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors. RESULTS The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies. DISCUSSION Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.
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Affiliation(s)
- Maria Bazo Perez
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Leslie D Frazier
- Department of Psychology, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
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Theodoropoulou O, Holyoak L, Caswell N, Gardner KJ. The continuation of non-physical abuse from childhood to adulthood in eating disorder patients: An interpretative phenomenological analysis. CHILD ABUSE & NEGLECT 2024; 149:106661. [PMID: 38295605 DOI: 10.1016/j.chiabu.2024.106661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The ED literature has focused on the physical forms of childhood abuse with respect to eating disorders, overlooking non-physical abuse even though eating disorder patients report the latter either as primary experiences or as a revival of their childhood experiences. Additionally, there is no literature exploring whether adult eating disorder patients who have experienced childhood non-physical abuse continue to experience abuse as adults, and if they do, how well-being is impacted or linked with eating pathology. OBJECTIVE This study explored the lived experiences of eating disorders patients who have experienced non-physical childhood abuse in childhood and adulthood. PARTICIPANTS AND SETTINGS Six adult female eating disorder outpatients each took part in a semi-structured interview. METHODS This study used the Interpretative Phenomenological Analysis framework. RESULTS Three master themes and eleven superordinate themes were drawn from the analysis, addressing the research question: continuation of non-physical abuse across a lifetime, developmental factors and non-physical abuse, and non-physical abuse and eating pathology. CONCLUSIONS The participants' accounts indicate that childhood non-physical abuse is related to eating disorder onset, and abuse continuation in adulthood contributes to the disorder's maintenance. Moreover, the lifelong consequences of non-physical childhood abuse impact psychological factors, such as self-esteem, attachment and emotion regulation, affecting the individuals' adult lives and keeping participants inside a vicious cycle of trauma re-enactment. Low self-esteem is considered by the participants as the key factor for their disturbed relationship with food.
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Affiliation(s)
- Olga Theodoropoulou
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Lynda Holyoak
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Noreen Caswell
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Kathryn Jane Gardner
- School of Psychology and Computer Science, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK
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Vaioli G, Bastoni I, Villa V, Mendolicchio L, Castelnuovo G, Mauro A, Scarpina F. "I cannot see your fear!" Altered recognition of fearful facial expressions in anorexia nervosa. Front Psychol 2023; 14:1280719. [PMID: 38125860 PMCID: PMC10732310 DOI: 10.3389/fpsyg.2023.1280719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Background The evidence about facial emotion recognition in anorexia nervosa as the role of alexithymic traits on this emotional ability is conflicting and heterogeneous. Objective We assessed the capability of recognizing facial expressions of two primary emotions, fear, and anger, in the context of anorexia nervosa. Methods Women affected by anorexia nervosa were compared with healthy weight women in a well-established implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the individual levels of alexithymia were assessed through a standard self-report questionnaire. Results Participants with anorexia nervosa reported a significantly lower performance in terms of reaction time and accuracy when the emotion of fear-but not anger-was the target. Notably, such an alteration was linked to the levels of alexithymia reported in the self-report questionnaire. Conclusion In anorexia nervosa, difficulties in processing facial fearful (but not angry) expressions may be observed as linked to higher expressions of alexithymic traits. We suggested future research in which emotional processing will be investigated taking into account the role of the bodily dimensions of emotional awareness.
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Affiliation(s)
- Giulia Vaioli
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
| | - Ilaria Bastoni
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
| | - Valentina Villa
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
| | - Leonardo Mendolicchio
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. dei Disturbi del Comportamento Alimentare, Ospedale San Giuseppe, Piancavallo, Italy
| | - Gianluca Castelnuovo
- I.R.C.C.S. Istituto Auxologico Italiano, Laboratorio di Psicologia, Ospedale San Giuseppe, Piancavallo, Italy
- Psychology Department, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Alessandro Mauro
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
| | - Federica Scarpina
- I.R.C.C.S. Istituto Auxologico Italiano, U.O. di Neurologia e Neuroriabilitazione, Ospedale San Giuseppe, Piancavallo, Italy
- “Rita Levi Montalcini” Department of Neurosciences, University of Turin, Turin, Italy
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Kadriu F, Claes L, Witteman C, Woelk M, Krans J. The effect of imagery rescripting on core beliefs and eating disorder symptoms in a subclinical population. J Behav Ther Exp Psychiatry 2023; 78:101804. [PMID: 36435546 DOI: 10.1016/j.jbtep.2022.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 06/08/2022] [Accepted: 10/29/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES This study compared the effect of imagery rescripting focusing on self-compassion, imagery rescripting focusing on mastery, and a positive memory control condition on (1) emotional responses towards the memory (one day after), (2) changes in the believability of negative core beliefs, and dysfunctional eating behaviors (one week after) in individual at risk for developing an eating disorder. METHODS Female participants (N = 69) were allocated to one of three conditions: ImRs focusing on self-compassion (N = 24), ImRs focusing on self-mastery (N = 23), and positive memory control condition (N = 22). Participants in the ImRs conditions received a 20-min self-guided ImRs intervention, whereas participants in the control condition received a 20-min self-guided task focusing on an unrelated positive memory. RESULTS The experimental manipulation successfully induced the use of self-compassion and mastery strategies in the respective imagery rescripting condition. However, our data show that a single 20-min session of self-guided imagery rescripting focusing on compassion and/or mastery has no effect on the emotional response towards the aversive memory or in the change of core beliefs and eating behaviors at follow up. LIMITATIONS We discuss potential reasons for the null findings, including the use of a single imagery rescripting session, the sample size and the measurement of manipulation checks. CONCLUSION Future studies are needed to rule out methodological explanations for the null results. These findings may be of value for the development of future experimental lab paradigms which aim to evaluate the causal effects and working mechanisms of imagery rescripting.
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Affiliation(s)
- Fortesa Kadriu
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | - Laurence Claes
- Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Faculty of Medicine and Health Sciences, University Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Cilia Witteman
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands
| | - Mandy Woelk
- Department of Clinical Psychology, Utrecht University, the Netherlands
| | - Julie Krans
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, 6525 GD Nijmegen, the Netherlands; Behavior, Health, and Psychopathology, KU Leuven, Tiensestraat 102, 3000, Leuven, Belgium; Pro Persona Overwaal Centre for Anxiety, OCD, and PTSD, Pastoor van Laakstr 48, 6663 CB Nijmegen, the Netherlands
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Masselman I, de Jong PJ, Glashouwer KA. Subjective disgust and facial electromyography responses towards unedited and morphed overweight self-pictures in women with varying levels of eating disorder symptomatology. EUROPEAN EATING DISORDERS REVIEW 2023; 31:98-109. [PMID: 35929599 PMCID: PMC10087951 DOI: 10.1002/erv.2940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/13/2022] [Accepted: 07/02/2022] [Indexed: 12/13/2022]
Abstract
Individuals with an eating disorder (ED) often report to be disgusted by their body. Body-related self-disgust could play an important role in the development and maintenance of EDs. We investigated if women with relatively high ED symptom scores indeed respond with disgust upon exposure to their body as indexed by facial electromyography (fEMG) of the m. levator labii superioris and self-report. Given that one's self-disgust may increase/decrease depending on the relative distance of the own body to the thin ideal, we also assessed women's disgust for overweight- and thin-morphs of their body. Female undergraduate students (N = 104) were photographed and presented with their (morphed) body pictures, next to disgust-relevant and overweight body control pictures. Higher levels of ED symptoms were associated with stronger self-reported disgust to unedited body-pictures and overweight-morphs. Disgust to thin-morphs was unrelated to ED symptoms. Participants generally showed heightened facial disgust towards overweight morphs, yet the strength of facial disgust was unrelated to ED symptoms. Thus, the findings provide evidence for the involvement of heightened body-related self-disgust in ED symptomatology, albeit only on the basis of self-report.
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Affiliation(s)
- Irina Masselman
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Eating Disorders, Accare Child and Adolescent Psychiatry, Groningen, Netherlands
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Lekkas D, Gyorda JA, Jacobson NC. A machine learning investigation into the temporal dynamics of physical activity-mediated emotional regulation in adolescents with anorexia nervosa and healthy controls. EUROPEAN EATING DISORDERS REVIEW 2023; 31:147-165. [PMID: 36005065 PMCID: PMC10082593 DOI: 10.1002/erv.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/06/2022] [Accepted: 08/14/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Anorexia nervosa (AN) is commonly experienced alongside difficulties of emotion regulation (ER). Previous works identified physical activity (PA) as a mechanism for AN sufferers to achieve desired affective states, with evidence towards mitigation of negative affect. However, temporal associations of PA with specific emotional state outcomes are unknown. METHOD Using lag-ensemble machine learning and feature importance analyses, 888 affect-based ecological momentary assessments across N = 75 adolescents with AN (N = 44) and healthy controls (N = 31) were analysed to explore significance of past PA, measured through passively collected wrist-worn actigraphy, with subsequent self-report momentary affect change across 9 affect constructs. RESULTS Among AN adolescents, later lags (≥2.5 h) were important in predicting change across negative emotions (hostility, sadness, fear, guilt). AN-specific model performance on held-out test data revealed the holistic "negative affect" construct as significantly predictable. Only joviality and self-assurance, both positively-valenced constructs, were significantly predictable among healthy-control-specific models. DISCUSSION Results recapitulated previous findings regarding the importance of PA in negative ER for AN individuals. Moreover, PA was found to play a uniquely prominent role in predicting negative affect 4.5-6 h later among AN adolescents. Future research into the PA-ER dynamic will benefit from targeting specific negative emotions across greater temporal scales.
