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Giunta S, Mannino G, Sideli L, Quattropani MC, Lenzo V. Reflective functioning mediates the relationship between insecure adult attachment and the severity of prolonged grief symptoms. Health Psychol Res 2024; 12:122543. [PMID: 39228864 PMCID: PMC11368632 DOI: 10.52965/001c.122543] [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: 11/24/2023] [Accepted: 02/13/2024] [Indexed: 09/05/2024] Open
Abstract
Background This study aimed to investigate the mediation role of reflective functioning (i.e., certainty and uncertainty about mental states) in the relationship between insecure attachment (i.e., attachment avoidance and attachment anxiety ) and the severity of prolonged grief symptoms. Methods A cross-sectional study was conducted with 329 bereaved participants (51.7% females, mean age= 46.94 ± 14.62 years). Participants completed the Prolonged Grief Scale (PG-13), the Attachment Style Questionnaire (ASQ), and the Reflective Functioning Questionnaire (RFQ). Demographic and bereavement-related information were also collected. Results Certainty about mental states fully mediated the relationship between both the attachment avoidance and attachement anxiety and severity of prolonged grief symptoms. Conclusions The findings of this study indicate that reflective functioning impairment, specifically certainty about mental states of self and others, mediate the paths from insecure attachment to prolonged grief symptoms. This suggests that improving reflective functioning may contribute to the treatment bereaved individuals at risk of PGD.
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Affiliation(s)
- Serena Giunta
- Department of Law Economics and Communication LUMSA Santa Silvia University
| | - Giuseppe Mannino
- Department of Law Economics and Communication LUMSA Santa Silvia University
| | - Lucia Sideli
- Department of Human Sciences Libera Università Maria SS. Assunta
| | | | - Vittorio Lenzo
- Department of Educational Sciences University of Catania
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Tironi M, Charpentier Mora S, Liotti M, Fiorini Bincoletto A, Tanzilli A, Cavanna D, Lingiardi V, Speranza AM, Giovanardi G, Bizzi F. Adverse childhood experiences and psychological maladjustment in adolescence: The protective role of epistemic trust, mentalized affectivity, and reflective functioning. J Clin Psychol 2024. [PMID: 39101491 DOI: 10.1002/jclp.23733] [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: 12/06/2023] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are psychosocial factors acknowledged as significant contributors to health consequences later in adolescence, including psychological maladjustment. The research suggests that, at a transdiagnostic and transtheoretical level, working on restoring epistemic trust (ET), mentalized affectivity (MA), and reflective functioning (RF) in adolescents with ACEs assumes a central role in the therapeutic process. However, there are still few studies that attempted to investigate the specific role of these sociocognitive factors in the detrimental positive association between levels of experienced ACEs during childhood and psychological maladjustment in nonclinical adolescents. METHODS A community sample of 306 Italian cisgender adolescents (61.4% assigned females at birth; age range 13-19 years old; Mage = 16.1, SD = 1.64) self-reported ACEs (Childhood Trauma Questionnaire-Short Form), psychological maladjustment (Strengths and Difficulties Questionnaire), ET (Epistemic Trust, Mistrust and Credulity Questionnaire), MA (Brief-Mentalized Affectivity Scale for Adolescence), and RF (Reflective Functioning Questionnaire). A multiple mediation regression analysis has been performed to explore the association between ACEs and psychological maladjustment through the interaction with socio-cognitive factors. RESULTS ACEs are positive predictors of psychological maladjustment later in adolescence. Regardless of gender differences, epistemic mistrust and credulity, processing and expressing emotions, and uncertainty about mental states mediated this association, while epistemic trust, identifying emotions, and certainty about mental states did not configure as significant mediators. CONCLUSION Findings suggest that ET disruptions and deficits in RF are risk factors, while MA is a protective factor within the link between ACEs and psychological maladjustment in adolescence. These links help to specify the role of sociocognitive factors in the development of mental problems in adolescents who have been exposed to adverse experiences in childhood.
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Affiliation(s)
- Marta Tironi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | | | - Marianna Liotti
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Annalisa Tanzilli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Donatella Cavanna
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | - Vittorio Lingiardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Speranza
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, Rome, Italy
| | - Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Genoa, Italy
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Gagliardini G, Pandolfi G, Colli A. Attachment, Mentalization, Emotion Dysregulation, and Empathy in Eating Disorders: Comparing Anorexic and Bulimic Patients. J Nerv Ment Dis 2024; 212:370-377. [PMID: 38704653 DOI: 10.1097/nmd.0000000000001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
ABSTRACT Eating disorders (EDs) represent a wide range of clinical symptoms related to food intake, body image, and weight issues, and include anorexia nervosa-restricting type (AN-R), anorexia nervosa-binge-purge type (AN-BP), and bulimia nervosa (BN). The aim was to investigate the characteristics of attachment, mentalization, emotion dysregulation, and empathy in a sample of 102 patients with EDs. A sample of 102 patients and therapists completed a series of measures for the assessment of ED pathology, mentalization, empathy, and emotion dysregulation. Pearson correlations and analysis of variance were used to test the characteristics of the variables among the groups. In relation to attachment and emotion dysregulation, no significant differences were found. In relation to mentalization, significant difference in good mentalization was found in AN-R subtype compared with the BN subtype. In relation to empathy, results showed significantly lower scores in BN subtype on affective empathy compared with the AN-BP subtype, and in AN-R subtype on cognitive empathy. Finally, we used Z -scores for each item ranked by value (higher to lower) to develop different clinical prototypes for each group. Our results point toward the clinical need to address the assessed variables, specifically mentalization, emotion dysregulation, and empathy, in the diagnosis and treatment of EDs.
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Kwan MY, Dodd D. Social cognition and bulimic symptoms in male undergraduate students: The conditional effect of emotion dysregulation. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38937917 DOI: 10.1002/erv.3120] [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: 03/13/2024] [Revised: 06/11/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Research demonstrates associations between poor social cognition and eating disorder (ED) pathology. Moreover, research shows that individuals with EDs struggle with emotion regulation. The present study replicates and extends the literature on social cognition and ED pathology, which previously focused largely on symptoms of anorexia nervosa among women while the present study focuses on symptoms of bulimia nervosa among undergraduate men. Further, this study tests the hypothesis that better emotion regulation mitigates the association between social cognition and ED pathology. METHODS At a single timepoint, undergraduate males (n = 520) completed a series of questionnaires, and a task assessing mentalising, a key element of social cognition. RESULTS Consistent with hypotheses, bulimic symptoms were associated with worse mentalising and worse self-reported emotion regulation. Moreover, the association between mentalising and bulimic symptomatology was conditional on emotion regulation, such that it was strongest among those with more difficulties regulating their emotions. CONCLUSION Results are consistent with existing theories that highlight an interplay between interpersonal (e.g., mentalisation) and intrapersonal (e.g., affective functioning) factors in relation to ED symptomatology. Among undergraduate males, bulimic symptoms were associated with worse mentalisation. However, a good ability to regulate emotions interrupted this association.
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Affiliation(s)
- Mun Yee Kwan
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Dorian Dodd
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
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5
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Zeeck A, Lau I, Endorf K, Schaefer L, Euler S, Lahmann C, Hartmann A. Mentalizing in psychotherapeutic processes of patients with eating disorders. Front Psychiatry 2024; 15:1367863. [PMID: 38707623 PMCID: PMC11067051 DOI: 10.3389/fpsyt.2024.1367863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Background Improvement in the capacity to mentalize (i.e., reflective functioning/RF) is considered both, an outcome variable as well as a possible change mechanism in psychotherapy. We explored variables related to (in-session) RF in patients with an eating disorder (ED) treated in a pilot study on a Mentalization-Based Treatment (MBT) - oriented day hospital program. The research questions were secondary and focused on the psychotherapeutic process: What average RF does the group of patients show in sessions and does it change over the course of a single session? Are differences found between sections in which ED symptomatology is discussed and those in which it is not? Does RF increase after MBT-type interventions? Methods 1232 interaction segments from 77 therapy sessions of 19 patients with EDs were rated for RF by reliable raters using the In-Session RF Scale. Additionally, content (ED symptomatology yes/no) and certain MBT interventions were coded. Statistical analysis was performed by mixed models. Results Patients showed a rather low RF, which increased on average over the course of a session. If ED symptomatology was discussed, this was associated with significantly lower RF, while MBT-type interventions led to a significant increase in RF. Conclusions Results suggest that in-session mentalizing can be stimulated by MBT-typical interventions. RF seems to be more impaired when disorder-specific issues are addressed. Further studies have to show if improving a patient´s ability to mentalize their own symptoms is related to better outcomes.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Inga Lau
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Endorf
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Laura Schaefer
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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De Coen J, Verbeken S, Goossens L. Body dissatisfaction and low self-esteem in elementary school-aged children: the role of media pressure and trust in parent-child relationships. Front Psychol 2024; 14:1228860. [PMID: 38235278 PMCID: PMC10791762 DOI: 10.3389/fpsyg.2023.1228860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Studies have indicated that the media plays a role in the development of body dissatisfaction in children. Nevertheless, there is limited understanding of the protective factors that may reduce this association, such as the parent-child relationship. Therefore, this study investigates children's body dissatisfaction and self-esteem and the role of media pressure and a trust in parent-child relationships herein. A sample of n = 246 participants (59.8% girls, aged 8-10) was recruited. Children completed self-report questionnaires that assessed body dissatisfaction, self-esteem, media pressure, and trust in parent-child relationships. Results revealed that higher scores on media pressure were linked to increased body dissatisfaction and decreased self-esteem. On the other hand, higher scores on trust in mother and father were associated with lower levels of body dissatisfaction and higher levels of self-esteem. However, the presence of trust in parent-child relationships did not attenuate the impact of media pressure on body dissatisfaction or self-esteem. Further investigation is necessary to gain a deeper understanding of how sociocultural and interpersonal factors interact and contribute to the development of body image problems. While current prevention and intervention programs predominantly focus on the individual, it may be beneficial to place greater emphasis on the family environment.
