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Rossi E, Cassioli E, Dani C, Marchesoni G, Monteleone AM, Wonderlich SA, Ricca V, Castellini G. The maltreated eco-phenotype of eating disorders: A new diagnostic specifier? A systematic review of the evidence and comprehensive description. Neurosci Biobehav Rev 2024; 160:105619. [PMID: 38462152 DOI: 10.1016/j.neubiorev.2024.105619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
This systematic review aimed to summarize the evidence on the existence of a distinct phenotypic expression of Eating Disorders (EDs) associated with childhood maltreatment (CM), the so-called maltreated eco-phenotype of EDs. PRISMA standards were followed. Articles providing data about the characteristics of individuals with an ED reporting CM were included. Relevant results were extracted and summarized. A quality assessment was performed. A total of 1207 records were identified and screened, and 97 articles published between 1994 and 2023 were included. Findings revealed distinct biological and clinical features in patients with EDs reporting CM, including neuroanatomical changes, altered stress responses, ghrelin levels, inflammation markers, and gut microbiota composition. Clinically, CM correlated with severer eating behaviors, higher psychiatric comorbidity, impulsivity, emotional dysregulation, and risky behaviors. Additionally, CM was associated with poorer treatment outcomes, especially in general psychopathology and psychiatric comorbidities. This review highlighted the need to move towards an etiologically informed nosography, recognizing CM not merely as a risk factor, but also as an etiologic agent shaping different eco-phenotypic variants of EDs.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristiano Dani
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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Pollmann A, Fritz J, Barker E, Fuhrmann D. Networks of Adversity in Childhood and Adolescence and Their Relationship to Adult Mental Health. Res Child Adolesc Psychopathol 2023; 51:1769-1784. [PMID: 36331717 PMCID: PMC10661796 DOI: 10.1007/s10802-022-00976-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
Adverse experiences before the age of eighteen are common and include diverse events ranging from sexual abuse to parental divorce. These stressful experiences have been linked to physical and mental health issues. Previous research has focused mainly on childhood adversity, such as experiences in the family environment. Little consideration has been given to adversities that may be particularly harmful in adolescence. To understand adolescents' adverse experiences, this project used data from the Avon Longitudinal Study of Parents and Children (ALSPAC, total N = 14,901, N ≈ 1,200 - 10,000 per measure). We modelled interrelations of adversities in childhood (1-11 years) and adolescence (11-23 years) and examined adversity clusters using network analysis. We found two similar clusters in the childhood and adolescence networks: (1) direct abuse and (2) adverse family factors. We identified a third cluster of (3) educational and social adversities for adolescence. For both age groups, emotional abuse in the family environment was closely linked to mental health in early adulthood and most adversities were linked with depression in early adulthood. In adolescence, housing and academic issues and abuse by a romantic partner were particularly central to the network of adversities. Thus, we found commonalities and differences in the relevance of adverse experiences at different developmental stages. These findings highlight the need to develop age-dependent frameworks for adversity research and policymaking.
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Affiliation(s)
- Ayla Pollmann
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, King's College London, Addison House, Guy's Campus, SE1 1UL, London, UK.
| | - Jessica Fritz
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Edward Barker
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, Henry Wellcome Building for Psychology, Denmark Hill Campus, SE5 8AF, London, UK
| | - Delia Fuhrmann
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, King's College London, Addison House, Guy's Campus, SE1 1UL, London, UK
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Tibubos AN, Werner AM, Brähler E, Shahar G, Ernst M, Reiner I, Beutel ME. Self-Criticism in the General Population: Development and Psychometric Properties of the Depressive Experiences Questionnaire Self-Criticism 4 (DEQ-SC4). J Pers Assess 2023; 105:74-86. [PMID: 35298312 DOI: 10.1080/00223891.2022.2043878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Self-criticism is a stable personality trait identified as a serious risk factor for psychopathology and weight-related health problems. Therefore, it is relevant to epidemiological research, which requires a relatively brief instrument for measuring trait self-criticism in the general population. The current study introduces a brief measure of self-criticism and presents empirical results that inform on its reliability and validity. Based on the six-item version of the Depressive Experiences Questionnaire Self-Criticism (DEQ-SC6), thorough psychometric analyses on a German representative sample (N = 2,516) were conducted and resulted in the final four-item scale: the Depressive Experiences Questionnaire Self-Criticism 4 (DEQ-SC4). Its internal consistency was good and a one-dimensional factor structure showed a good model fit. In terms of construct validity, the DEQ-SC4 was moderately linked to symptoms of depression and a non-linear association between the DEQ-SC4 and body mass index was observed, with the highest levels of self-criticism reported by underweight participants. In addition, the DEQ-SC4 showed high positive correlations with another short version of the DEQ-SC and the Big Five personality dimensions assessed in samples of university students (N = 206) and patients (N = 55), meeting theoretically-based expectations. The DEQ-SC4 therefore represents a brief screening measure of self-criticism in the general population with good psychometric properties.