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Affiliation(s)
- Damien Lekkas
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, New Hampshire, USA
| | - Joseph A. Gyorda
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, New Hampshire, USA
| | - Nicholas C. Jacobson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
- Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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Panero M, Longo P, De Bacco C, Abbate-Daga G, Martini M. Shame, Guilt, and Self-Consciousness in Anorexia Nervosa. J Clin Med 2022; 11:jcm11226683. [PMID: 36431160 PMCID: PMC9694537 DOI: 10.3390/jcm11226683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND the role of self-conscious emotions (SCE) such as shame and guilt in eating disorders (ED) has been systematically studied only in recent years, but it is still debated. This study aims to investigate the role of SCE in anorexia nervosa (AN), evaluating the role of self-consciousness. METHODS fifty-five individuals with AN and seventy-four healthy controls (HC) were enrolled and completed a battery of tests evaluating the proneness to feel shame and guilt, as well as comparing self-consciousness, eating, and general psychopathology. RESULTS individuals with AN showed a higher proneness to shame. Shame was correlated with body dissatisfaction and drive for thinness, which are core symptoms in AN, after controlling for scores of depression and anxiety. Proneness to guilt seemed to be less correlated with eating and body symptomatology, but it appeared to have a negative correlation with binge-purging symptoms. Furthermore, proneness to shame was independent of guilt or self-consciousness and the two groups did not differ regarding public and private self-consciousness. CONCLUSIONS shame is an important and independent factor in AN. Future research may offer progress in the development of shame-focused therapies.
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Petersson S, Wåhlin I. A piece of a puzzle-Patient and psychologist experiences of the Affect School as additional treatment in a Swedish eating disorder unit. PLoS One 2022; 17:e0271902. [PMID: 35901040 PMCID: PMC9333312 DOI: 10.1371/journal.pone.0271902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Emotion dysregulation has been shown to be a transdiagnostic characteristic of eating disorders. The Affect School aims to enhance emotional awareness and the ability to perceive and express emotions. This study was conducted as part of an RCT where patients with various eating disorders were randomised to participation in the Affect School as a supplement to treatment. AIM To explore Affect School participants' and leaders' experiences of the Affect school at an Eating Disorder outpatient unit in Sweden. METHOD Nine patients with eating disorder diagnoses and three Affect School leaders at an eating disorder outpatient clinic in Sweden were interviewed for their experiences of the intervention. The interviews were analysed with Thematic Analysis. RESULT Eight themes were revealed at the analysis, five from the participants: "Worries about group participation", "Not alone anymore and gaining new insights about oneself", "Shared stories can also be painful", "Relationships outside the Affect School as a foundation for affective work", and "A change is coming", and three from the leaders:"Affect awareness is important in eating disorders", "Group meetings create opportunities and challenges", and "The Affect School setup needs more customisation". CONCLUSION The results suggested that the Affect School provided an acceptance for experiencing all sorts of affects. Both leaders and participants considered working with affects necessary, although participants reported no changes in their life situation or condition after the intervention but considered the intervention as part of a process with gradual results. Being part of a group and sharing experiences was experienced as positive by participants and leaders, but the model could be further developed to better adapt to patients with an eating disorder.
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Affiliation(s)
- Suzanne Petersson
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Division of Rehabilitation, Region Kalmar County, Kalmar, Sweden
| | - Ingrid Wåhlin
- Department of Health and Caring Science, Linnaeus University, Kalmar, Sweden
- The Research Section, Region Kalmar County, Kalmar, Sweden
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Mason D, James D, Andrew L, Fox JRE. 'The last thing you feel is the self-disgust'. The role of self-directed disgust in men who have attempted suicide: A grounded theory study. Psychol Psychother 2022; 95:575-599. [PMID: 35229436 PMCID: PMC9313556 DOI: 10.1111/papt.12389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Globally, suicide affects more men than women. Emotional pain underpins many theoretical accounts of suicidality, yet little is known about the role of disgust in suicide. Self-directed disgust, whereby aspects of the self-serve as an object of disgust, has been hypothesised to factor in suicide. This research aimed to explore the processes which link self-disgust to attempted suicide in males. METHOD Nine men who had attempted suicide completed semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology. RESULTS Three concepts emerged out of the analysis: (1) self-disgust; (2) worthlessness; and (3) the endured emotional distress of 'the abyss'" - these concepts interweaved, leading the men to experience hopelessness, disconnection and an inability to cope, leading ultimately to their suicide attempt. Throughout this journey, various disgust-related processes worsened men's distress and increased their suicidal risk. Historic adversities prevailed across the data, as did the men's difficulties in understanding their emotions. CONCLUSION Self-disgust was an important emotion in the men's experiences of suicide and shaped their views of themselves and their lives. The distancing and repellent properties of self-disgust, in addition to the fear of having their 'disgustingness' exposed, increased suicidal risk. Self-disgust appeared more pervasive in the suicidality of men with a history of multiple childhood adversities. The limitations of this research are discussed as implications for clinical practice and directions for future research.
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Petersson S, Årestedt K, Birgegård A. Evaluation of the Affect School as supplementary treatment of Swedish women with eating disorders: a randomized clinical trial. J Eat Disord 2022; 10:76. [PMID: 35637512 PMCID: PMC9153112 DOI: 10.1186/s40337-022-00596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite solid research there remains a large group of patients with eating disorders who do not recover. Emotion dysregulation has been shown to be a feature in the different eating disorders. A manualized group intervention developed in Sweden, the Affect School, aims to enhance emotional awareness and the ability to perceive and express emotions. AIM This study aimed to test the hypothesis that participation in the Affect School as a complement to ordinary eating disorder treatment would enhance awareness and regulation of emotions and reduce alexithymia and cognitive eating disorder symptoms in a sample of patients with eating disorders at a Swedish specialized outpatient clinic. METHOD Forty patients with various eating disorders were randomized to either participation in the Affect School as a supplement to treatment as usual (TAU), or to a TAU control group. Participants were assessed with the Eating Disorder Examination Questionnaire, the Deficits in Emotion Regulation Scale-36, and the Toronto Alexithymia Scale-20 at start, end of intervention, and at the 6- and 12-month follow-ups. RESULTS No significant differences were observed post-treatment but Affect School participants had improved significantly more than controls on eating disorder cognitions and behaviours and emotion dysregulation at the 6- and 12-month follow-ups and had significantly less alexithymia at the 6-month follow-up. CONCLUSION Difficulties with emotion recognition and/or regulation can complicate fulfilment of personal needs and obstruct communication and relationships with others. The present study indicates that adding Affect School group sessions to regular treatment enhances emotional awareness and emotion regulation and decreases eating disorder symptoms and alexithymia. Patients with eating disorder diagnoses have described problems with emotional management, for example: lower emotional awareness and difficulties in using adaptive emotional regulatory strategies compared to people without eating disorders. It has been suggested that interventions aiming at enhancing emotional awareness and acceptance would be beneficial in treatment. In the present study we explored whether adding the Affect School to regular treatment would enhance awareness and regulation of emotions and decrease eating disorder symptoms. Forty women with an eating disorder were randomly allocated to either an additional participation in a group treatment for 8 weeks or usual treatment only. The treatment contained education on different affects such as joy, fear, interest, shame, anger, disgust, and worry. The education was followed by discussions on own experiences. Participants filled in self-assessment forms that measured eating disorder symptoms, emotional recognition, and emotion regulation before the start and at the end of the group treatment, and after 6 and 12 months respectively. The results when comparing the two groups suggested that the Affect School could be an effective additional treatment. Participants in the Affect School improved their scorings but the change took time and did not show until at the 6- and 12 months follow-ups.
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Affiliation(s)
- Suzanne Petersson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
- Department of Rehabilitation, Kalmar Regional Council, Hus 13, plan 7, Länssjukhuset, 391 85, Kalmar, Sweden.
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Arunagiri V, Reilly EE. Revisiting alexithymia as an important construct in the treatment of anorexia nervosa: a proposal for future research. Eat Disord 2022; 30:267-278. [PMID: 32966162 DOI: 10.1080/10640266.2020.1814987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Consistent research supports altered emotional processing in adult patients with anorexia nervosa (AN), including elevations in alexithymia, or deficits in identifying and describing emotions and other internal experiences. Despite increasing interest in emotion-focused therapies for AN, alexithymia is often not directly addressed within many existing treatments, and little empirical work has moved beyond descriptive, cross-sectional research. In this paper, we propose that refining the field's understanding of alexithymia may provide insights into poor outcomes in existing psychological treatments for AN. First, we provide a brief overview of existing work exploring alexithymia in AN, and then describe several next steps in treatment-relevant research, including differentiating alexithymia from related constructs, considering neurobiological correlates of alexithymia, testing the link between alexithymia and outcome across treatment modalities, and piloting adjunctive treatment techniques focused on emotional identification and description. Altogether, exploring adjunctive treatment approaches targeting alexithymia may offer one promising possibility for improving long-term outcomes.