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Affiliation(s)
- Jolien De Coen
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Rowlands K, Simic M, Treasure J, Cardi V. Emotional reactivity and prosocial behaviour in response to witnessing social exclusion in adolescents with eating disorders and healthy controls. J Eat Disord 2023; 11:224. [PMID: 38098100 PMCID: PMC10722719 DOI: 10.1186/s40337-023-00927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Prosocial behaviour can promote positive social interactions and it is a key skill in adolescence. People with emotional problems or psychiatric disorders, such as people with eating disorders might have impairments in prosocial behaviour, due to broader documented difficulties in underlying processes (e.g., mentalizing). METHODS The aim of this study was to examine prosocial behaviour in adolescents with eating disorders compared to healthy controls, using a computerised behavioural task. Adolescents (N = 123) including patients with eating disorders (n = 61) and healthy adolescents (n = 62) played a four-player computerised Prosocial Cyberball Game with three pre-programmed avatar players. During the task, participants witnessed the exclusion of one of the players, and subsequently had the opportunity to compensate for this by throwing the ball more often to the excluded player. Throughout the game, participants rated the level of negative emotion in themselves and in the excluded player. RESULTS Patients made significantly fewer ball tosses towards the excluded player during the compensation round compared to healthy controls (large effect size). Patients reported a significantly smaller increase in negative emotion after witnessing the exclusion and a significantly smaller decrease in negative emotion following the compensation round (large effect sizes). Patients also estimated a smaller decrease in negative emotion in the excluded player following the compensation round (medium effect size). There were no significant associations between these outcomes and eating disorder psychopathology in patients. CONCLUSIONS Compared to healthy adolescents, adolescent patients with eating disorders demonstrated less prosocial compensatory behaviour towards a computerised victim of social exclusion. In addition, they reported flatter negative emotion in themselves in response to witnessing and compensating for exclusion, and in the excluded player following compensation. If these findings are replicated, interventions to target these difficulties might contribute to improvements in social functioning in this patient group.
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Affiliation(s)
- Katie Rowlands
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valentina Cardi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of General Psychology, University of Padova, Padua, Italy.
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Korczynski S, Khiar Zerrouk A, Revah-Levy A, Sibeoni J, Lachal J. Issues around food in mixed families of adolescent girls with bulimia nervosa: A qualitative study with photo-elicitation. L'ENCEPHALE 2023; 49:606-611. [PMID: 36253177 DOI: 10.1016/j.encep.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Bulimia nervosa (BN) is a common psychiatric disorder among adolescent girls with potentially significant complications. Family relationships play a major role in the development and progression of this disorder. Studies in migrant populations suffering from eating disorders show contrasting results depending on the generation of migrants: first generation migrants have fewer eating disorders than the native population, while the prevalence of this disorder is more important than the latter among second and third generation migrants. In our clinical experience, we have frequently encountered so-called "mixed" families, which are families composed of one migrant parent and one non-migrant parent. Research focusing on this kind of family is scarce which is why we chose to explore their dynamic. METHODS This study explored the issues around food and family relationships of adolescent girls suffering from BN, a topic that, to date, has not yet been studied. Ten interviews were conducted with five adolescent girls with BN between the ages of 16 and 20 and their parents, using photo-elicitation to enrich the collected data. RESULTS The results were organized around two axes: (1) identity issues around food, that is the assimilation process described by both parents and adolescents concerning family meals and food habits, and how the adolescents struggle to manage this interbreeding; and (2) transmission issues with the consequences the migrant parent has to deal with to transmit his/her cultural identity with food while being far away from the homeland, and the difficulties between this parent and his/her child to share this heritage. Both issues, identity and transmission, appear to be central among these families. CONCLUSIONS Our results suggest a difficulty in mentalizing identity issues in adolescent girls; the function of appeasement around non-mentalized tensions was highlighted. In our opinion, in this particular context, BN acts as a means of expressing the difficulty of their mixed culture. This enables it to draw some clinical implications, especially using mentalization-based therapy which has already shown efficacy in adolescents with borderline personality disorder and ED.
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Affiliation(s)
- S Korczynski
- University of Lorraine, 54000 Nancy, France; Service of Adolescent Psychiatry, Hospital Center of Jury, Maison des Adolescents de Metz, 57000 Metz, France.
| | - A Khiar Zerrouk
- University of Lorraine, 54000 Nancy, France; Service of Adolescent Psychiatry, Hospital Center of Jury, Maison des Adolescents de Metz, 57000 Metz, France; Université de Lorraine, Laboratoire INTERPSY, UR 4432, Team PRISME, F- 54000 Nancy, France
| | - A Revah-Levy
- University Service of Adolescent Psychiatry, Argenteuil Hospital Centre, 69, rue du Lieutenant-Colonel Prud'hon, 95107 Argenteuil Cedex, France; ECSTRRA Team, UMR-1153, Inserm, université de Paris, 75010 Paris, France
| | - J Sibeoni
- University Service of Adolescent Psychiatry, Argenteuil Hospital Centre, 69, rue du Lieutenant-Colonel Prud'hon, 95107 Argenteuil Cedex, France; ECSTRRA Team, UMR-1153, Inserm, université de Paris, 75010 Paris, France
| | - J Lachal
- Child and Adolescent Psychiatry Service, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; University of Clermont Auvergne, 63000 Clermont-Ferrand, France; University Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
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Goshen D, Stein D, Kurman J, Farbstein D, Enoch-Levy A, Aival-Naveh E, Gur E, Yoeli N, Bretler T, Koren D, Rothschild-Yakar L. The association between deficiencies in paternal and maternal reflective functioning and anorexia nervosa symptomatology. J Eat Disord 2023; 11:116. [PMID: 37434261 DOI: 10.1186/s40337-023-00836-6] [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: 03/04/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND A large theoretical body of knowledge exists emphasizing the importance of parental mentalizing in the context of anorexia-nervosa (AN). However, the empirical support to these assumptions is still scarce. The aim of the present study was to examine whether parents of patients with AN are characterized by a lower mentalizing ability, and whether it is associated with impaired mentalizing, AN symptomatology and eating disorder (ED) related psychological traits in the daughters. METHODS Thirty-two family triads (fathers, mothers, and daughters) of female adolescent and young adult inpatients with AN were compared with thirty-three non-clinical family triads (N = 195). The mentalizing ability of all the participants was assessed using semi-structured interviews and coded using the Reflective Functioning Scale (RFS). Self-report questionnaires were administered to the daughters to evaluate ED symptomatology and ED related psychological traits (e.g., low self-esteem, interpersonal insecurity, emotional dysregulation). RESULTS Decreased reflective functioning (RF) levels were found among mothers and fathers of patients with AN compared to their control peers. Examining the entire sample, clinical and non-clinical groups together, showed that both paternal and maternal RF were associated with the daughters' RF and each were found to have a significant and distinct contribution to the daughters' RF. Significant associations were found between lower levels of maternal and paternal RF and increased ED symptoms and ED related psychological traits. The use of a mediation model suggested a serial relationship in which low maternal and paternal RF contributes to the daughters' low RF, which in turn is associated with higher levels of psychological maladjustment, and ultimately contributes to the increased severity of ED symptoms. CONCLUSIONS The present results provide strong empirical support for theoretical models that suggest that deficits in parental mentalizing may represent important correlates of the presence and severity of ED symptoms in AN. Furthermore, the results highlight the relevance of fathers' mentalizing ability in the context of AN. Finally, clinical and research implications are discussed.
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Affiliation(s)
- Dor Goshen
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel.
| | - Daniel Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Jenny Kurman
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Dan Farbstein
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Erez Aival-Naveh
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Eitan Gur
- Center for the Treatment of Eating Disorders and Obesity, Sheba Medical Center, Tel Hashomer, Israel
| | - Neta Yoeli
- Ziv Medical Center, Zfat, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya, Israel
| | - Tali Bretler
- Ziv Medical Center, Zfat, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya, Israel
| | - Danny Koren
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
- Psychiatry Division, Rambam Medical Center, Haifa, Israel
| | - Lily Rothschild-Yakar
- Department of Psychology, School of Psychological Sciences, University of Haifa, Haifa, Israel
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Meshkova TA, Mitina OV, Aleksandrova RV. Risk factors of disordered eating in adolescent girls from a community sample: a multidimensional approach. CONSORTIUM PSYCHIATRICUM 2023; 4:21-39. [PMID: 38250642 PMCID: PMC10795956 DOI: 10.17816/cp6132] [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: 03/27/2023] [Accepted: 06/26/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Eating disorders (ED) are severe, chronic, and complex in nature mental illnesses that are difficult to treat. One of the ways to stave off EDs is by screening among adolescents to preempt the development of clinical forms of ED in risk groups. AIM 1) to investigate the prevalence of ED risk among adolescent girls and compare subgroups at high and low risk of ED; 2) to investigate using a multidimensional approach those variables that can interact with temperament and character traits to predict ED symptomatology. METHODS The cross-sectional observational self-report study of a community sample of adolescent girls 1217 years old (n=298; M=14.771.13) was carried out in the city of Ryazan, Russia. The Russian versions of Eating Attitudes Test and Cloningers Temperament and Character Inventory-Revised were used. In addition, an original questionnaire (Risk Factors of Eating Disorders) was developed. Regression models (to test for significant moderation) and path analysis (to test for significant mediations) were used. RESULTS Girls at risk of developing EDs are characterized by a heightened level of concern about weight and dissatisfaction with their body, tend to suffer from low self-directedness, higher novelty seeking and tendency to higher harm avoidance, display high alexithymia, experience self-distrust, negative emotionality and are dissatisfied with family relationships. They also suffer from low self-esteem and tend to be perfectionism and engage in risk behavior. Significant moderating effects were uncovered between the following ED risk factors: (1) self-distrust/risk behavior and BMI; (2) alexithymia/negative emotionality/self-esteem and cooperativeness; and (3) negative emotionality/risk behavior and self-transcendence. Family relationship dissatisfaction mediates the association between self-directedness/cooperativeness/self-transcendence and disordered eating. CONCLUSION There are various mutual influences between the numerous ED risk and prevention factors, which all together determine the paths between the predictors and final outcome.