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Affiliation(s)
- Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Nursing Science, Diagnostics in Healthcare & E-Health, University Trier, Trier, Germany
| | - Antonia M Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Golan Shahar
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Momeñe J, Estévez A, Griffiths MD, Macia P, Herrero M, Olave L, Iruarrizaga I. Childhood trauma and body dissatisfaction among young adult women: the mediating role of self-criticism. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03495-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AbstractThe present study examined the relationship between childhood trauma and body dissatisfaction among young women. The mechanisms through which childhood trauma are related to body dissatisfaction have not been sufficiently examined previously. The aims of the present study were to analyze the (i) relationships between childhood trauma, self-criticism, and body dissatisfaction and (ii) mediating role of self-criticism in the relationship between childhood trauma and body dissatisfaction. A total of 754 young adult women aged 18 to 30 years participated (M = 20.49 years; SD = 2.28). The findings showed positive correlations between childhood trauma, self-criticism, and body dissatisfaction. The mediation model indicated that (i) greater childhood trauma was associated with greater self-criticism, and (ii) greater self-criticism was significantly associated with greater body dissatisfaction. Therefore, childhood trauma was indirectly associated with increased body dissatisfaction and explained by the positive relationship with increased self-criticism. These results highlight the importance of childhood trauma in body dissatisfaction among young adult women and demonstrates self-criticism coping style as a key factor in this relationship. Early detection of self-criticism-based coping styles and childhood trauma could improve (i) quality of life and prevent the onset of body dissatisfaction, and (ii) treatment planning and prevent body dissatisfaction from escalating into major problems (e.g., eating disorders, body dysmorphic disorder, morbid exercise and/or depressive symptomatology).
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Exploring risk factors of food and alcohol disturbance (FAD) in U.S. college students. Eat Weight Disord 2022; 27:1739-1749. [PMID: 34622393 DOI: 10.1007/s40519-021-01313-2] [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: 04/25/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Current research examining mental health and history of childhood trauma as risk factors of food and alcohol disturbance (FAD) is limited. College students may be at greater risk to engage in FAD behaviors because of the common co-occurrence of alcohol misuse and disordered eating behaviors within college populations. Therefore, the current study examined anxiety, depression, and adverse childhood experiences as possible risk factors of FAD behaviors in a college student sample. METHODS Two-hundred and seven undergraduate students from a large Midwest university completed a cross-sectional survey assessing history of adverse childhood experiences, depressive symptoms, anxiety symptoms, FAD behaviors, and frequency of alcohol use. RESULTS Current symptoms of generalized anxiety were significantly associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.13, F(1, 204) = 4.10, p = 0.04; Bulimia subscale, β = 0.17, F(1, 204) = 6.19, p = 0.01; Diet and Exercise subscale, β = 0.19, F(1, 204) = 9.05, p < 0.01). Adverse childhood experiences were associated with engagement in FAD behaviors (Alcohol Effects subscale, β = 0.14, F(1, 204) = 4.27, p = 0.04). Current depressive symptoms were not significantly associated with FAD behaviors. CONCLUSIONS Study findings suggest that students who experience greater current symptoms of anxiety are at a greater risk to engage in FAD behaviors. Further understanding the role of anxiety in the development and maintenance of FAD behaviors may provide clinically useful information for the prevention and treatment of FAD behaviors. These findings highlight the need for further research to examine psychological distress as a risk factor for engagement in FAD behaviors longitudinally, in a larger, more diverse study sample. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Hessler-Kaufmann JB, Heese J, Berking M, Voderholzer U, Diedrich A. Emotion regulation strategies in bulimia nervosa: an experimental investigation of mindfulness, self-compassion, and cognitive restructuring. Borderline Personal Disord Emot Dysregul 2020; 7:13. [PMID: 32637120 PMCID: PMC7333379 DOI: 10.1186/s40479-020-00129-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/10/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While improving emotion regulation (ER) is a central goal in the therapy of bulimia nervosa (BN), there is no experimental evidence on the efficacy of different ER strategies. (1) We hypothesized that mindfulness as well as self-compassion as contextual strategies and cognitive restructuring as classical cognitive behavioral strategy would outperform waiting in improving emotional and eating disorder related outcomes after an unpleasant mood induction. Further, we explored (2) whether contextual strategies outperformed cognitive restructuring and (3) whether comorbid mental disorders and previous treatment for BN influenced the efficacy of contextual ER strategies compared to cognitive restructuring. METHODS Within their first 2 weeks of treatment, inpatients with BN were instructed to utilize mindfulness, self-compassion, and cognitive restructuring or to wait after a pre-induced sadness in a permuted repeated measures design. Patients further rated different emotional and cognitive outcomes on a visual analogue scale at baseline, and before and after each ER strategy. Multiple linear regression analyses were employed to compare (1) the active conditions to waiting, (2) the contextual strategies with cognitive restructuring, and (3) the latter analysis again, but separated according to comorbidity and previous treatment. RESULTS Forty-eight female inpatients with BN (mean age = 26.44 years, SD = 6.64) completed the study. (1) Contextual ER strategies were more efficacious than waiting for eating disorder symptoms. Cognitive restructuring did not differ from waiting for any outcome. (2) Contextual strategies were more efficacious than cognitive restructuring for emotional outcomes. (3) Self-compassion was more efficacious than cognitive restructuring in patients with comorbid mental disorders and previous treatment in increasing control over the present feeling. CONCLUSIONS Contextual strategies, especially self-compassion, seem more efficacious than waiting and cognitive restructuring in improving short-term ER in patients with BN in an experimental setting.
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Affiliation(s)
- Johannes Baltasar Hessler-Kaufmann
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Julia Heese
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Matthias Berking
- Department of Psychology and Sport Sciences, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Alice Diedrich
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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McIntyre R, Smith P, Rimes KA. The role of self-criticism in common mental health difficulties in students: A systematic review of prospective studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.mhp.2018.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Stieglitz RD, Haug A, Fähndrich E, Rösler M, Trabert W. Comprehensive Psychopathological Assessment Based on the Association for Methodology and Documentation in Psychiatry (AMDP) System: Development, Methodological Foundation, Application in Clinical Routine, and Research. Front Psychiatry 2017; 8:45. [PMID: 28439242 PMCID: PMC5383714 DOI: 10.3389/fpsyt.2017.00045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
The documentation of psychopathology is core to the clinical practice of the psychiatrist and clinical psychologist. However, both in initial as well as further training and specialization in their fields, this particular aspect of their work receives scanty attention only. Yet, for the past 50 years, the Association for Methodology and Documentation in Psychiatry (AMDP) System has been in existence and available as a tool to serve precisely the purpose of offering a systematic introduction to the terminology and documentation of psychopathology. The motivation for its development was based on the need for an assessment procedure for the reliable documentation of the effectiveness of newly developed psychopharmacological substances. Subsequently, the AMDP-System began to be applied in the context of investigations into a number of methodological issues in psychiatry (e.g., the frequency and specificity of particular symptoms, the comparison of rating scales). The System then became increasingly important also in clinical practice and, today, represents the most used instrument for the documentation of psychopathology in the German-speaking countries of Europe. This paper intends to offer an overview of the AMDP-System, its origins, design, and functionality. After an initial account of the history and development of the AMDP-System, the discussion will in turn focus on the System's underlying methodological principles, the transfer of clinical skills and competencies in its practical application, and its use in research and clinical practice. Finally, potential future areas of development in relation to the AMDP-System are explored.