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Affiliation(s)
| | - Erin E Reilly
- Department of Psychology, Hofstra University, Hempstead, NY, USA
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Determining the Intensity of Basic Emotions among People Suffering from Anorexia Nervosa Based on Free Statements about Their Body. ELECTRONICS 2022. [DOI: 10.3390/electronics11010138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Objective: This study sought to address one of the challenges of psychiatry-computer aided diagnosis and therapy of anorexia nervosa. The goal of the paper is to present a method of determining the intensity of five emotions (happiness, sadness, anxiety, anger and disgust) in medical notes, which was then used to analyze the feelings of people suffering from anorexia nervosa. In total, 96 notes were researched (46 from people suffering from anorexia and 52 from healthy people). Method: The developed solution allows a comprehensive assessment of the intensity of five feelings (happiness, sadness, anxiety, anger and disgust) occurring in text notes. This method implements Nencki Affective Word List dictionary extension, in which the original version has a limited vocabulary. The method was tested on a group of patients suffering from anorexia nervosa and a control group (healthy people without an eating disorder). Of the analyzed medical, only 8% of the words are in the original dictionary. Results: As a result of the study, two emotional profiles were obtained: one pattern for a healthy person and one for a person suffering from anorexia nervosa. Comparing the average emotional intensity in profiles of a healthy person and person with a disorder, a higher value of happiness intensity is noticeable in the profile of a healthy person than in the profile of a person with an illness. The opposite situation occurs with other emotions (sadness, anxiety, disgust, anger); they reach higher values in the case of the profile of a person suffering from anorexia nervosa. Discussion: The presented method can be used when observing the patient’s progress during applied therapy. It allows us to state whether the chosen method has a positive effect on the mental state of the patient, and if his emotional profile is similar to the emotional profile of a healthy person. The method can also be used during first diagnosis visit.
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Bryant E, Aouad P, Hambleton A, Touyz S, Maguire S. 'In an otherwise limitless world, I was sure of my limit.' † Experiencing Anorexia Nervosa: A phenomenological metasynthesis. Front Psychiatry 2022; 13:894178. [PMID: 35978851 PMCID: PMC9376373 DOI: 10.3389/fpsyt.2022.894178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia Nervosa (AN) has the highest mortality rate of the mental disorders, with still less than 50% of affected individuals achieving recovery. Recent calls to bring innovative, empirical research strategies to the understanding of illness and its core psychopathological features highlight the need to address significant paucity of efficacious treatment. The current study brings a phenomenological approach to this challenge, synthesizing lived experience phenomena as described by qualitative literature. Fifty-three studies published between the years 1998 and 2021 comprising a total of 1557 participants aged 12-66 suffering from AN or sub-threshold AN are included. Reciprocal and refutational analysis generated six key third-order constructs: "emotion experienced as overwhelming," "identity," "AN as a tool," "internal conflict relating to Anorexia," "interpersonal communication difficulties" and "corporeality." Twenty-six sub-themes were identified, the most common being fear, avoidance, AN as guardian/protector, and AN as intertwined with identity. Some themes associated with current treatment models such as low self-esteem, need for social approval and feelings of fatness were less common. We highlight the significant role of intense and confusing emotion in AN, which is both rooted in and engenders amplified fear and anxiety. Restrictive eating functions to numb these feelings and withdraw an individual from a chaotic and threatening world whilst providing a sense of self around which to build an illness identity. Results have implications for therapeutic practice and overly protective weight and shape focused medical treatment models, which may serve to reinforce the disease.
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Affiliation(s)
- Emma Bryant
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Ashlea Hambleton
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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Perthes K, Kirschbaum-Lesch I, Legenbauer T, Holtmann M, Hammerle F, Kolar DR. Emotion regulation in adolescents with anorexia and bulimia nervosa: Differential use of adaptive and maladaptive strategies compared to healthy adolescents. Int J Eat Disord 2021; 54:2206-2212. [PMID: 34542185 DOI: 10.1002/eat.23608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Adolescents with anorexia (AN) and bulimia nervosa (BN) often struggle with emotion regulation (ER). These difficulties have predominantly been assessed across emotions, without considering adaptive and maladaptive ER separately. We compared adolescents with AN or BN to healthy adolescents (HCs) regarding the adaptive and maladaptive ER of three emotions. METHOD A treatment-seeking sample of 197 adolescents (atypical/full-threshold AN: N = 118, atypical/full-threshold BN: N = 32; HC: N = 47) reported emotion-specific ER with the FEEL-KJ questionnaire. Mixed models were calculated for adaptive and maladaptive ER to assess differences between emotions (anxiety, anger, and sadness) and groups (AN, BN, and HC). RESULTS Main effects of emotion (p < .001) and group (p < .001) were found, but no interaction effects were found (p > .05). Post hoc tests showed lower maladaptive and higher adaptive ER for anxiety than anger or sadness (p < .001). AN and BN reported lower adaptive (p < .001) and higher maladaptive ER than HCs (p < .001). BN showed the highest levels of maladaptive ER (p = .009). DISCUSSION The differences between AN and BN in adaptive and maladaptive ER should be considered. Furthermore, investigating differences in ER of other emotions in eating disorders might be promising.
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Affiliation(s)
- Karin Perthes
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany
| | - Inken Kirschbaum-Lesch
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Martin Holtmann
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Florian Hammerle
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany
| | - David R Kolar
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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16
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Marques C, Simão M, Guiomar R, Castilho P. Self-disgust and urge to be thin in eating disorders: how can self-compassion help? Eat Weight Disord 2021; 26:2317-2324. [PMID: 33387278 DOI: 10.1007/s40519-020-01099-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE This study aimed to examine the moderator role of self-compassion in the relationship between self-disgust and drive for thinness, controlling for external shame, in eating disorder patients and in a community sample. METHODS Sixty-two female participants with an eating disorder diagnose and 119 female participants from the community, were asked to fill instruments that assess self-disgust, self-compassion, drive for thinness, and external shame. RESULTS We found a moderator effect of self-compassion on the association between self-disgust and drive for thinness in the clinical sample when adjusting for shame. The association between self-disgust and drive for thinness was buffered among those who reported medium and lower levels of self-compassion. Replicating the findings in the community sample we found no moderator effect of self-compassion. CONCLUSION These results provide evidence that people with eating disorders who perceive the self as highly disgusting may benefit from promoting a self-compassionate response to diminish drive for thinness. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Cristiana Marques
- Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal.
| | - Marta Simão
- Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
- Santa Casa da Misericórdia de Alvaiázere, 3250-115, Alvaiázere, Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3000-115, Coimbra, Portugal
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Lev-Ari L, Zohar AH, Bachner-Melman R. Eating for numbing: a community-based study of trauma exposure, emotion dysregulation, dissociation, body dissatisfaction and eating disorder symptoms. PeerJ 2021; 9:e11899. [PMID: 34430083 PMCID: PMC8349516 DOI: 10.7717/peerj.11899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 12/24/2022] Open
Abstract
Objective The current study tests the relationship between eating disorder (ED) symptoms and trauma exposure. The mechanisms via which trauma is related to ED symptoms have not been sufficiently examined. This study examines the complex role of dissociation and emotional dysregulation in the context of trauma, BMI, ED symptoms and body dissatisfaction (BD). We hypothesized that dissociation and emotional dysregulation would mediate the relationship between trauma exposure and ED symptoms/BD. We further hypothesized that BMI would play a moderating role in this association. Method A community sample of 229 (16.2% male) participants, with a mean age of 29.08 ± 10.68 reported online on traumatic events (Life Events Checklist), dissociation (Dissociative Experiences Scale-II), emotional dysregulation (Difficulties in Emotional Regulation Scale), ED symptoms (Eating Disorders Examination-Questionnaire) and BD (Figure Rating Scale). Results Participants reported experiencing a mean of 2.87 ± 2.27 traumatic events, with a relatively high percentage (~86%) reporting at least one. The most commonly reported traumatic events were transportation accidents and physical assault. Although frequency of traumatic events did not directly predict ED symptoms, BMI, dissociation, emotional dysregulation and BD did. An SEM model showed that traumatic events predicted ED symptoms indirectly through dissociation, emotional dysregulation and BMI. Dissociation and emotional dysregulation predicted ED symptoms directly. BMI also moderated the association between traumatic events and both ED symptoms and BD. Conclusions Therapists treating patients with high BMI or obesity should be aware of these relationships and investigate the possibility that trauma and/or PTSD may underlie the presenting disordered eating or eating disorder.
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Affiliation(s)
- Lilac Lev-Ari
- Clinical Psychology, Ruppin Academic Center, Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Ada H Zohar
- Clinical Psychology, Ruppin Academic Center, Emek Hefer, Israel.,The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Rachel Bachner-Melman
- Clinical Psychology, Ruppin Academic Center, Emek Hefer, Israel.,School of Social Work, Hebrew University of Jerusalem, Jerusalem, Israel
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18
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Manchón J, Quiles MJ, Quiles Y, López-Roig S. Positive and Negative Emotional Eating Are Not the Same-The Spanish Version of the Positive-Negative Emotional Eating Scale (PNEES). Front Psychol 2021; 12:709570. [PMID: 34290657 PMCID: PMC8287204 DOI: 10.3389/fpsyg.2021.709570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
The literature points to the importance of distinguishing between positive and negative emotional eating in relation to overeating and binge eating. The aim of this study was to evaluate the Spanish version of the Positive-Negative Emotional Eating Scale (PNEES) in a Spanish community sample. The sample consisted of 628 participants. The mean age was 27.5 (SD = 12.7) and 70.1% of them were women. The participants completed the PNEES, and measures of anxiety and depression (HADS), and eating disorder-related scales (TFEQ-R18, BULIT-R, and EAT-26) that were selected to examine convergent validity. A confirmatory factor analysis was conducted, replicating the original two-factor solution, consisting of Negative Emotional Eating (PNEES-N) and Positive Emotional Eating (PNEES-P). The results showed an acceptable fit of the model (CFI = 0.986; TLI = 0.984, RMSEA = 0.055). Internal consistency ranged from ω = 0.92 to ω = 0.96 for both subscales and the total score. PNEES-P correlations with other variables were lower with respect to the PNEES-N, showing that they are different constructs. A mediation analysis was conducted, in which PNEES-P significantly predicted binge eating and PNEES-N was a partially mediator variable. The results showed that the adaptation process was successful.