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Affiliation(s)
| | | | - Roza V. Aleksandrova
- Research Educational Center of Applied Psychology and Psychological Services of S. Yesenin Ryazan State University
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Sarig-Shmueli Y, Kurman J, Talmon S, Yoeli N, Gur E, Stein D, Rothschild-Yakar L. Mentalizing ability, mentalizing impairments, and anorexia nervosa: Validation of the Hebrew version of the Movie for the Assessment of Social Cognition (MASC). Clin Psychol Psychother 2023; 30:873-881. [PMID: 36869582 DOI: 10.1002/cpp.2848] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 03/05/2023]
Abstract
The goal of this study was to validate the Hebrew version of the Movie for the Assessment of Social Cognition (MASC)-an ecological measure for assessing mentalizing ability-among patients with anorexia nervosa (AN) and healthy individuals. We examined the validity of the MASC's general mentalizing ability scale and of its mentalizing impairments subscales using validated measures of mentalizing ability (Reading the Mind in the Eyes test, Cambridge Mindreading Face-Voice Battery, and Reflective Function questionnaire) among female patients with AN (N = 35) and control participants (N = 42). ED symptoms were assessed via self-report questionnaires. The MASCHeb correlated with measures of mentalizing ability and was found to significantly differentiate patients with AN from controls. In addition to differing on general mental ability, the groups differed on hypomentalizing (but not hypermentalizing). Based on our findings, the MASCHeb proved to be an ecologically valid tool for assessing mentalizing ability and impairments among patients with AN. Moreover, our findings demonstrated the role played by general mentalizing ability in EDs and specifically pointed to the importance of hypomentalization in EDs. These findings have therapeutic implications, as outlined in the Discussion section.
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Affiliation(s)
| | - Jenny Kurman
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Shira Talmon
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | - Eitan Gur
- Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Warne N, Heron J, Mars B, Solmi F, Biddle L, Gunnell D, Hammerton G, Moran P, Munafò M, Penton‐Voak I, Skinner A, Stewart A, Bould H. Emotional dysregulation in childhood and disordered eating and self-harm in adolescence: prospective associations and mediating pathways. J Child Psychol Psychiatry 2023; 64:797-806. [PMID: 36541428 PMCID: PMC10152493 DOI: 10.1111/jcpp.13738] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emotional dysregulation may be a risk factor for disordered eating and self-harm in young people, but few prospective studies have assessed these associations long-term, or considered potential mediators. We examined prospective relationships between childhood emotional dysregulation and disordered eating and self-harm in adolescence; and social cognition, emotional recognition, and being bullied as mediators. METHODS We analysed Avon Longitudinal Study of Parents and Children data on 3,453 males and 3,481 females. We examined associations between emotional dysregulation at 7 years and any disordered eating and any self-harm at 16 years with probit regression models. We also assessed whether social cognition (7 years), emotional recognition (8 years) and bullying victimisation (11 years) mediated these relationships. RESULTS Emotional dysregulation at age 7 years was associated with disordered eating [fully adjusted probit B (95% CI) = 0.082 (0.029, 0.134)] and self-harm [fully adjusted probit B (95% CI) = 0.093 (0.036, 0.150)] at age 16 years. There was no evidence of sex interactions or difference in effects between self-harm and disordered eating. Mediation models found social cognition was a key pathway to disordered eating (females 51.2%; males 27.0% of total effect) and self-harm (females 15.7%; males 10.8% of total effect). Bullying victimisation was an important pathway to disordered eating (females 17.1%; males 10.0% of total effect), but only to self-harm in females (15.7% of total effect). Indirect effects were stronger for disordered eating than self-harm. CONCLUSIONS In males and females, emotional dysregulation in early childhood is associated with disordered eating and self-harm in adolescence and may be a useful target for prevention and treatment. Mediating pathways appeared to differ by sex and outcome, but social cognition was a key mediating pathway for both disordered eating and self-harm.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | | | - Lucy Biddle
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - David Gunnell
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- NIHR Applied Research Collaboration West at University Hospitals Bristol and Weston NHS Foundation TrustBristolUK
| | - Marcus Munafò
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Ian Penton‐Voak
- NIHR Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust, University of BristolBristolUK
- School of Psychological ScienceUniversity of BristolBristolUK
| | - Andy Skinner
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Integrative Cancer Epidemiology ProgrammeBristol Medical School, University of BristolBristolUK
| | - Anne Stewart
- Department of PsychiatryUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
- Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
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13
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Christoffersen H, Skårderud HR, Vrabel K, Weider S. Self-compassion as a mechanism of change in patients with eating disorders and childhood trauma receiving CFT-E; a study of within-person processes. NORDIC PSYCHOLOGY 2023. [DOI: 10.1080/19012276.2023.2192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Hedvig Christoffersen
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - Hanna Røed Skårderud
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
| | - KariAnne Vrabel
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Siri Weider
- Department, of psychology, Norwegian university of science and technology, Trondheim, Norway
- Eating Disorder Unit, Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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14
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Locati F, Milesi A, Conte F, Campbell C, Fonagy P, Ensink K, Parolin L. Adolescence in lockdown: The protective role of mentalizing and epistemic trust. J Clin Psychol 2023; 79:969-984. [PMID: 36256870 PMCID: PMC9874639 DOI: 10.1002/jclp.23453] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Mentalizing is the ability to interpret one's own and others' behavior as driven by intentional mental states. Epistemic trust (openness to interpersonally transmitted information) has been associated with mentalizing. Balanced mentalizing abilities allow people to cope with external and internal stressors. Studies show that social isolation imposed by the COVID-19 pandemic was highly stressful for most people, especially for adolescents. Here we examine whether mentalizing and epistemic trust were protective factors in relation to emotional distress during the lockdown. METHOD A total of 131 nonclinical adolescents, aged between 12 and 18 years, were evaluated during the lockdown using the Reflective Functioning Questionnaire for Youth, Inventory of Parent and Peer Attachment, Perceived Stress Scale, and Difficulties in Emotion Regulation Scale. RESULTS Results from network analysis showed that epistemic trust and mentalizing were negatively associated with perceived stress and emotion dysregulation. Epistemic trust in fathers was associated with level of perceived stress, and epistemic trust in mothers with emotion dysregulation. CONCLUSION These findings suggest that epistemic trust and the capacity to mentalize were low in adolescents during lockdown, and this was associated with high levels of stress. However, robust levels of epistemic trust and mentalizing may have acted as protective factors that buffered individuals from the risk of emotional dysregulation during the lockdown.
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Affiliation(s)
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Chloe Campbell
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Psychoanalysis Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Karin Ensink
- Faculté des sciences sociales, Université Laval, Québec, Canada
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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15
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Jewell T, Apostolidou E, Sadikovic K, Tahta-Wraith K, Liston S, Simic M, Eisler I, Fonagy P, Yorke I. Attachment in individuals with eating disorders compared to community controls: A systematic review and meta-analysis. Int J Eat Disord 2023; 56:888-908. [PMID: 36916409 DOI: 10.1002/eat.23922] [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: 10/07/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Individuals with eating disorders are known to have higher rates of insecure attachment compared to community controls, but the factors underlying this finding are poorly understood. We conducted the first meta-analysis comparing attachment in eating disorder samples compared to community controls that included quality assessment, publication bias and moderation analysis. METHOD We pre-registered our meta-analysis (CRD42019146799) and followed PRISMA guidelines. We searched PsychINFO, Embase, Medline, CINAHL, and Scopus for publications. Attachment scores were extracted, and Cohen's d calculated for each study using a random effects model. RESULTS In total, 35 studies were included in the meta-analysis and six studies were summarized in a narrative review. Eating disorder samples showed higher rates of insecure attachment compared to community controls, with a large effect size, across measurement methods and different attachment dimensions. Blinding of assessors moderated effect sizes for attachment interview studies, but no other moderators were significant. DISCUSSION Risk of insecure attachment is elevated in individuals with eating disorders, albeit heterogeneity is high and largely unexplained. Clinicians may need to take this into account in their work, particularly given the association between attachment insecurity and challenges to therapeutic alliance. Future studies comparing eating disorder samples with community samples should control for general psychopathology. PUBLIC SIGNIFICANCE Attachment is a broad concept referring to a person's thoughts, feelings and behaviors in relation to close others. This systematic review and meta-analysis found that individuals with eating disorders are lower in attachment security than community controls, regardless of attachment construct or measurement approach. Attachment may be relevant in influencing eating disorder recovery, the development of therapeutic alliance, and potentially clinical outcomes, although more research is needed.