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Affiliation(s)
- Rolf-Dieter Stieglitz
- Department of Psychology, Clinical Psychology and Psychiatry, Psychiatric University Hospital, University Basel, Basel, Switzerland
| | - Achim Haug
- Clienia-Group, University of Zürich, Zürich, Switzerland
| | - Erdmann Fähndrich
- Psychiatric Hospital of the Vivantes Klinikum Neukölln, Berlin, Germany
| | - Michael Rösler
- University of the Saarland Neurocentre, Homburg, Saarland, Germany
| | - Wolfgang Trabert
- Department of Psychiatry, Psychotherapy and Psychosomatics, Klinikum Emden, Emden, Germany
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9
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Gale C, Gilbert P, Read N, Goss K. An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clin Psychol Psychother 2012; 21:1-12. [PMID: 22740105 DOI: 10.1002/cpp.1806] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study explored the outcome of introducing Compassion Focused Therapy (CFT) into a standard treatment programme for people with eating disorders. In particular, the aim was to evaluate the principle that CFT can be used with people with eating disorders and improve eating disorder symptomatology. METHOD Routinely collected questionnaire data were used to assess cognitive and behavioural aspects of eating disorders and social functioning/well being (n = 99). RESULTS There were significant improvements on all questionnaire measures during the programme. An analysis by diagnosis found that people with bulimia nervosa improved significantly more than people with anorexia nervosa on most of the subscales. Also, in terms of clinical significance, 73% of those with bulimia nervosa were considered to have made clinically reliable and significant improvements at the end of treatment (compared with 21% of people with anorexia nervosa and 30% of people with atypical eating disorders). CONCLUSION This study demonstrates the potential benefits of using CFT with people with eating disorders and highlights the need for further research on this new approach. KEY PRACTITIONER MESSAGE CFT offers new ways to conceptualize and formulate some of the self-critical and shame-based difficulties associated with eating disorders. CFT offers a framework that can enable people with eating disorders to conceptualize their difficulties in different ways. CFT can be combined with standard therapies especially cognitive behavioural therapy. CFT can be especially useful in a group context where the relationships between members can become increasingly compassionate, validating, supportive and encouraging.
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Affiliation(s)
- Corinne Gale
- Mental Health Research Unit, Kingsway, Derby, UK
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Fennig S, Hadas A, Itzhaky L, Roe D, Apter A, Shahar G. Self-criticism is a key predictor of eating disorder dimensions among inpatient adolescent females. Int J Eat Disord 2008; 41:762-5. [PMID: 18570191 DOI: 10.1002/eat.20573] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Although the unipolar depression-eating disorder comorbidity is adequately documented, examination of the role of depressive personality styles in eating disorders is relatively scarce. METHOD Associations between depressive symptoms, depressive risk and resilience (i.e., dependency, self-criticism, and sense of efficacy), and eating disorder symptoms (as measured by the Eating Disorder Inventory-2) were examinedin inpatient adolescent females (N = 81). RESULTS Self-criticism emerged as independent, robust, and strong predictor of eating disorder symptoms. CONCLUSION Patients self-criticism should be targeted in psychotherapy and might serve as an obstacle for successful inpatient treatment. The role of self-derogation in eating disorders should be examined further.
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Affiliation(s)
- Silvana Fennig
- Inpatient unit, Schneider Children's Hospital, Petach Tikva, Israel.
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Nandrino JL, Escande JD, Faure S, Doba K, Vandeweeghe E. Profil psychologique et comportemental de vulnérabilité à la dépendance à l’exercice et au risque de pratiques dopantes chez les sportifs amateurs: l’exemple des semi-marathoniens. ANNALES MEDICO-PSYCHOLOGIQUES 2008. [DOI: 10.1016/j.amp.2006.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Ahrén‐Moonga J, Holmgren S, von Knorring L, af Klinteberg B. Personality traits and self‐injurious behaviour in patients with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2008; 16:268-75. [DOI: 10.1002/erv.860] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Corcos M, Speranza M, Stephan P, Lang F, Venisse JL, Loas G, Perez-Diaz F, Verrier A, Nezelof S, Bizouard P, Jeammet P. Risk Factors for Addictive Disorders: A Discriminant Analysis on 374 Addicted and 513 Nonpsychiatric Participants. Psychol Rep 2008; 102:435-49. [DOI: 10.2466/pr0.102.2.435-449] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many common risk factors have been described in addictive disorders. Little is known about factors' respective contributions to discrimination of addicted and nonaddicted participants. Two large samples were compared including 513 nonpsychiatric participants and 374 addicted participants meeting the DSM–IV criteria for eating disorders, alcohol, or substance dependence. Twenty-six risk factors were assessed by interview or self-rating scales. A discriminant analysis determined the respective weight of each risk factor. One discriminant function emerged and characterized a depressive dimension. The results suggest that the different risk factors described in addiction could be related to a depressive dimension.