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Romero-Mesa J, Peláez-Fernández MA, Extremera N. Emotional intelligence and eating disorders: a systematic review. Eat Weight Disord 2021; 26:1287-1301. [PMID: 32734465 DOI: 10.1007/s40519-020-00968-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/17/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology, varies across lifespan development. However, while the findings suggest promising results for the development of potential effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and ED due to the diversity of theoretical approaches and variety of EI and ED measures. OBJECTIVE Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and clinical populations and across different developmental stages. METHODS The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used. RESULTS All the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted. CONCLUSION The systematic review suggests promising but challenging preliminary evidence of the associations between EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and limitations are discussed. LEVEL OF EVIDENCE I Systematic review.
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Affiliation(s)
- Juana Romero-Mesa
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
| | - María Angeles Peláez-Fernández
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain.
| | - Natalio Extremera
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology and Logopedics, University of Málaga, Campus de Teatinos, s/n. 29071, Málaga, Spain
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20
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Petersson S, Gullbing L, Perseius KI. Just like fireworks in my brain - a Swedish interview study on experiences of emotions in female patients with eating disorders. J Eat Disord 2021; 9:24. [PMID: 33597045 PMCID: PMC7890966 DOI: 10.1186/s40337-021-00371-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with eating disorders have reported poorer emotional awareness, more emotional suppression, less use of adaptive emotional regulation strategies, and more use of maladaptive emotional regulation strategies compared to people in healthy control groups. AIM To explore experiences of emotions by a transdiagnostic sample of patients with eating disorders. METHOD Nine patients with different eating disorder diagnoses at an eating disorder outpatient clinic in Sweden were interviewed for their thoughts on emotions. The interviews were analyzed with Thematic Analysis. RESULT Four themes were constructed: "Not knowing what one feels", "Switch off, run away, or hide behind a mask", "Emotions in a lifelong perspective", and "Using eating behaviours to regulate emotions". The patients described uncertainty regarding whether they experienced emotions correctly. They described how they tried to avoid difficult emotions through suppressive strategies and eating disorder behaviour. All described strategies were inefficient and all emotions were experienced as problematic, even joy. Since joy was used as a mask, the real experience of happiness was lost and mourned. CONCLUSION All kinds of emotions were considered problematic to experience, but shame, fear, and sadness were considered worst. It is difficult to know if the emotional difficulties preceded an eating disorder, however such difficulties may have increased as a result of the eating disorder.
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Affiliation(s)
- Suzanne Petersson
- Department of Medicine and Optometry, Linnaeus University, Länssjukhuset, Hus 13, plan 7, SE-391 85, Kalmar, Sweden. .,Division of Rehabilitation, Region Kalmar County, Länssjukhuset, Hus 13, Plan 7, SE-391 85, Kalmar, Sweden.
| | - Lydia Gullbing
- Division of Psychiatry, Region Kalmar County, SE-391 85 Kalmar, Sweden
| | - Kent-Inge Perseius
- Department of Caring Science, Linnaeus University, SE-39182, Kalmar, Sweden
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21
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Joyce C, Greasley P, Weatherhead S, Seal K. Beyond the Revolving Door: Long-Term Lived Experience of Eating Disorders and Specialist Service Provision. QUALITATIVE HEALTH RESEARCH 2019; 29:2070-2083. [PMID: 31165677 DOI: 10.1177/1049732319850772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this study, we undertook a narrative analysis of participants' long-term lived experience of eating disorders and specialist service provision. Eight participants were recruited with service experience across five National Health Service (NHS) Trusts in the United Kingdom. All participants had a minimum of 10 years self-reported experience living with an eating disorder. The data are presented across different temporal stages that demonstrate the development of participants' self-construct in relation to their first contact with specialist services, what had happened in their lives for this to become necessary, and their current relationships with services, before exploring what participants need from services to help them feel heard going forward. Findings suggest that current methods of service delivery result in delayed and inappropriate supports and a consequent "battling" against professionals, which can provide an obstacle to compassionate and collaborative working and promote "revolving door" experiences.
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Affiliation(s)
- Ciara Joyce
- Lancaster University, Lancaster, United Kingdom
- Trinity College Dublin, Dublin, Ireland
| | | | | | - Karen Seal
- Lancashire Care NHS Foundation Trust, Preston, United Kingdom
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22
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Rai T, Mainali P, Raza A, Rashid J, Rutkofsky I. Exploring the Link Between Emotional Child Abuse and Anorexia Nervosa: A Psychopathological Correlation. Cureus 2019; 11:e5318. [PMID: 31598427 PMCID: PMC6777933 DOI: 10.7759/cureus.5318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/04/2019] [Indexed: 01/08/2023] Open
Abstract
Eating disorders (ED) are well known psychiatric disorders associated with dysregulated eating behaviors and related thoughts and emotions. Common eating disorders are bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorders (BED). There is an active link between child abuse and eating disorders, emotional child abuse being the important subtype of CA and has a strong comorbid psychopathological relationship with EDs, including AN. The PubMed database was searched for the related articles about child abuse, including emotional childhood maltreatment and their psychopathology associated with EDs, especially AN. No filters were used for the date of publication and article types. Childhood abuse, including physical, sexual, and emotional maltreatment, has an active link with psychopathology associated with dysregulated eating behaviors. However, emotional childhood maltreatment including emotional abuse, neglect, and/or exposure to intimate partner violence (IPV) has been least studied, but studies have shown a strong relationship with the symptoms of anorexia nervosa such as weight concern, negative self-image, and maladaptive emotional response. Emotional dysregulation is the crucial psychopathological factor involved in mediating the effects of emotional childhood maltreatment and symptoms of anorexia nervosa and is strongly associated with long-term morbidity in patients with AN. Conducting more clinical studies in the future would help explore the temporal causation, and this association may help the practitioners to develop new diagnostic and therapeutic strategies in the management of AN.
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Affiliation(s)
- Tehrima Rai
- Pediatrics, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Pranita Mainali
- Psychiatry, Washington DC VA Medical Center, Washington DC, USA
| | - Ali Raza
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Junaid Rashid
- Medicine and Histopathology, California Instititute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ian Rutkofsky
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Henderson ZB, Fox JR, Trayner P, Wittkowski A. Emotional development in eating disorders: A qualitative metasynthesis. Clin Psychol Psychother 2019; 26:440-457. [PMID: 30889630 PMCID: PMC6766861 DOI: 10.1002/cpp.2365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/27/2023]
Abstract
Emotions are considered to be an important feature in eating disorders. The present study aimed to conduct a systematic review and metasynthesis of qualitative studies, which considered the role of emotions in eating disorders in order to gain further insight on how these individuals experience various emotions and the strategies they use to manage them. Databases including Web of Science, PsychInfo, EMBASE, Medline, and the Cochrane library were searched for qualitative studies. The search identified 16 relevant studies. Meta-ethnography was used to synthesize the data, which involved identifying the key findings and concepts of the studies and creating metaphors. The synthesis involved reciprocal translations and lines of argument approaches being applied to the present data. Results of the synthesis identified four second-order themes and one third-order theme relating to the emotional experiences of such individuals. The second-order themes were (a) negative emotional environments, (b) interpersonal vulnerability, (c) the experience of negative emotions in social contexts, and (d) the management of emotions. The third-order theme was the emotional self within a social environment. This is the first metasynthesis on emotions and eating disorders, and our synthesis highlights the important role that emotions play in the development and maintenance of eating disorders. Our model demonstrates how poor emotional development whilst growing up results in development of poor socioemotional bonds and the inability to handle negative emotions. The most significant finding of the review is that individuals use their eating disorder to manage negative emotions.
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Affiliation(s)
- Ziporah B. Henderson
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | | | - Penny Trayner
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health SciencesUniversity of ManchesterManchesterUK
- Department of Clinical Psychology, Greater Manchester Mental Health NHS Foundation TrustManchesterUK
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Korn J, Dietel FA, Hartmann AS. An experimental Study on the Induction of an Eating Disorder-Specific Interpretation Bias in Healthy Individuals: Testing the Interpretation Modification Paradigm for Eating Disorders (IMP-ED). COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10026-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Sex-dependent associations of childhood neglect and bodyweight across the life span. Sci Rep 2019; 9:5080. [PMID: 30911019 PMCID: PMC6434018 DOI: 10.1038/s41598-019-41367-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/07/2019] [Indexed: 01/08/2023] Open
Abstract
Eating disorders and weight problems across the life span have been linked to adverse childhood experiences. Previous research often focused on child abuse and omitted investigating effects of child neglect. The present study evaluates effects of neglect on bodyweight across the life span and how emotional neglect and bodyweight are linked via mental distress. Within a large survey representative of the German population (N = 2,500), individuals completed measures of mental distress, childhood trauma, and height and weight. We conducted logistic regression analyses on bodyweight extremes and a moderated mediation analysis. In men, physical neglect aggravated the risk to be underweight. In women, emotional neglect was linked to severe obesity. In both sexes, emotional neglect was related to mental distress. We found an indirect effect of emotional neglect on bodyweight via mental distress, however, it was only present in women. Our results attest to long-term consequences of adverse early experiences. We showed a possible mechanism for women’s higher vulnerability towards eating disorders. In general, investigations of eating and weight disorders should also include men and employ sex-specific methods of analyses. Lastly, neglect should also receive more attention to prevent suffering and negative sequelae over the life span.