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Affiliation(s)
- Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Eleni Apostolidou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kevser Sadikovic
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | | | - Sarah Liston
- Leicestershire Partnership NHS Foundation Trust, Leicester, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Anna Freud Centre, London, UK
| | - Isabel Yorke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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16
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Zeeck A. Psychodynamisch orientierte (teil-)stationäre Behandlung von Essstörungen. PDP - PSYCHODYNAMISCHE PSYCHOTHERAPIE 2023. [DOI: 10.21706/pdp-22-1-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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17
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Bizzi F, Riva A, Charpentier Mora S, Tironi M, Sforza SE, Milani LM, Nacinovich R. Investigating Functioning Profile of Adolescents with Anorexia before and during the COVID-19 Pandemic: A Cross-Sectional Study on Mentalizing, Alexithymia, and Impulsiveness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3670. [PMID: 36834365 PMCID: PMC9959039 DOI: 10.3390/ijerph20043670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
Anorexia nervosa (AN) usually emerges in adolescence when important changes occur in cognitive, emotional, and social processes. Mentalizing, alexithymia, and impulsiveness represent key dimensions for the understanding and interpretation of psychological difficulties in AN. The outbreak of the COVID-19 pandemic has impacted adolescents with AN, showing a worsening of the disease. The main aims of the present paper are (1) to compare adolescents with AN before and during the COVID-19 pandemic and (2) to explore the relationship between mentalizing, alexithymia, impulsiveness, and psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. One hundred and ninety-six AN female adolescents (N = 94 before COVID-19; N = 102 during COVID-19) participated in this study. The results show that adolescents with AN during the COVID-19 pandemic had a more impaired functioning profile than the before COVID-19 group. Mentalizing, alexithymia, and impulsiveness had a predictive role on psychological difficulties related to eating disorders in adolescents with AN during the COVID-19 pandemic. In conclusion, our data reveal that the COVID-19 pandemic has likely represented a stress condition that affects mental health; worsening the severity of adolescents with AN clinical condition. Lastly, predictive patterns suggest the existence of a link between difficulties in the ability to face the problems of the present time using effective strategies and the severity of psychological symptoms.
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Affiliation(s)
- Fabiola Bizzi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Anna Riva
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Simone Charpentier Mora
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Marta Tironi
- Department of Educational Sciences, University of Genoa, Corso A. Podestà 2, 16121 Genoa, Italy
| | - Sofia Elena Sforza
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- School of Medicine and Surgery, University of Brescia, 25123 Brescia, Italy
| | - Lorenzo Maria Milani
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
| | - Renata Nacinovich
- Child and Adolescent Mental Health Department, Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, Via Pergolesi 33, 20900 Monza, Italy
- NeuroMI—Milan Center for Neuroscience, University of Milano-Bicocca, 20126 Milan, Italy
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18
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Meier AF, Zeeck A, Taubner S, Gablonski T, Lau I, Preiter R, Gläser H, Zipfel S, Herzog W, Wild B, Friederich HC, Resmark G, Giel K, Teufel M, Burgmer M, Dinkel A, Herpertz S, Löwe B, Tagay S, von Wietersheim J, De Zwaan M, Hartmann A. Mentalization-enhancing therapeutic interventions in the psychotherapy of anorexia nervosa: An analysis of use and influence on patients’ mentalizing capacity. Psychother Res 2022; 33:595-607. [DOI: 10.1080/10503307.2022.2146542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alexander Ferdinand Meier
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, Center for Psychosocial Medicine, University Hospital, Heidelberg, Germany
| | - Thorsten Gablonski
- Department for Psychology, Psychotherapy and Psychoanalysis, Institute for Psychology, University of Klagenfurth, Klagenfurth, Austria
| | - Inga Lau
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Romi Preiter
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Hannes Gläser
- Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR Universityhospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL-Hospital Muenster and University Hospital Muenster, Muenster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- TH Köln, University of Applied Sciences, Köln, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Martina De Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Armin Hartmann
- Department Of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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State of Mind Assessment in Relation to Adult Attachment and Text Analysis of Adult Attachment Interviews in a Sample of Patients with Anorexia Nervosa. Eur J Investig Health Psychol Educ 2022; 12:1760-1779. [PMID: 36547025 PMCID: PMC9777650 DOI: 10.3390/ejihpe12120124] [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: 08/30/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Attachment theory represents one of the most important references for the study of the development of an individual throughout their life cycle and provides the clinician with a profound key for the purposes of understanding the suffering that underlies severe psychopathologies such as eating disorders. As such, we conducted a cross-sectional study with a mixed-methods analysis on a sample of 32 young women with anorexia nervosa (AN); this study was embedded in the utilized theoretical framework with the following aims: 1. to evaluate the state of mind (SoM) in relation to adult attachment, assuming a prevalence of the dismissing (DS) SoM and 2. to analyze the linguistic attachment profile emerging from the transcripts of the AAIs. METHODS Interviews were transcribed verbatim, coded, and analyzed using the linguistic inquiry and word count (LIWC) method. RESULTS The results were observed to be consistent with the referenced literature. The prevalence of a DS SoM (68.75%) is observed in the study sample, whereas the results of the lexical analysis of the stories deviate from expectations. Notably, the lexical results indicate the coexistence of the dismissing and entangled aspects at the representational level. CONCLUSIONS The study results suggest a high level of specificity in the emotional functioning of patients with AN, with a focusing on a pervasive control of emotions that is well illustrated by the avoidant/ambivalent (A/C) strategy described in Crittenden's dynamic-maturational model. These findings and considerations have important implications for clinical work and treatment, which we believe must be structured on the basis of starting from a reappraisal of emotional content.
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20
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Lukas L, Buhl C, Schulte-Körne G, Sfärlea A. Family, friends, and feelings: the role of relationships to parents and peers and alexithymia in adolescents with anorexia nervosa. J Eat Disord 2022; 10:143. [PMID: 36175986 PMCID: PMC9520900 DOI: 10.1186/s40337-022-00661-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with impairments in socio-emotional functioning, including difficulties in interpersonal relationships as well as alexithymia (difficulties identifying and describing one's emotions). Although the onset of the disorder is mostly in adolescence, a developmental period in which interpersonal relationships to parents as well as peers undergo major changes, only few studies have investigated the quality of interpersonal relationships in adolescent AN patients. Furthermore, the mechanisms linking poor relationship quality to eating disorder psychopathology are not yet clarified, albeit some research suggests that alexithymia might play a pivotal role. The aims of the present study were investigating the quality of interpersonal relationships to parents and peers in adolescents with AN compared to healthy adolescents as well as exploring the mediating role of alexithymia in the association between relationship quality and eating disorder symptoms. METHODS Self-report questionnaires were used to assess relationship quality (Inventory of Parent and Peer Attachment) and alexithymia (Toronto Alexithymia Scale) in 12-18 year old female adolescents with AN (n = 35) in comparison to healthy adolescents (n = 40). RESULTS Adolescents with AN reported lower relationship quality to both of their parents and to peers compared to healthy controls. Relationship quality scores were negatively correlated to alexithymia as well as eating disorder symptoms. Alexithymia fully meditated the association between eating disorder symptoms and relationship quality to parents and partially mediated the association between eating disorder symptoms and relationship quality to peers. CONCLUSION The results indicate difficulties in interpersonal relationships among adolescents with AN and emphasize the role of peer relationships for adolescents' eating disorder psychopathology. Alexithymia seems to play an important role in explaining the link between quality of relationships and eating disorder psychopathology. Results suggest that treatment should not only focus on family relationships but also address relationships to peers as well as adolescents' competence in identifying and dealing with their emotions.
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Affiliation(s)
- Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Christina Buhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstr. 5, 80336, Munich, Germany.
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21
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Lenzo V, Sardella A, Musetti A, Petralia MC, Grado I, Quattropani MC. Failures in Reflective Functioning and Reported Symptoms of Anxiety and Depression in Bereaved Individuals: A Study on a Sample of Family Caregivers of Palliative Care Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191911930. [PMID: 36231227 PMCID: PMC9564509 DOI: 10.3390/ijerph191911930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 05/13/2023]
Abstract
Introduction. This study aims at examining the role of failures in reflective functioning in predicting anxiety and depression among family caregivers of palliative care patients deceased for at least one year. Methods. A sample of 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years) completed the Hospital Anxiety and Depression Scale (HADS) and the Reflective Functioning Questionnaire (RFQ). Results. Results of the correlational analysis showed that anxiety was positively correlated with uncertainty about mental states, indicating one type of impairment in reflective functioning. Anxiety was also negatively correlated with the certainty about mental states. Depression was negatively correlated with certainty but not with uncertainty about mental states. The results of regression analysis indicated that gender and certainty about mental states were statistically significant predictors of anxiety, with the final model explaining 23% of the variance. The results also showed that gender, the condition of being the main caregiver, and the certainty about mental states were significant predictors of depression, with the final model predicting 14% of the variance. Conclusions. Overall, the results of this study point out that the bereaved individuals who scored low on certainty about mental states reported more symptoms of anxiety and depression. Psychological interventions to prevent mental disorders and to promote psychological health in the context of palliative care should carefully consider these findings.