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26
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Khairallah C, Zoghbi M, Richa S, Bou Khalil R. Disgust, impulsivity and depressive dimensions in subjects at risk for bulimia nervosa and/or binge eating disorder. Asian J Psychiatr 2019; 39:32-34. [PMID: 30522004 DOI: 10.1016/j.ajp.2018.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE the study aims to assess the depressive symptoms, the disgust feeling and the impulsivity index in subjects showing a high risk of binge eating disorder (BED) and/or bulimia nervosa (BN) through a cross-sectional study of 150 participants. RESULTS There was no significant difference regarding age, sex, employment and marital status between subjects at high risk for BED/BN (Group A) and controls (Group B). However, participants in group A presented higher scores of depressions (p = 0.021), impulsivity (p = 0.027) and Disgust (p = 0.030) with significant associations. CONCLUSION The neurobiological basis for these associations might be related to a dysfunction in the insular cortex.
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Affiliation(s)
| | - Marouan Zoghbi
- Biostatistics, Saint-Joseph University, Achrafieh, Lebanon
| | - Sami Richa
- Department of Psychiatry, Hotel Dieu de France Hospital, Achrafieh, Lebanon
| | - Rami Bou Khalil
- Department of Psychiatry, Hotel Dieu de France Hospital, Achrafieh, Lebanon
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Ferrer-Cascales R, Albaladejo-Blázquez N, Ruiz-Robledillo N, Rubio-Aparicio M, Laguna-Pérez A, Zaragoza-Martí A. Low Adherence to the Mediterranean Diet in Isolated Adolescents: The Mediation Effects of Stress. Nutrients 2018; 10:E1894. [PMID: 30513937 PMCID: PMC6315583 DOI: 10.3390/nu10121894] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 01/15/2023] Open
Abstract
Loneliness perception during adolescence has been increased dramatically in recent years. Changes in lifestyle and difficulties in social interaction could explain this increased phenomenon. As described in previous research, this fact has been associated with the development of high stress levels and dysfunctional lifestyles, in which eating habits play a main role. In this regard, loneliness has been classically associated with poor eating habits, fundamentally the consumption of processed food with little nutritional value. However, the relationship between loneliness and healthy eating patterns, such as the Mediterranean Diet (MD), has not been previously analyzed. The main aim of the present study was to identify the relationship between perceived loneliness, stress, dietary habits, and adherence to the MD in a sample of 527 Spanish adolescents. The obtained results show a significant association between high perceived loneliness and high stress levels with lower MD adherence. Hence, adolescents with high perceived loneliness exhibit poor dietary habits in comparison to those counterparts with low perceived loneliness. Mediation analyses demonstrated an indirect effect of the loneliness on adherence to the MD through the mediation effect of stress. These findings point out a possible mechanism that underlies the classic association between loneliness and health deterioration, based on a poor adherence to a healthy dietary pattern, such as the MD.
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Affiliation(s)
- Rosario Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | | | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | - María Rubio-Aparicio
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | - Ana Laguna-Pérez
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
| | - Ana Zaragoza-Martí
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain.
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28
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Becker KR, Fischer S, Crosby RD, Engel SG, Wonderlich SA. Dimensional analysis of emotion trajectories before and after disordered eating behaviors in a sample of women with bulimia nervosa. Psychiatry Res 2018; 268:490-500. [PMID: 30145506 PMCID: PMC6195433 DOI: 10.1016/j.psychres.2018.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/02/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
There is an established relationship between increases in negative affect and engagement in binge eating and purging behaviors. Some evidence suggests that these behaviors may also be maintained via subsequent increases in positive affect. However, negative and positive affect are broad terms encompassing many emotions, and there is a theoretical speculation that every emotion consists of at least of three separate dimensions: valence, arousal, and approach/withdrawal. We conducted secondary analyses on a previously collected dataset using ecological momentary assessment in 133 women with bulimia nervosa. Participants rated their experience of discrete emotions and bulimic behaviors six times per day. Negative and positive emotions were organized within the 3-dimensional space characterized by valence, arousal, and approach/withdrawal. With multilevel modeling, we examined the trajectories of dimensionally defined emotion constructs prior and subsequent to bulimic behaviors as well as on days with and without bulimic behaviors. Negative valence, high arousal, and avoidance typified emotions that reached the highest levels before bulimic behaviors and were at the highest mean levels on days with bulimic behaviors. Arousal did not appear to moderate the trajectories of positive emotions. Application of a dimensional understanding of emotions may help elucidate the complex relationship between mood and disordered eating.
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Affiliation(s)
- Kendra R. Becker
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | | | | | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa. J Clin Psychol Med Settings 2018; 26:33-46. [DOI: 10.1007/s10880-018-9562-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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30
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A neural basis for antagonistic control of feeding and compulsive behaviors. Nat Commun 2018; 9:52. [PMID: 29302029 PMCID: PMC5754347 DOI: 10.1038/s41467-017-02534-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023] Open
Abstract
Abnormal feeding often co-exists with compulsive behaviors, but the underlying neural basis remains unknown. Excessive self-grooming in rodents is associated with compulsivity. Here, we show that optogenetically manipulating the activity of lateral hypothalamus (LH) projections targeting the paraventricular hypothalamus (PVH) differentially promotes either feeding or repetitive self-grooming. Whereas selective activation of GABAergic LH→PVH inputs induces feeding, activation of glutamatergic inputs promotes self-grooming. Strikingly, targeted stimulation of GABAergic LH→PVH leads to rapid and reversible transitions to feeding from induced intense self-grooming, while activating glutamatergic LH→PVH or PVH neurons causes rapid and reversible transitions to self-grooming from voracious feeding induced by fasting. Further, specific inhibition of either LH→PVH GABAergic action or PVH neurons reduces self-grooming induced by stress. Thus, we have uncovered a parallel LH→PVH projection circuit for antagonistic control of feeding and self-grooming through dynamic modulation of PVH neuron activity, revealing a common neural pathway that underlies feeding and compulsive behaviors.
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31
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Demirci E. Non suicidal self-injury, emotional eating and insomnia after child sexual abuse: Are those symptoms related to emotion regulation? J Forensic Leg Med 2018; 53:17-21. [DOI: 10.1016/j.jflm.2017.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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32
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Fox S, Conneely S, Egan J. Emotional expression and eating in overweight and obesity. Health Psychol Behav Med 2017. [DOI: 10.1080/21642850.2017.1378580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Susan Fox
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Conneely
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jonathan Egan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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33
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Fox JRE, Msetfi RM, Johnson RS, Haigh E. The Perception of Threat from Emotions in Predicting Binge Eating Behaviours in People Who Are Obese and Seeking Treatment for Their Weight. Clin Psychol Psychother 2017; 23:452-459. [PMID: 26238312 DOI: 10.1002/cpp.1972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 05/08/2015] [Accepted: 06/30/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The affect regulation theory suggests that people binge eat to regulate negative emotional states. In this study, we used a basic emotions perspective to consider the role of perceived threat of emotions, emotional suppression and reduced emotional expressiveness in predicting binge eating behaviours in people who are obese. METHOD Treatment-seeking participants with obesity (N = 51, body mass index range from 30.8 to 60.2 kg m-2 ) completed measures of 'perception of threat from emotion' as well as 'emotional expressiveness' and binge eating. RESULTS The results demonstrated that perceived threat of sadness predicted binge eating (β = .55, p < .05). Additionally, a mediation analysis revealed that reduced emotional expressiveness mediated the relationship between perceived threat of fear and binge eating (β = .25, 95%). DISCUSSION These findings are contextualized within a theoretical perspective that suggests that individuals who binge eat are threatened by certain emotional states and they use binge eating to suppress certain, but not all, emotional states. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Considering basic emotions within binge eating should be a part of a psychological assessment and treatment. This should consider how emotions could often be perceived as being threatening and their expression is limited. It is possible that the emotions of fear and sadness appear to be particularly threatening within binge eating/obese populations.
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Affiliation(s)
- J R E Fox
- Department of Psychology, Royal Holloway University of London And Enfield Complex Care Team Barnet, Enfield and Haringey NHS Trust.
| | - R M Msetfi
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
| | - R S Johnson
- Manchester and Salford Pain Centre, Salford Royal Hospital, Salford, UK
| | - E Haigh
- Division of Health Research, Lancaster University
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34
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Jennings KM, Wildes JE, Coccaro EF. Intermittent explosive disorder and eating disorders: Analysis of national comorbidity and research samples. Compr Psychiatry 2017; 75:62-67. [PMID: 28324677 PMCID: PMC5410643 DOI: 10.1016/j.comppsych.2017.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 02/17/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Clinical studies suggest comorbidity between eating disorders and aggressive behaviors. This study examined the pattern of comorbidity between intermittent explosive disorder (IED) and eating disorders (ED). METHODS Data were analyzed from both the adult and adolescent samples of the National Comorbidity Survey-Replication (n = 19,430) and a clinical research sample (n = 1,642). RESULTS Lifetime prevalence of Any ED was elevated in IED vs. non-IED for both the community and clinical research samples. Though anorexia nervosa displayed no relationship with IED in either sample, bulimia nervosa was associated with IED in the community sample and binge eating disorder was associated with IED in both the community and clinical research samples. Onset of IED preceded onset of Any ED in at least 70% of comorbid IED/ED cases in both community and clinical research samples. Associations of IED with Any ED and bulimia nervosa in the community sample, and associations of IED with binge eating disorder in the clinical research sample, remained significant after controlling for other psychiatric disorders. CONCLUSIONS Individuals with IED are more likely to report lifetime prevalence of ED, particularly bulimic spectrum disorders. This finding, and the observation that the onset of IED occurs prior to the onset of ED in the majority of individuals, suggests that longitudinal studies are needed to clarify this relationship and determine whether IED is a risk factor for the development of ED. Early identification of individuals with IED or impulsive aggression may provide clinically useful information to determine most effective treatment interventions.