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Affiliation(s)
- Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, 89125 Reggio Calabria, Italy
- Sisifo-Consortium of Social Cooperatives, 95125 Catania, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
- Correspondence:
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy
| | - Maria Cristina Petralia
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Irene Grado
- Sisifo-Consortium of Social Cooperatives, 95125 Catania, Italy
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22
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Klein EM, Benecke C, Kasinger C, Brähler E, Ehrenthal JC, Strauß B, Ernst M. Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning. J Psychosom Res 2022; 160:110975. [PMID: 35763941 DOI: 10.1016/j.jpsychores.2022.110975] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although the relationship between insecure attachment patterns and eating disorder (ED) psychopathology has repeatedly been demonstrated, the underlying mechanisms of this association are not fully understood. Therefore, the current study aimed to examine personality functioning, defined as an impairment in self and interpersonal functioning, as a mediator between attachment insecurity and ED psychopathology. METHODS In a representative population-based sample (N = 2508; age range 14-92 years) ED symptomatology, personality functioning, and attachment insecurity (anxiety and avoidance) were assessed. Besides descriptive uni-/bivariate analysis, path analysis was used to test a mediation model while controlling for the effects of age, gender, mental distress, and BMI. RESULTS ED symptomatology was associated with lower levels of personality functioning (r = 0.22) and higher levels of attachment anxiety (r = 0.14) but did not correlate with attachment avoidance (r = 0.02). Path analysis revealed that personality functioning fully mediated the effect of attachment anxiety on ED symptomatology: The indirect effect via personality functioning (β = 0.04, p < .001) accounted for 77% of the total effect. Fit indices were excellent. Sensitivity analyses revealed that the main results were mainly applicable to women and the middle age group. CONCLUSION The present findings contribute to the growing body of research using dimensional conceptualizations of personality functioning, suggesting that it provides an informative, overarching framework for understanding and treating ED psychopathology. Findings indicate that underlying individual differences, e.g., with respect to insecure attachment configurations, have relevant implications for symptom manifestations. Potential clinical implications and avenues for future research are discussed.
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Affiliation(s)
- Eva M Klein
- DFG Research Training Group "Life Sciences, Life Writing", University Medical Center of the Johannes Gutenberg-University Mainz, Am Pulverturm 13, 55131 Mainz, Germany.
| | - Cord Benecke
- Department of Psychology, University of Kassel, Holländische Straße 36-38, 34127 Kassel, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig 04103, Germany
| | - Johannes C Ehrenthal
- Department of Psychology, University of Cologne, Bernhard-Feilchenfeld-Str. 11, 50969 Cologne, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Stoystr. 3, 07740 Jena, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacherstr. 8, 55131 Mainz, Germany
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Saunokonoko AJ, Mars M, Sattmann-Frese WJ. The significance of the father-daughter relationship to understanding and treating Bulimia Nervosa: a Hermeneutic Phenomenological Study. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2095721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - M. Mars
- Torrens University Australia, Pyrmont, New South Wales, Australia
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24
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Quattropani MC, Geraci A, Lenzo V, Sardella A, Schimmenti A. Failures in Reflective Functioning, Dissociative Experiences, and Eating Disorder: a Study On a Sample of Italian Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:365-374. [PMID: 35600515 PMCID: PMC9120272 DOI: 10.1007/s40653-022-00450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 05/27/2023]
Abstract
Although impairments in mentalizing and dissociation have been linked to the onset of eating disorders, there is still a paucity of studies investigating their relationships among adolescents. This study aimed at investigating the role of failures in reflective functioning and dissociation in predicting the risk of eating disorders during adolescence. The Eating Disorder Inventory-3 (EDI-3), the Reflective Functioning Questionnaire (RFQ), and the Adolescent Dissociative Experiences Scale (A-DES) were administered to a sample of 427 adolescents between 13 and 20 years old. Results of correlational analysis showed that the risk of eating disorders was positively correlated with uncertainty about mental states. Eating disorder risk was also inversely correlated with certainty about mental states. Dissociation scores and its domain scores were all positively related to the risk of eating disorders. Results of regression analysis displayed that uncertainty about mental states and dissociation were statistically significant predictors of an increased risk of eating disorders. Gender and BMI were also significant predictors in the final model, which explained 24% of the variance. Regarding the specific dissociative domains, findings indicate that the depersonalization/derealization factor was the only significant predictor for the risk of eating disorder. The present study points out that uncertainty about mental states and dissociation could play a relevant role in increasing the risk of eating disorders during adolescence.
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Affiliation(s)
| | - Alessandra Geraci
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners “Dante Alighieri” of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Educational Sciences, University of Catania, Catania, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
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25
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Pace CS, Muzi S, Parolin L, Milesi A, Tognasso G, Santona A. Binge eating attitudes in community adolescent sample and relationships with interview-assessed attachment representations in girls: a multi-center study from North Italy. Eat Weight Disord 2022; 27:495-504. [PMID: 33846936 PMCID: PMC8933298 DOI: 10.1007/s40519-021-01183-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare community girls at risk and not at risk for binge eating (BE) in attachment representations through a narrative interview and to test the predictive role of attachment pattern(s) on the risk of binge eating among community girls. METHODS From 772 community adolescents of both sexes (33% boys) screened through the Binge Eating Scale (BES), 112 girls between 14 and 18 years, 56 placed in a group at risk for binge eating (BEG), and 56 matched peers, not at risk (NBEG), were assessed in attachment representations through the Friends and Family Interview (FFI). RESULTS (1) Compared to NBEG, girls in the BEG showed more insecure-preoccupied classifications and scores, together with lower narrative coherence, mother's representation as a secure base/safe haven, reflective functioning, adaptive response, and more anger toward mother. (2) Both insecure-dismissing and preoccupied patterns predicted 15% more binge-eating symptoms in the whole sample of community girls. CONCLUSIONS Insecure attachment representations are confirmed risk factors for more binge eating, affecting emotional regulation and leading to "emotional eating", thus a dimensional assessment of attachment could be helpful for prevention and intervention. Implications and limits are discussed. LEVEL OF EVIDENCE III. Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Cecilia Serena Pace
- Department of Educational Sciences (DISFOR), University of Genoa, Corso Andrea Podestà, 2, 16128, Genova, GE, Italy.
| | - Stefania Muzi
- Department of Educational Sciences (DISFOR), University of Genoa, Corso Andrea Podestà, 2, 16128, Genova, GE, Italy
| | - Laura Parolin
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, Italy
| | - Alberto Milesi
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, Italy
| | - Giacomo Tognasso
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, Italy
| | - Alessandra Santona
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo, 1, Milan, Italy
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26
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Hampshire C, Mahoney B, Davis SK. Parenting Styles and Disordered Eating Among Youths: A Rapid Scoping Review. Front Psychol 2022; 12:802567. [PMID: 35153924 PMCID: PMC8830294 DOI: 10.3389/fpsyg.2021.802567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/21/2021] [Indexed: 12/27/2022] Open
Abstract
Youth is a critical period in the development of maladaptive eating behaviors. Previous systematic reviews suggest the etiological significance of parent-child relationships for the onset of disordered eating in youth, but less is known about the role of parenting styles. This rapid scoping review aimed to identify whether research supports the role of parenting styles in the development of disordered eating symptoms among youths. Sixteen studies, retrieved from three databases (PsycArticles, PsycInfo, and BASE), met the inclusion criteria: original studies, published in English, examined the effect of parenting styles (authoritative or neglectful) on cognitive (drives for thinness and body dissatisfaction) and behavioral (weight control behaviors) disordered eating outcomes, among young people up to 18 years of age. Studies supported an association between various youth disordered eating symptoms such as unhealthy weight control behaviors, and experiences of adverse parenting styles characterized by high levels of control and low levels of responsiveness. Associations between adverse parenting styles and youth disordered eating were frequently indirect and differed depending on the sex of the parent and offspring. Synthesis of findings was limited due to variation in the operationalization and measurement of parenting styles, family context and disordered eating across studies. Longitudinal and standardized research is required to better understand the dynamic associations between parenting styles and youth disordered eating. Implications for family-based care in clinical practice are discussed.
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Affiliation(s)
- Chloe Hampshire
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Bérénice Mahoney
- School of Psychology, University of Worcester, Worcester, United Kingdom
| | - Sarah K Davis
- School of Psychology, University of Worcester, Worcester, United Kingdom
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27
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Giles EM, Cross AS, Matthews RV, Lacey JH. Disturbed families or families disturbed: a reconsideration. Eat Weight Disord 2022; 27:11-19. [PMID: 33721219 PMCID: PMC8860793 DOI: 10.1007/s40519-021-01160-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades. OBJECTIVE The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years. METHODS A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied. RESULTS This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation. CONCLUSION The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty. EMB RATING Level V. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
| | | | | | - J Hubert Lacey
- Schoen Clinic Newbridge, Birmingham, UK.
- St Georges, University of London, London, UK.
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28
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Zeeck A, Taubner S, Gablonski TC, Lau I, Zipfel S, Herzog W, Wild B, Friederich HC, Resmark G, Giel K, Teufel M, Burgmer M, Dinkel A, Herpertz S, Löwe B, Tagay S, von Wietersheim J, De Zwaan M, Zettl M, Meier AF, Hartmann A. In-Session-Reflective-Functioning in Anorexia Nervosa: An Analysis of Psychotherapeutic Sessions of the ANTOP Study. Front Psychiatry 2022; 13:814441. [PMID: 35677868 PMCID: PMC9169151 DOI: 10.3389/fpsyt.2022.814441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 04/19/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Previous research suggests that patients with anorexia nervosa (AN) show an impaired capacity to mentalize (reflective functioning, RF). RF is discussed as a possible predictor of outcome in psychotherapeutic processes. The study aimed to explore RF in sessions of patients with AN and its association with outcome and type of treatment. METHODS A post-hoc data analysis of selected cases from a randomized trial on outpatient psychotherapy for AN was conducted. Transcripts from 84 sessions of 28 patients (early phase, middle phase, and end of treatment) were assessed using the In-Session-Reflective-Functioning-Scale [14 cognitive-behavior therapy, enhanced (CBT-E); 14 focal psychodynamic therapy (FPT); 16 with good, 12 with poor outcome after 1 year]. Relations between the level of RF, type of treatment, and outcome were investigated using mixed linear models. Additionally, associations with depressive symptoms, weight gain, and therapeutic alliance were explored. RESULTS Mean in-session RF was low. It was higher in FPT when compared to CBT-E treatments. The findings point to an association between RF increase and a positive outcome. An increase in BMI in the first half of treatment was associated with higher subsequent in-session RF. There was no association between RF and depressive symptoms or the therapeutic alliance. DISCUSSION Patients with AN show a low capacity to mentalize in sessions, which seems to be at least partly dependent on the degree of starvation. The results suggest a possible relationship between an increase in in-session RF and outcome, which has to be replicated by further studies.
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Affiliation(s)
- Almut Zeeck
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Svenja Taubner
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, University Hospital, Heidelberg, Germany
| | - Thorsten C Gablonski
- Department for Psychology, Psychotherapy and Psychoanalysis, Institute for Psychology, University of Klagenfurth, Klagenfurth, Austria
| | - Inga Lau
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital Muenster, Muenster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- TH Köln, University of Applied Sciences, Köln, Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Martina De Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Max Zettl
- Center for Psychosocial Medicine, Institute for Psychosocial Prevention, University Hospital, Heidelberg, Germany
| | - Alexander F Meier
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Center for Mental Health, Department of Psychosomatic Medicine und Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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29
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Jewell T, Herle M, Serpell L, Eivors A, Simic M, Fonagy P, Eisler I. Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa. Eur Child Adolesc Psychiatry 2021:10.1007/s00787-021-01930-3. [PMID: 34967934 DOI: 10.1007/s00787-021-01930-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
Anorexia nervosa-focussed family therapy (FT-AN) is the first-line treatment for adolescent anorexia nervosa (AN), but the predictors of poor treatment response are not well understood. The main aim of this study was to investigate the role of attachment and mentalization in predicting treatment outcome. The secondary aims of the study were to investigate therapeutic alliance at 1 month as a predictor of outcome, and to test the associations between alliance and baseline attachment and mentalization. 192 adolescents with AN and their parents were recruited as they began family therapy in out-patient specialist eating disorder services. Self-report measures of attachment, mentalization, and emotion regulation were completed at the start of treatment by adolescent patients and one of their parents. Self-reported alliance scores were collected at one month. Higher scores on the Certainty Scale of the Reflective Functioning Questionnaire, completed by parents, which indicate over-certainty about mental states, were the strongest predictor of poor outcome (Odds Ratio: 0.42, CI: 0.20-0.87). Similarly, for adolescents, higher Lack of Clarity scores on the Difficulties in Emotion Regulation Scale, representing being unclear about one's feelings, were predictive of positive treatment outcome (OR: 1.10, CI: 1.00-1.21). Higher alliance scores at 1 month predicted positive outcome, and were associated with attachment security and mentalization. These novel findings suggest that, particularly in parents, a tendency towards excessive certainty about mental states in others may predict poor outcome in FT-AN. Further research is warranted to replicate the finding and characterise families at risk of poor outcome.
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Affiliation(s)
- Tom Jewell
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Moritz Herle
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Lucy Serpell
- North East London NHS Foundation Trust, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Alison Eivors
- Leicestershire Partnership NHS Foundation Trust, Leicester, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
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30
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Attachment, rumination, and disordered eating among adolescent girls: The moderating role of stress. Eat Weight Disord 2021; 26:2271-2279. [PMID: 33389702 DOI: 10.1007/s40519-020-01029-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Disordered eating behaviors are prevalent and problematic in adolescent girls. Given that disordered eating has been linked to attachment insecurity and emotion dysregulation, the current study used an emotion regulation model of attachment theory to investigate pathways to disordered eating among adolescent girls. While past research has examined attachment and eating, an emotion regulation perspective is rarely used. Additionally, limited studies have investigated specific types of eating or mediators or moderators. To address these research gaps, this study examined whether rumination mediates the relationship between attachment anxiety and avoidance and three types of disordered eating and whether stress moderates this mediation. METHODS 100 adolescent girls (Mage = 14.35 years, SD = 2.29) completed online surveys including the Relationship Structures Questionnaire, Dutch Eating Behaviour Questionnaire, Rumination Questionnaire, and Perceived Stress Scale. RESULTS The interaction between stress and attachment anxiety on rumination was significant (b = .09, SE = .04, p < .05), and stress and attachment anxiety predicted emotional eating through rumination (b = .50, SE = .15, p < .05). Rumination also predicted external eating (b = .32, SE = .11, p < .05). The mediation was not significant for restrained eating. Attachment avoidance did not significantly predict eating behaviors. CONCLUSION The emotion regulation model of attachment theory provides a suitable framework for studying disordered eating in adolescent girls. Future research may continue the use of this framework to examine related topics. Clinicians treating girls experiencing disordered eating may use interventions to promote healthy emotion regulation strategies. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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31
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Zeeck A, Endorf K, Euler S, Schaefer L, Lau I, Flösser K, Geiger V, Meier AF, Walcher P, Lahmann C, Hartmann A. Implementation of mentalization-based treatment in a day hospital program for eating disorders-A pilot study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:783-801. [PMID: 34272786 DOI: 10.1002/erv.2853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Aim of the pilot study was to evaluate the effectiveness of a day hospital program for eating disorders (EDs) after implementation of mentalization-based treatment (MBT), including a comparison to a historical matched control group. METHOD All consecutively admitted patients with an ED were included in a prospective, observational study over a period of 2 years. Main outcome criteria were eating and overall psychopathology. Furthermore, changes in the capacity to mentalize (reflective functioning [RF]), difficulties with affect regulation and interpersonal problems were assessed at admission, discharge and a three months follow-up. RESULTS Thirty-eight out of fourty patients could be included. The program led to significant reductions in eating and general pathology. There was significant improvement in RF, difficulties in emotion regulation and interpersonal functioning. However, there was no advantage in comparison to a matched control group (main outcomes). ED symptoms showed a slight renewed increase after discharge, while body mass index further increased. RF change was predictive of change in overall psychopathology, but not ED symptoms. Drop-out rate was 13.2%. CONCLUSION The program showed no advantage in comparison to a historical control group concerning a reduction in eating and overall psychopathology. However, it was associated with low drop-out rates, and changes which MBT targets: An increase in RF and a reduction of interpersonal problems as well as difficulties in emotion regulation.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katharina Endorf
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
| | - Laura Schaefer
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Inga Lau
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Valeria Geiger
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Ferdinand Meier
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter Walcher
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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32
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Garrett CJ, Ismail K, Fonagy P. Understanding developmental psychopathology in Type 1 diabetes through attachment, mentalisation and diabetes distress. Clin Child Psychol Psychiatry 2021; 26:682-694. [PMID: 33624515 DOI: 10.1177/1359104521994640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article examines the combined roles of attachment mentalisation and diabetes distress in the psychological development of young people with Type 1 diabetes (T1D). We use these ideas to unify the evidence for psychological variables affecting young people and their families and suggest how diabetes distress and mentalisation might be part of the pathways for development of psychiatric diagnoses.Attachment theory's central hypothesis is that a secure relationship with a care-giver in the early life of a child is essential to normal emotional and relational development, whilst diabetes distress is a well recognised phenomena of burden experienced by both child and parent in relation to the condition.We extend the ideas of attachment, into the psychological adaptation processes for young people at the time of diagnosis of T1D with emphasis on the function of the parent/caregiver in mentalising the experience of the child. We also connect our current understanding of diabetes distress to the associated increased risk for disorders of eating and personality in T1D.Using principles learnt in other areas of psychotherapeutic practice we end by suggesting interventions that could impact mental health and diabetes outcomes using the mentalisation model.
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Affiliation(s)
- Christopher J Garrett
- Bart's Health and East London Foundation Trust.,Diabetes, Psychiatry and Psychology Research Group, King's College London, UK
| | - Khalida Ismail
- Diabetes, Psychiatry and Psychology Research Group, King's College London, UK
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, UK
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33
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Oldham-Cooper R, Semple C, Wilkinson LL. Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes. Clin Child Psychol Psychiatry 2021; 26:669-681. [PMID: 33601940 DOI: 10.1177/1359104520986215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach).
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human & Health Sciences, Swansea University, Singleton Park, UK
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34
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Parent-Infant Attachment Insecurity and Emotional Eating in Adolescence: Mediation through Emotion Suppression and Alexithymia. Nutrients 2021; 13:nu13051662. [PMID: 34068872 PMCID: PMC8153636 DOI: 10.3390/nu13051662] [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: 03/17/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023] Open
Abstract
Emotional eating (EE), the propensity to eat in response to emotions, is thought to have its origins in the early parent–infant relationship. This study tested the hypothesis that infant attachment insecurity results in EE in adolescence through the increased use of the emotion regulation strategy suppression of emotions and subsequent alexithymia. At the age of 15 months, parent–infant attachment security (n = 129) was observed with two abbreviated attachment measures: the shortened strange situation procedure (SSSP), and the shortened attachment Q-set (S-AQS). At the age of 12 years, children completed self-report questionnaires to assess the suppression of emotions, alexithymia, and EE. At the age of 16 years, EE was measured again. The mediation models indicated that lower parent–infant attachment security predicted increased use of suppression of emotions, which was related to increased alexithymia, and in turn more EE at the age of 12 years. These results were similar and significant for both attachment measures, and also (marginal) significant with EE at the age of 16 years as an outcome. Lastly, when parental caregiving quality was included, the models with the SSSP as predictor remained significant, but the models with the S-AQS became insignificant. These results indicated that to a certain extent, infant attachment security could predict adolescent EE above and beyond parental caregiving quality.