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Affiliation(s)
- Karen M Jennings
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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35
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Palmeira L, Pinto-Gouveia J, Cunha M. The role of self-disgust in eating psychopathology in overweight and obesity: Can self-compassion be useful? J Health Psychol 2017; 24:1807-1816. [DOI: 10.1177/1359105317702212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explores the relationship between self-disgust and eating psychopathology and whether self-compassion plays a mediator role on this relationship. Participants were 203 adults, from both genders, with overweight and obesity ( MBMI = 31.17, standard deviation = 5.43). Women reported higher levels of self-disgust and eating psychopathology and lower levels of self-compassion than men. Path analysis results suggested that the effect of self-disgust on eating psychopathology occurred partially through one’s inability to be self-compassionate. The results highlight the damaging role of self-disgust on eating psychopathology and the importance of developing a more compassionate attitude towards the self to promote healthy eating behaviors.
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Affiliation(s)
| | | | - Marina Cunha
- CINEICC, Universidade de Coimbra, Portugal
- Miguel Torga Superior Institute (ISMT), Portugal
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36
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Use of doping agents and symptoms of eating disorders among male and female patients in drug addiction treatment. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/nsad-2013-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims This study investigates the prevalence of use of doping agents and symptoms of eating disorders among patients in drug addiction treatment. The aim is also to look for characteristics of the groups reporting the use of doping agents or symptoms of eating disorders. Design A survey including questions on exercise, the use of doping agents and Eating Disorder Inventory-2 was administered in a Norwegian drug addiction facility. The study included 109 patients in residential drug treatment, 30 females and 79 males (ranging from 17 to 50 years old). Results –Symptoms of eating disorders were reported by 33 percent of the females and 7.6 percent of the males. Previous use of doping agents (anabolic-androgenic steroids in particular) was reported by 40.5 percent of the men and 20 percent of the women. The results are discussed in light of the theory on emotion regulation, gender and cultural expectations, drug treatment as a liminal phase and similarities to drug addiction. Conclusions The symptoms of eating disorders and the use of doping agents are prevalent in this sample of male and female drug addicts in treatment. Drug treatment facilities should be aware of this and take the appropriate actions regarding attention, screening and treatment.
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37
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Nandrino JL, Ducro C, Iachini T, Coello Y. Perception of Peripersonal and Interpersonal Space in Patients with Restrictive-type Anorexia. EUROPEAN EATING DISORDERS REVIEW 2017; 25:179-187. [PMID: 28260238 DOI: 10.1002/erv.2506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 11/08/2022]
Abstract
This study examines whether the perception of peripersonal action-space and interpersonal social-space is modified in patients with restrictive-type anorexia in two experimental conditions using videos. First, participants stopped the video of an approaching stimulus when they felt the distance to be comfortable for interacting with it (first-person perspective). Second, participants stopped the video when an observed individual approaching a stimulus, or being approached by it, was at a comfortable distance (third-person perspective). In the first-person perspective, the results showed an estimation of peripersonal space that did not differ from controls when an object was approaching and an increase in interpersonal space compared with controls when a male or female individual was approaching. In the third-person perspective, both individual-object and individual-individual distances were larger in anorexic patients. These results indicate a specific deficit in adjusting interpersonal distances in both the first-person and third-person perspectives. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Jean-Louis Nandrino
- Laboratoire de sciences Cognitives et affectives SCALab - Sciences Cognitives et Affectives, CNRS, UMR 9193, University of Lille, France.,Clinique des 4 Cantons, Fondation Santé des Etudiants de France, Villeneuve d'Ascq, France
| | - Claire Ducro
- Laboratoire de sciences Cognitives et affectives SCALab - Sciences Cognitives et Affectives, CNRS, UMR 9193, University of Lille, France
| | - Tina Iachini
- Laboratory of Cognitive Science and Immersive Virtual Reality, Department of Psychology, Second University of Naples, Italy
| | - Yann Coello
- Laboratoire de sciences Cognitives et affectives SCALab - Sciences Cognitives et Affectives, CNRS, UMR 9193, University of Lille, France
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38
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Boerhout C, Swart M, Voskamp M, Troquete NAC, van Busschbach JT, Hoek HW. Aggression Regulation in Day Treatment of Eating Disorders: Two-Centre RCT of a Brief Body and Movement-Oriented Intervention. EUROPEAN EATING DISORDERS REVIEW 2016; 25:52-59. [DOI: 10.1002/erv.2491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/28/2016] [Accepted: 10/18/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Cees Boerhout
- University Center of Psychiatry, University Medical Center Groningen; University of Groningen; Groningen the Netherlands
- PsyQ Eating Disorders; Lentis Psychiatric Institute; Groningen the Netherlands
| | - Marte Swart
- University Center of Psychiatry, University Medical Center Groningen; University of Groningen; Groningen the Netherlands
- PsyQ Eating Disorders; Lentis Psychiatric Institute; Groningen the Netherlands
| | - Marjon Voskamp
- Amarum Center for Eating Disorders; GGNet Mental Health Care; Zutphen the Netherlands
| | - Nadine A. C. Troquete
- Department of General Practice; University Medical Center Groningen, University of Groningen; Groningen the Netherlands
| | - Jooske T. van Busschbach
- University Center of Psychiatry, University Medical Center Groningen; University of Groningen; Groningen the Netherlands
- Windesheim University of Applied Sciences; Zwolle the Netherlands
| | - Hans W. Hoek
- University Center of Psychiatry, University Medical Center Groningen; University of Groningen; Groningen the Netherlands
- Parnassia Psychiatric Institute; The Hague the Netherlands
- Department of Epidemiology, Mailman School of Public Health; Columbia University; New York NY USA
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39
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Munro C, Randell L, Lawrie SM. An Integrative Bio-Psycho-Social Theory of Anorexia Nervosa. Clin Psychol Psychother 2016; 24:1-21. [PMID: 27739190 DOI: 10.1002/cpp.2047] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 06/24/2016] [Accepted: 09/14/2016] [Indexed: 12/16/2022]
Abstract
The need for novel approaches to understanding and treating anorexia nervosa (AN) is well recognized. The aim of this paper is to describe an integrative bio-psycho-social theory of maintaining factors in AN. We took a triangulation approach to develop a clinically relevant theory with face validity and internal consistency. We developed theoretical ideas from our clinical practice and reviewed theoretical ideas within the eating disorders and wider bio-psycho-social literature. The synthesis of these ideas and concepts into a clinically meaningful framework is described here. We suggest eight key factors central to understanding the maintenance and treatment resistance of anorexia nervosa: genetic or experiential predisposing factors; dysfunctional feelings processing and regulation systems; excessive vulnerable feelings; 'feared self' beliefs; starvation as a maladaptive physiological feelings regulation mechanism; maladaptive psychological coping modes; maladaptive social behaviour; and unmet physical and psychological core needs. Each of these factors serves to maintain the disorder. The concept of universal physical and psychological core needs can provide an underpinning integrative framework for working with this distinctly physical and psychological disorder. This framework could be used within any treatment model. We suggest that treatments which help address the profound lack of trust, emotional security and self-acceptance in this patient group will in turn address unmet needs and improve well-being. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE The concept of unmet physical and psychological needs can be used as an underlying integrative framework for understanding and working with this patient group, alongside any treatment model. A functional understanding of the neuro-biological, physiological and psychological mechanisms involved in anorexia nervosa can help patients reduce self-criticism and shame. Fears about being or becoming fat, greedy, needy, selfish and unacceptable ('Feared Self') drive over-compensatory self-depriving behaviour ('Anorexic Self'). Psychological treatment for anorexia nervosa should emphasize a focus on feelings and fostering experiences of acceptance and trust. Treatment for patients with anorexia nervosa needs to be longer than current clinical practice.
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Affiliation(s)
- Calum Munro
- Anorexia Nervosa Intensive Treatment Team Eating Disorders Department, Royal Edinburgh Hospital, Edinburgh, UK.,Department of Psychiatry, The University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Louise Randell
- Anorexia Nervosa Intensive Treatment Team Eating Disorders Department, Royal Edinburgh Hospital, Edinburgh, UK
| | - Stephen M Lawrie
- Department of Psychiatry, The University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
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40
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Gramaglia C, Ressico F, Gambaro E, Palazzolo A, Mazzarino M, Bert F, Siliquini R, Zeppegno P. Alexithymia, empathy, emotion identification and social inference in anorexia nervosa: A case-control study. Eat Behav 2016; 22:46-50. [PMID: 27086047 DOI: 10.1016/j.eatbeh.2016.03.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 03/21/2016] [Accepted: 03/30/2016] [Indexed: 11/15/2022]
Abstract
Alexithymia, difficulties in facial emotion recognition, poor socio-relational skills are typical of anorexia nervosa (AN). We assessed patients with AN and healthy controls (HCs) with mixed stimuli: questionnaires (Toronto Alexithymia Scale-TAS, Interpersonal Reactivity Index-IRI), photographs (Facial Emotion Identification Test-FEIT) and dynamic images (The Awareness of Social Inference Test-TASIT). TAS and IRI Personal Distress (PD) were higher in AN than HCs. Few or no differences emerged at the FEIT and TASIT, respectively. Larger effect sizes were found for the TAS results. Despite higher levels of alexithymia, patients with AN seem to properly acknowledge others' emotions while being inhibited in the expression of their own.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Francesca Ressico
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | - Anna Palazzolo
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy
| | | | - Fabrizio Bert
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Roberta Siliquini
- Department of Public Health and Paediatric Sciences, Università degli Studi di Torino, via Santena 5/bis, 10126 Torino, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Department of Translational Medicine, Università del Piemonte Orientale, Via Solaroli n° 17, 28100 Novara, Italy; AOU Maggiore della Carità, Corso Mazzini n° 18, 28100, Novara, Italy.