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Cortés-García L, McLaren V, Vanwoerden S, Sharp C. Attachment, mentalizing, and eating disorder symptoms in adolescent psychiatric inpatients and healthy controls: a test of a mediational model. Eat Weight Disord 2021; 26:1159-1168. [PMID: 32989688 DOI: 10.1007/s40519-020-01017-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Research has supported a link between insecure attachment and eating disorders (EDs) in adolescents; however, mechanisms accounting for this association remain unclear. Growing evidence suggests impaired mentalizing as a potential mechanism. Yet, little is known about the relationship between mentalizing and ED symptoms or how it relates to the link between attachment and EDs in adolescents. This study examined mentalizing deficits in adolescents with ED symptoms relative to psychiatric and healthy controls and tested a mediational model, wherein mentalizing capacity mediates the relationship between attachment and ED symptoms. METHOD Inpatient adolescents with EDs and other pathology (n = 568) and healthy controls (n = 184) were administered the child attachment interview, the movie for the assessment of social cognition and the diagnostic interview schedule for children to assess attachment, mentalizing and ED symptoms, respectively. RESULTS Inpatients showed lower attachment security and more hypermentalizing than healthy adolescents. Hypermentalizing explained the association between insecure attachment and ED symptoms. CONCLUSIONS These findings suggest potential utility of targeting mentalizing in prevention and treatment of EDs in adolescents. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- L Cortés-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela. Campus Vida, Calle Xosé María Suárez Núñez, s/n, 15782, Santiago de Compostela, A Coruña, Spain.
| | - V McLaren
- Department of Psychology, University of Houston, Houston, TX, United States
| | - S Vanwoerden
- Department of Psychology, University of Houston, Houston, TX, United States
| | - C Sharp
- Department of Psychology, University of Houston, Houston, TX, United States
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Cortés-García L, Akça ÖF, Wall K, Sharp C. Exploring mentalizing in adolescents with anorexia nervosa and borderline personality disorder: A comparative study of psychiatric inpatients and healthy controls. Scand J Child Adolesc Psychiatr Psychol 2021; 9:16-26. [PMID: 33928050 PMCID: PMC8077418 DOI: 10.21307/sjcapp-2021-003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Impaired mentalizing, i.e., difficulties in understanding oneself and others in terms of mental states, has been associated with the development of Anorexia Nervosa (AN), mainly among adults. However, few studies have addressed this question in clinical samples of adolescents with AN. Moreover, no study has explored mentalizing abilities among inpatient adolescents presenting with AN and Borderline Personality Disorder (BPD), despite their high comorbidity in a highly relevant age group. Objective: This study attempted, for the first time, to further examine differences in mentalizing abilities and to identify specific mentalizing impairments in different psychiatric inpatient groups and healthy adolescents. Methods: Using samples of female adolescents aged 12–17, comparison analyses were performed between psychiatric inpatient adolescents with AN (n = 44), BPD (n = 101), AN+BPD (n = 48), other psychopathology (n = 163) and healthy adolescents (n = 129). Structured and semi-structured clinical interviews, and two experimental tasks were administered to assess AN, BPD and mentalizing, respectively. Results: Comparison analyses showed that patients with BPD and other psychiatric disorders evidenced higher levels of hypermentalizing compared to healthy adolescents. Hypermentalizing was also reported among inpatients with AN+BPD, although to a lesser extent. BPD and AN scores were positively correlated with hypermentalizing responses. Conclusions: Our results suggest that hypermentalizing is a specific mentalization impairment in inpatient adolescents, particularly with BPD and both AN+BPD. Further investigation into the efficacy of mentalization based treatments for adolescents with BPD and AN+BPD is recommended. Prospective studies are needed to assess mentalizing using experimental tasks among adolescents with AN, taking into account the potential influence of temporality and severity of the disorders’ symptoms.
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Affiliation(s)
- Laura Cortés-García
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Kiana Wall
- University of Houston, Department of Psychology, Houston, Texas, USA
| | - Carla Sharp
- University of Houston, Department of Psychology, Houston, Texas, USA.,University of the Free State, Center for Developmental Support, Bloemfontein, South Africa
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Iwinski S, Cole NC, Saltzman JA, Donovan SM, Lee SY, Fiese BH, Bost KK. Child attachment behavior as a moderator of the relation between feeding responsiveness and picky eating behavior. Eat Behav 2021; 40:101465. [PMID: 33310487 PMCID: PMC10796209 DOI: 10.1016/j.eatbeh.2020.101465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Picky eating (PE) behavior is common in early childhood, but persistent PE is associated with unhealthy development and caregiver-child stress during feeding. Identifying modifiable feeding and parent-child relationship factors that impact PE is important for decreasing risks associated with PE. OBJECTIVE This study examined associations between caregiver Feeding Responsiveness (FR) and child PE behaviors using caregiver reports and observations of family mealtimes. An additional aim examined whether children's attachment behavior moderates this association. METHODS The analysis sample consisted of 110 families participating in a larger longitudinal study of nutrition and child health. Home observations were conducted when children were 18-24 months (52% females) to assess caregiver-child interactions. Caregivers were, on average, 30.9 years old and mostly White (73.6%). Family mealtimes were videotaped and coded for FR and child PE behaviors. Caregivers completed surveys regarding FR and PE behaviors. RESULTS Caregiver-reported FR was significantly correlated with observed FR, r (107) = 0.26, p = 0.007; and caregiver-reported PE was associated with observed PE, r (107) = 0.21, p = 0.029. Caregiver-reported FR was inversely related to observed PE, but only when children were characterized by observers to have more positively toned and smooth interactions with caregivers. Using observational data, child attachment significantly moderated the relationship between FR and PE behaviors. CONCLUSIONS The quality of caregiver-child interactions may impact the degree to which FR is effective in reducing PE. Future longitudinal studies that include more diverse populations, multiple caregivers, and potential mechanisms accounting for these associations are needed.
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Affiliation(s)
- Samantha Iwinski
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America.
| | - Natasha Chong Cole
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America
| | - Jaclyn A Saltzman
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America; The MITRE Corporation, Bedford, MA, United States of America
| | - Sharon M Donovan
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America; Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States of America
| | - Soo-Yeun Lee
- Division of Nutritional Sciences, University of Illinois, Urbana, IL, United States of America; Food Science and Human Nutrition, University of Illinois, Urbana, IL, United States of America
| | - Barbara H Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America
| | - Kelly K Bost
- Department of Human Development and Family Studies, University of Illinois, Urbana, IL, United States of America
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von Essen E. Young adults' transition to a plant-based diet as a psychosomatic process: A psychoanalytically informed perspective. Appetite 2020; 157:105003. [PMID: 33091479 DOI: 10.1016/j.appet.2020.105003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Abstract
This study examined transition to a plant-based diet by young adults and the challenges and conflicts this brings. Interviews were conducted with nine young adults in Sweden and the answers were analysed guided by a psychological method from descriptive phenomenology. The results indicate that the transition to a plant-based diet is a process comprising five dimensions: 1) Exploring new ways of living based on health anxieties, 2) regulating conflicting emotions through differentiation, 3) transforming traditional models into new alternatives, 4) confirming new skills and abilities and 5) integrating experiences and emotions into a whole. These five dimensions reflect how transition to a plant-based diet is experienced physically and emotionally. The results also indicate that plant-based meals and ingredients used in the new diet are loaded with symbols and conflicting emotions. Psychoanalytically informed theory, especially object relation theory, was used in discussing what can happen to the mind during the transition. In a wider perspective, this study provides insights into how a dietary transition can bring stability to the life of young adults and help them endure and master their situation. More research is needed to assess the role of mental health in transitioning to a plant-based diet and to draw more general conclusions, an area where psychodynamic theory can provide insights.
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Affiliation(s)
- Elisabeth von Essen
- Department of Work Science, Business Economics and Environmental Psychology, Swedish University of Agricultural Sciences, 230 53, Alnarp, Sweden.
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Mediating role of depressive symptoms linking insecure attachment and disordered eating in adolescents: A multiwave longitudinal study. Dev Psychopathol 2020; 34:115-127. [PMID: 32928329 DOI: 10.1017/s0954579420001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Research has supported a link between insecure attachment and disordered eating in adolescents; however, how this influence is exerted remains unclear. This study explored whether depressive symptoms constitute a pathway through which insecure attachment to parents predicts subsequent development of disordered eating in the transition from childhood to adolescence. The study also examines whether there are differential effects regarding the attachment figure, child's gender, or reciprocity between variables. A community-based sample of Spanish youth (n = 904; 49.4% girls) was followed biennially from age 10 to 16 years. Attachment, depressive symptoms, and disordered eating were measured using the Inventory of Parental and Peer Attachment, Children's Depression Inventory, and Children's Eating Attitudes Test, respectively. Prospective data were analyzed using a dynamic panel model, which accounts for unmeasured time-invariant factors. Whereas insecure attachment to the father did not predict later depression or disordered eating, higher insecure attachment to the mother at ages 10 and 12 years predicted more disordered eating at ages 14 and 16 years via increased depressive symptoms at ages 12 and 14 years. No child's gender-specific or reverse mediational effects were found. This study suggests that an increase in depressive symptoms might be one mechanism by which insecure attachment exerts its influence on the development of eating disorders symptomatology in adolescence. Intervention efforts aimed at strengthening particularly the mother-child attachment relationship may reduce the vulnerability to develop depressive symptoms and disordered eating.