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41
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Gorwood P, Blanchet-Collet C, Chartrel N, Duclos J, Dechelotte P, Hanachi M, Fetissov S, Godart N, Melchior JC, Ramoz N, Rovere-Jovene C, Tolle V, Viltart O, Epelbaum J. New Insights in Anorexia Nervosa. Front Neurosci 2016; 10:256. [PMID: 27445651 PMCID: PMC4925664 DOI: 10.3389/fnins.2016.00256] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/23/2016] [Indexed: 12/18/2022] Open
Abstract
Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidences from physiology, genetics, epigenetics, and brain imaging which allow to consider AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelino-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors-the "pondero-nutritional-feeding basements"- are also discussed.
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Affiliation(s)
- Philip Gorwood
- Centre Hospitalier Sainte-Anne (CMME)Paris, France; UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | | | - Nicolas Chartrel
- Institut National de la Santé et de la Recherche Médicale U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in BiomedicineRouen, France; Normandy UniversityCaen, France; University of RouenRouen, France
| | - Jeanne Duclos
- Adolescents and Young Adults Psychiatry Department, Institut Mutualiste MontsourisParis, France; CESP, Institut National de la Santé et de la Recherche Médicale, Université Paris-Descartes, USPCParis, France; University Reims, Champagne-Ardenne, Laboratoire Cognition, Santé, Socialisation (C2S)-EA 6291Reims, France
| | - Pierre Dechelotte
- Institut National de la Santé et de la Recherche Médicale U1073 IRIB Normandy UniversityRouen, France; Faculté de Médecine-PharmacieRouen, France
| | - Mouna Hanachi
- Université de Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone VeilMontigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de ParisGarches, France
| | - Serguei Fetissov
- Institut National de la Santé et de la Recherche Médicale U1073 IRIB Normandy University Rouen, France
| | - Nathalie Godart
- Adolescents and Young Adults Psychiatry Department, Institut Mutualiste MontsourisParis, France; CESP, Institut National de la Santé et de la Recherche Médicale, Université Paris-Descartes, USPCParis, France
| | - Jean-Claude Melchior
- Université de Versailles Saint-Quentin-en-Yvelines, Institut National de la Santé et de la Recherche Médicale U1179, équipe Thérapeutiques Innovantes et Technologies Appliquées aux Troubles Neuromoteurs, UFR des Sciences de la Santé Simone VeilMontigny-le-Bretonneux, France; Département de Médecine (Unité de Nutrition), Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de ParisGarches, France
| | - Nicolas Ramoz
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | - Carole Rovere-Jovene
- Institut de Pharmacologie Moléculaire et Cellulaire, UMR6097, Centre National de la Recherche Scientifique Valbonne, France
| | - Virginie Tolle
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
| | - Odile Viltart
- Université Lille, Inserm, CHU Lille, UMR-S 1172 - JPArc - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer Lille, France
| | - Jacques Epelbaum
- UMR-S 894, Institut National de la Santé et de la Recherche Médicale, Centre de Psychiatrie et NeurosciencesParis, France; Université Paris Descartes, Sorbonne Paris CitéParis, France
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Boerhout C, Swart M, Van Busschbach JT, Hoek HW. Effect of Aggression Regulation on Eating Disorder Pathology: RCT of a Brief Body and Movement Oriented Intervention. EUROPEAN EATING DISORDERS REVIEW 2015; 24:114-21. [DOI: 10.1002/erv.2429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 11/19/2015] [Accepted: 11/21/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Cees Boerhout
- PsyQ Eating Disorders; Lentis Psychiatric Institute; Groningen The Netherlands
- Rob Giel Research Center; University of Groningen, University Medical Center Groningen, University Center of Psychiatry; Groningen The Netherlands
| | - Marte Swart
- PsyQ Eating Disorders; Lentis Psychiatric Institute; Groningen The Netherlands
- Rob Giel Research Center; University of Groningen, University Medical Center Groningen, University Center of Psychiatry; Groningen The Netherlands
| | - Jooske T. Van Busschbach
- Rob Giel Research Center; University of Groningen, University Medical Center Groningen, University Center of Psychiatry; Groningen The Netherlands
- Windesheim University of Applied Sciences; Zwolle The Netherlands
| | - Hans W. Hoek
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry; Groningen The Netherlands
- Parnassia Psychiatric Institute; The Hague The Netherlands
- Department of Epidemiology; Columbia University, Mailman School of Public Health; New York NY USA
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Uzunian LG, Vitalle MSDS. Habilidades sociais: fator de proteção contra transtornos alimentares em adolescentes. CIENCIA & SAUDE COLETIVA 2015; 20:3495-508. [DOI: 10.1590/1413-812320152011.18362014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo desse estudo foi revisar a literatura a cerca da relação entre transtornos alimentares e habilidades sociais em adolescentes. Pesquisou-se as bases de dados Medline, SciELO e Lilacs, cruzando os descritores “transtornos alimentares”, “anorexia nervosa”, “bulimia nervosa” e “comportamento alimentar”, com os descritores “psicologia social” e “isolamento social”, e com as palavras chave “competência social”, “habilidade social” e “relação interpessoal”. Incluiu-se estudos com adolescentes, nos idiomas português, inglês e espanhol, e publicações realizadas entre os anos de 2007 a 2012. A busca resultou em 63 artigos, sendo incluídos 50 nesta revisão. A maioria dos estudos foi conduzido no Brasil e nos Estados Unidos. Do total, 43 eram artigos originais. Os estudos visavam compreender como o estado emocional poderia influenciar no estabelecimento dos transtornos alimentares, assim como as relações interpessoais e a relação entre os pares. Os artigos também discutiram a influência da mídia e da sociedade neste processo. A partir da análise dos estudos, observou-se que quanto maior o repertório de habilidades sociais dos adolescentes, maior será o fator de proteção contra o desenvolvimento de transtornos alimentares.
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Fitzsimmons-Craft EE, Accurso EC, Ciao AC, Crosby RD, Cao L, Pisetsky EM, Le Grange D, Peterson CB, Crow SJ, Engel SG, Mitchell JE, Wonderlich SA. Restrictive eating in anorexia nervosa: Examining maintenance and consequences in the natural environment. Int J Eat Disord 2015; 48:923-31. [PMID: 26310991 PMCID: PMC4618028 DOI: 10.1002/eat.22439] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined negative and positive affect in relation to restrictive eating episodes (i.e., meals/snacks perceived as restrictive) and whether restrictive eating was associated with likelihood of subsequent eating disorder behaviors (i.e., additional restrictive eating, binge eating, vomiting, laxative use, weighing, exercising, meal skipping, drinking fluids to curb appetite, body checking). METHOD Women with anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment protocol. RESULTS For both restrictive and nonrestrictive eating, negative affect significantly increased from prebehavior to the time of the behavior but remained stable thereafter, while positive affect remained stable from prebehavior to the time of the behavior but decreased significantly thereafter. Across time, negative affect was significantly lower and positive affect was significantly greater in restrictive than nonrestrictive episodes. Engagement in restrictive eating was associated with an increased likelihood of subsequent restrictive eating, laxative use, and body checking, but not other behaviors. Engagement in nonrestrictive eating was associated with a decreased likelihood of subsequent restrictive eating, binge eating, vomiting, laxative use, weighing, meal skipping, drinking fluids to curb appetite, and body checking. DISCUSSION Despite similar patterns of affect across eating episodes over time, results suggest affect may be involved in the maintenance of restrictive eating in anorexia nervosa since restrictive episodes were associated with lower negative and greater positive affect across time compared to nonrestrictive episodes. Further, while restrictive episodes increased the likelihood of only three subsequent eating disorder behaviors, nonrestrictive episodes were protective since they decreased likelihood of all but one behavior.
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Affiliation(s)
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Anna C. Ciao
- Department of Psychology, Western Washington University, Bellingham, WA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND, USA, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND, USA, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
| | - Emily M. Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA, The Emily Program, St. Paul, MN, United States
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA, The Emily Program, St. Paul, MN, United States
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, ND, USA, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, ND, USA, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND, USA, Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine & Health Sciences, Fargo, ND, USA
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45
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Faija CL, Fox JRE, Tierney S, Peters S, Gooding PA. Development and Validation of the Pride in Eating Pathology Scale (PEP-S). Clin Psychol Psychother 2015; 24:126-138. [PMID: 26503108 DOI: 10.1002/cpp.1988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 11/08/2022]
Abstract
There is a growing body of theoretical and clinical literature highlighting the role of pride in maintaining eating disordered behaviours. Despite its clinical importance, there are no measures to assess feelings of pride associated with eating psychopathology. This study describes the development and validation of the Pride in Eating Pathology Scale (PEP-S), a self-report questionnaire that examines feelings of pride towards eating disordered symptoms (e.g., pride in food restriction, thinness and weight loss). Participants were 390 females, recruited from university and community populations, whose mean age was 26.99 years. Respondents rated pride in eating pathology on a 7-point Likert-scale. Principal Component Analysis indicated that the 60-item scale comprised a four component structure: (1) pride in weight loss, food control and thinness, (2) pride in healthy weight and healthy eating, (3) pride in outperforming others and social recognition and (4) pride in capturing other people's attention due to extreme thinness. These four components explained a total of 65.31% of the variance. The PEP-S demonstrated very good internal reliability (α ranging from 0.88 to 0.98) and very good test-retest reliability over a 3-week time-span (r ranging from 0.81 to 0.93). The PEP-S also showed excellent convergent and discriminant validity. Furthermore, the scale discriminated between women with high and low levels of eating psychopathology. The PEP-S is a psychometrically robust measure of pride in eating pathology. It has the potential to advance theoretical understanding and may also be clinically useful. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE The PEP-S is a valid, reliable, quick and easy to administer self-report questionnaire that measures pride related to eating pathology. The PEP-S assesses four clinically relevant dimensions: (1) pride in weight loss, food control and thinness, (2) pride in healthy weight and healthy eating, (3) pride in outperforming others and social recognition and (4) pride in capturing other people's attention due to extreme thinness. The PEP-S has very good internal and test-retest reliability, and very good convergent and discriminant validity. The PEP-S distinguishes between women with higher and lower levels of eating psychopathology. The PEP-S makes an important contribution to understanding pride in eating psychopathology, which is essential from both clinical and theoretical perspectives.
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Affiliation(s)
- Cintia L Faija
- School of Psychological Sciences, The University of Manchester, Manchester, United Kingdom
| | - John R E Fox
- Department of Psychology, Royal Holloway University of London and Complex Care, Barnet, Enfield and Haringey Mental Health NHS Trust, London, United Kingdom
| | - Stephanie Tierney
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sarah Peters
- School of Psychological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Patricia A Gooding
- School of Psychological Sciences, The University of Manchester, Manchester, United Kingdom
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46
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Chang PF, Bazarova NN. Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites. HEALTH COMMUNICATION 2015; 31:217-229. [PMID: 26266693 DOI: 10.1080/10410236.2014.946218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pro-anorexic websites are a popular online venue for individuals with anorexia, but recent research suggests that they play a role of "online negative enabling support groups" because they can undermine recovery and encourage negative behaviors by validating pro-anorexic views. By analyzing 22,811 messages from 5,590 conversations from the Pro-Ana Nation online discussion board forum, this study examines communicative mechanisms of online negative enabling support through language analysis of disclosure-response sequences, changes in the language of the initial discloser within an interaction exchange, and the role of responses in eliciting those changes. The findings show that initiating disclosures containing stigma-related emotion words, anorexia-specific content, and sociorelational content are typically met with negatively valenced responses from other members of the pro-anorexic community. Moreover, although the act of revealing stigmatized information has some cathartic effects, disclosers use more, not fewer, stigma-related emotion words when they receive negatively valenced responses. These results provide insight into communicative dynamics and effects of online negative enabling support through validation of the pro-anorexic identity and the dangerous cycle of stigma escalation in disclosure-response exchanges on pro-anorexic online communities.
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47
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Cardi V, Corfield F, Leppanen J, Rhind C, Deriziotis S, Hadjimichalis A, Hibbs R, Micali N, Treasure J. Emotional Processing, Recognition, Empathy and Evoked Facial Expression in Eating Disorders: An Experimental Study to Map Deficits in Social Cognition. PLoS One 2015; 10:e0133827. [PMID: 26252220 PMCID: PMC4529105 DOI: 10.1371/journal.pone.0133827] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Difficulties in social cognition have been identified in eating disorders (EDs), but the exact profile of these abnormalities is unclear. The aim of this study is to examine distinct processes of social-cognition in this patient group, including attentional processing and recognition, empathic reaction and evoked facial expression in response to discrete vignettes of others displaying positive (i.e. happiness) or negative (i.e. sadness and anger) emotions. METHOD One hundred and thirty-eight female participants were included in the study: 73 healthy controls (HCs) and 65 individuals with an ED (49 with Anorexia Nervosa and 16 with Bulimia Nervosa). Self-report and behavioural measures were used. RESULTS Participants with EDs did not display specific abnormalities in emotional processing, recognition and empathic response to others' basic discrete emotions. However, they had poorer facial expressivity and a tendency to turn away from emotional displays. CONCLUSION Treatments focusing on the development of non-verbal emotional communication skills might be of benefit for patients with EDs.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Freya Corfield
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Jenni Leppanen
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Charlotte Rhind
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Stephanie Deriziotis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Alexandra Hadjimichalis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Rebecca Hibbs
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
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Wolz I, Agüera Z, Granero R, Jiménez-Murcia S, Gratz KL, Menchón JM, Fernández-Aranda F. Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front Psychol 2015; 6:907. [PMID: 26175710 PMCID: PMC4485313 DOI: 10.3389/fpsyg.2015.00907] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 01/29/2023] Open
Abstract
Objective: The aims of the study were to (1) validate the Difficulties in Emotion Regulation Scale (DERS) in a sample of Spanish adults with and without eating disorders, and (2) explore the role of emotion regulation difficulties in eating disorders (ED), including its mediating role in the relation between key personality traits and ED severity. Methods: One hundred and thirty four patients (121 female, mean age = 29 years) with anorexia nervosa (n = 30), bulimia nervosa (n = 54), binge eating (n = 20), or Other Specified Feeding or Eating Disorders (n = 30) and 74 healthy control participants (51 female, mean age = 21 years) reported on general psychopathology, ED severity, personality traits and difficulties in emotion regulation. Exploratory and confirmatory factor analyses were conducted to examine the psychometrics of the DERS in this Spanish sample (Aim 1). Additionally, to examine the role of emotion regulation difficulties in ED (Aim 2), differences in emotion regulation difficulties across eating disorder subgroups were examined and structural equation modeling was used to explore the interrelations among emotion regulation, personality traits, and eating disorder severity. Results: Results support the validity and reliability of the DERS within this Spanish adult sample and suggest that this measure has a similar factor structure in this sample as in the original sample. Moreover, emotion regulation difficulties were found to differ as a function of eating disorder subtype and to mediate the relation between two specific personality traits (i.e., high harm avoidance and low self-directedness) and ED severity. Conclusions: Personality traits of high harm avoidance and low self-directedness may increase vulnerability to ED pathology indirectly, through emotion regulation difficulties.
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Affiliation(s)
- Ines Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Zaida Agüera
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Psychobiology and Methodology, University Autònoma of Barcelona Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
| | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center Jackson, MS, USA
| | - José M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain ; Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III Barcelona, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL Barcelona, Spain ; Ciber Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III Barcelona, Spain ; Department of Clinical Sciences, School of Medicine, University of Barcelona Barcelona, Spain
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Seed T, Fox J, Berry K. Experiences of Detention under the Mental Health Act for Adults with Anorexia Nervosa. Clin Psychol Psychother 2015; 23:352-62. [PMID: 26123878 DOI: 10.1002/cpp.1963] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022]
Abstract
UNLABELLED People with Anorexia Nervosa are often resistant to treatment and can be detained under the Mental Health Act. Detention can be distressing for some client groups; however, there is little research to explore how people with Anorexia Nervosa experience detention and how these experiences impact on recovery. This study utilized a qualitative methodology to develop a model for understanding how people perceive, experience and process detention under the Mental Health Act. Data from 12 participants was analysed using constructivist grounded theory. Four overarching categories conceptualize their experience over time: 'the battle', 'the bubble', 'stepping out of the bubble' and 'the anorexic self'. Within each overarching category are further subordinate categories that represent the nuances of the data. The resultant model is discussed in relation to the literature, whilst recommendations have been made to embed person-centred, recovery practice into inpatient services. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE People detained under the mental health act with anorexia nervosa often respond by engaging in a battle with clinicians. This follows by the person withdrawing into a 'bubble' where the individual starts to feel some relief that they are no longer in control of their eating, but this competes with the lack of self and the emerging anorexic self. Clinicians need to be aware that individuals detained may have mixed feelings about their hospital admission.
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Affiliation(s)
- Tara Seed
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - John Fox
- Department of Psychology, Royal Holloway University of London, Egham, UK
- Enfield Complex Care Team, Barnet, Enfield and Haringey Mental Health NHS Trust
| | - Katherine Berry
- School of Psychological Sciences, The University of Manchester, Manchester, UK
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Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Clin Psychol Rev 2015; 39:83-95. [PMID: 26043394 DOI: 10.1016/j.cpr.2015.04.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
This systematic review sought to examine the generation and regulation of emotion in people with Anorexia Nervosa (AN). Key databases (Medline, Embase, PsychINFO and Web of Science) were searched for peer-reviewed articles published by March 2015 yielding 131 studies relevant to emotion generation and emotion regulation (ER) processes as defined by Gross (1998). Meta-analyses determined pooled group differences between AN and healthy control (HC) groups. More maladaptive schemata were reported by people with AN than HCs, with largest pooled effects for defectiveness/shame (d=2.81), subjugation (d=1.59) and social isolation (d=1.66). Poorer awareness of and clarity over emotion generated and some elevated emotionality (disgust and shame) were reported. A greater use of 'maladaptive' ER strategies was reported by people with AN than HCs, alongside less use of 'adaptive' strategies. Pooled differences of particularly large effect were observed for: experiential avoidance (d=1.00), negative problem-solving style (d=1.06), external/social comparison (d=1.25), submissiveness (d=1.16), attention concentration (worry/rumination; d=1.44) and emotion suppression (d=1.15), particularly to avoid conflict (d=1.54). These data support the notion that emotion regulation difficulties are a factor in AN and support use of associated cognitive-affective models. The implications of these findings for further understanding AN, and developing models and related psychological interventions are discussed.
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