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Rossman SM, Eddy KT, Franko DL, Rose J, DuBois R, Weissman RS, Dierker LC, Thomas JJ. Behavioral symptoms of eating disorders among adopted adolescents and young adults in the United States: Findings from the Add Health survey. Int J Eat Disord 2020; 53:1515-1525. [PMID: 32701179 DOI: 10.1002/eat.23334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE More adopted individuals report experiencing general psychopathology, poor parental attachment, and early childhood eating difficulties than nonadopted individuals, yet little is known about disordered eating in this population. This study sought to describe the relationship between adoption status and behavioral eating-disorder (ED) symptoms, and to examine potential correlates of ED symptoms that are unique to adopted individuals. METHOD We examined data from adolescents and young adults from Waves 1 (n adopted = 561, nonadopted = 20,184), 2 (n adopted = 211, nonadopted = 14,525), and 3 (n adopted = 416, nonadopted = 14,754) of the National Longitudinal Study of Adolescent to Adult Health. ED symptom items included dieting, breakfast skipping, binge eating, extreme weight loss behaviors (EWLBs; i.e., self-induced vomiting, laxative use, diet pill use) and lifetime ED diagnosis. RESULTS Compared to nonadopted individuals, adopted individuals were more likely to report EWLBs at Wave 2 and binge eating and lifetime ED diagnosis at Wave 3 (ps < .05). Among adopted individuals, contact with a biological parent was associated with higher rates of binge eating and lifetime ED diagnosis at Wave 3 (ps < .05), whereas age at adoption and having ever been in foster care were not associated with rates of ED symptoms. DISCUSSION This study provides preliminary evidence that being adopted may be a risk factor for certain behavioral symptoms of EDs. Given the benefits of early detection and treatment of ED symptoms, mental health professionals working with adopted individuals should assess for disordered eating.
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Affiliation(s)
- Setareh M Rossman
- Department of Psychology, Clark University, Worcester, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Debra L Franko
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
| | - Jennifer Rose
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Russell DuBois
- Department of Clinical Research, Blueprint Health, Chicago, Illinois, USA
| | | | - Lisa C Dierker
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Monteleone AM, Corsi E, Cascino G, Ruzzi V, Ricca V, Ashworth R, Bird G, Cardi V. The Interaction Between Mentalizing, Empathy and Symptoms in People with Eating Disorders: A Network Analysis Integrating Experimentally Induced and Self-report Measures. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10126-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Domon-Archambault V, Terradas MM, Drieu D, De Fleurian A, Achim J, Poulain S, Jerrar-Oulidi J. Mentalization-Based Training Program for Child Care Workers in Residential Settings. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:239-248. [PMID: 32549935 PMCID: PMC7290019 DOI: 10.1007/s40653-019-00269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.
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Affiliation(s)
- Vincent Domon-Archambault
- CIUSSS du Centre-Sud-de-l’Île-de-Montréal, 1001 rue de Maisonneuve, bureau 686, Montréal, Québec H2L 4P9 Canada
| | | | | | | | | | - Stéphane Poulain
- Hébergement thérapeutique, Maison des adolescents de Caen, Caen, France
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Luyten P, Campbell C, Allison E, Fonagy P. The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. Annu Rev Clin Psychol 2020; 16:297-325. [DOI: 10.1146/annurev-clinpsy-071919-015355] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may benefit individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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Abstract
Eating disorders are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes towards weight, body shape, and eating play a key role in the origin and maintenance of eating disorders. Eating disorders have been increasing over the past 50 years and changes in the food environment have been implicated. All health-care providers should routinely enquire about eating habits as a component of overall health assessment. Six main feeding and eating disorders are now recognised in diagnostic systems: anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant-restrictive food intake disorder, pica, and rumination disorder. The presentation form of eating disorders might vary for men versus women, for example. As eating disorders are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed.
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Affiliation(s)
- Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tiago Antunes Duarte
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Serviço de Psiquiatria e Saúde Mental, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Treasure J, Willmott D, Ambwani S, Cardi V, Clark Bryan D, Rowlands K, Schmidt U. Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness. J Clin Med 2020; 9:E630. [PMID: 32120847 PMCID: PMC7141127 DOI: 10.3390/jcm9030630] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.
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Affiliation(s)
- Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Daniel Willmott
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, PA17013, USA;
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Danielle Clark Bryan
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (J.T.); (V.C.); (D.C.B.); (K.R.); (U.S.)
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Dufresne L, Bussières EL, Bédard A, Gingras N, Blanchette-Sarrasin A, Bégin PhD C. Personality traits in adolescents with eating disorder: A meta-analytic review. Int J Eat Disord 2020; 53:157-173. [PMID: 31633223 DOI: 10.1002/eat.23183] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Given the growing interest in personality traits among the young population with eating disorders (EDs) and the recognition that a better understanding of personality can facilitate clinical management, this meta-analytic study reviewed evidence concerning the relationship between personality traits and the presence of an ED during adolescence. METHOD We conducted a systematic literature search to identify studies that examined personality traits among adolescents with an ED (anorexia nervosa, bulimia nervosa, binge-eating disorder, eating disorder not otherwise specified) and that compared these traits with a normative group without an ED. The personality traits investigated in the selected studies were organized according to the personality trait domains presented in the Diagnostic and Statistical Manual of Mental Disorders (fifth ed.). Effect sizes of the mean differences were calculated for each domain. We performed meta-regressions to assess the moderating effect of ED subtype and age on the combined effect sizes. RESULTS Twenty-six studies met our inclusion criteria, containing a total of 63 effect sizes. Adolescents with EDs differed from the non-ED group according to traits related to negative affectivity (g = 0.78), detachment (g = 0.69), and conscientiousness (g = -0.53). The presence of an anorexia nervosa diagnosis moderated the relationship between an ED and personality traits; this diagnosis was more strongly associated with conscientious traits compared to other EDs. DISCUSSION Our findings provide evidence that personality traits are related to EDs in adolescents. Thus, considering personality traits could lead to a better understanding of etiological and maintenance factors for EDs.
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Affiliation(s)
- Laurie Dufresne
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Eve-Line Bussières
- Department of Psychology, University of Quebec at Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Alexandra Bédard
- Faculty of Agricultural and Food Sciences, Institute of Nutrition and Functional Food, Laval University, Québec, Québec, Canada
| | - Nathalie Gingras
- Department of Psychiatry, Laval University, Québec, Québec, Canada
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Sibeoni J, Verneuil L, Poulmarc'h L, Orri M, Jean E, Podlipski MA, Gérardin P, Révah-Lévy A. Obstacles and facilitators of therapeutic alliance among adolescents with anorexia nervosa, their parents and their psychiatrists: A qualitative study. Clin Child Psychol Psychiatry 2020; 25:16-32. [PMID: 31648525 DOI: 10.1177/1359104519882765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Therapeutic alliance is one of the most important aspects of treatment of adolescents with anorexia nervosa. Little is known about the facilitators and obstacles of its process in this situation. We aimed to explore the experience of therapeutic alliance in inpatient treatment among adolescents with anorexia nervosa, their parents and their psychiatrists. METHODS This qualitative study, using semi-structured interviews, took place in France. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. RESULTS Forty-one participants were included, 15 teenaged girls, 18 parents and 8 psychiatrists. Analysis showed two themes: (1) what facilitates an alliance in treatment - with four facilitators: (a) human qualities, (b) an active role in the treatment, (c) taking time and (d) taking care of the entire family and (2) what impedes an alliance in treatment with four obstacles: (a) being too close or too distant, (b) focusing on weight, (c) control and constraints and (d) psychiatrization. CONCLUSION Collaborative work between paediatricians and psychiatrists could facilitate therapeutic alliance with parents. Definition of therapeutic alliance in this situation should be enlarged to include the adolescent-parent relationship. It is necessary to construct specific items to integrate these specific aspects to existing scales.
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Affiliation(s)
- Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, France
| | | | - Léa Poulmarc'h
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, France
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Canada.,Bordeaux Population Health Research Center, INSERM U1219, University of Bordeaux, France
| | - Elise Jean
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, France
| | - Marc-Antoine Podlipski
- Centre Hospitalier du Rouvray, Fédération Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Rouen - CH du Rouvray, France
| | - Priscille Gérardin
- Centre Hospitalier du Rouvray, Fédération Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Rouen - CH du Rouvray, France
| | - Anne Révah-Lévy
- Service Universitaire de Psychiatrie de l'Adolescent, Argenteuil Hospital Centre, France.,ECSTRRA Team, UMR-1153, Inserm, Université de Paris, France
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Adult attachment in eating disorders mediates the association between perceived invalidating childhood environments and eating psychopathology. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00524-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2019; 10:708. [PMID: 31649563 PMCID: PMC6796791 DOI: 10.3389/fpsyt.2019.00708] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs. Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD. Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD. Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Viktoria Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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McComb SE, Mills JS. Orthorexia nervosa: A review of psychosocial risk factors. Appetite 2019; 140:50-75. [DOI: 10.1016/j.appet.2019.05.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 02/01/2023]
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