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Affiliation(s)
- Maurice Corcos
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris
| | - Mario Speranza
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris
| | - Philippe Stephan
- University Department of Child and Adolescent Psychiatry, Lausanne, Switzerland
| | - François Lang
- University Department of Psychiatry, Saint Etienne, Prance
| | | | - Gwenolé Loas
- University Department of Psychiatry Hôpital Pinel
| | | | | | | | - Paul Bizouard
- University Department of Psychiatry Besançon, France
| | - Philippe Jeammet
- Department of Adolescent Psychiatry of the Institut Mutualiste Monsouris, Paris, Institut National de la Santé et de la Recherche, Médicale (INSERM)
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Cohen RA, Hitsman BL, Paul RH, McCaffery J, Stroud L, Sweet L, Gunstad J, Niaura R, MacFarlane A, Bryant RA, Gordon E. Early life stress and adult emotional experience: an international perspective. Int J Psychiatry Med 2006; 36:35-52. [PMID: 16927577 DOI: 10.2190/5r62-9pqy-0nel-tlpa] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Early life stress (ELS) has been linked to adult psychopathology, though few studies have examined the universality of specific adverse childhood events (ACEs) in healthy adults. We examined the co-occurrence of specific ACEs and their relationship to current emotional distress in an international sample of adults without psychopathology. Participants were 1659 men and women recruited for an international neurocognitive-neuroimaging database from sites in the United States, Australia, England, and the Netherlands. Participants had no current or prior diagnosis of major depression, anxiety, substance abuse, or neurological brain disorder. The occurrence and age on onset of 19 ACEs was assessed by a self-report questionnaire (ELSQ), and current symptoms of stress, depression, and anxiety by the Depression Anxiety Stress Scale (DASS). The relationship of specific ACEs to DASS symptoms was examined. Participants reported relatively high prevalence of ACEs. Only 27.6% of the sample reported no ACEs, while 39.5% reported one or two significant experiences and 32.9% reported more than two ACEs. Rates of most ACEs were quite similar across the three continents. Various ACEs were significantly associated with current DASS severity, particularly ACEs involving emotional abuse, neglect, and family conflict, violence, and breakup. Finding nearly one-third of the sample reported three or more ACEs suggest a high prevalence of ELS in otherwise healthy "normal" adults around the world. Associations between ELS and current emotional distress suggest that these events have functional relevance and deserve further investigation.
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15
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Cohen RA, Grieve S, Hoth KF, Paul RH, Sweet L, Tate D, Gunstad J, Stroud L, McCaffery J, Hitsman B, Niaura R, Clark CR, McFarlane A, MacFarlane A, Bryant R, Gordon E, Williams LM. Early life stress and morphometry of the adult anterior cingulate cortex and caudate nuclei. Biol Psychiatry 2006; 59:975-82. [PMID: 16616722 DOI: 10.1016/j.biopsych.2005.12.016] [Citation(s) in RCA: 306] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Revised: 12/16/2005] [Accepted: 12/19/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early life stress (ELS) is linked to adult psychopathology and may contribute to long-term brain alterations, as suggested by studies of women who suffered childhood sexual abuse. We examine whether reported adverse ELS defined as stressful and/or traumatic adverse childhood events (ACEs) is associated with smaller limbic and basal ganglia volumes. METHOD 265 healthy Australian men and women without psychopathology or brain disorders were studied. ACEs were assessed by the ELSQ and current emotional state by the DASS. Anterior cingulate cortex (ACC), hippocampus, amygdala, and caudate nucleus volumes were measured from T1-weighted MRI. Analyses examined ROI volumetric associations with reported ACEs and DASS scores. RESULTS Participants with greater than two ACEs had smaller ACC and caudate nuclei than those without ACEs. A significant association between total ACEs and ROI volumes for these structures was observed. Regression analysis also revealed that ELS was more strongly associated than current emotional state (DASS) with these ROI volumes. CONCLUSIONS Reported ELS is associated with smaller ACC and caudate volumes, but not the hippocampal or amygdala volumes. The reasons for these brain effects are not entirely clear, but may reflect the influence of early stress and traumatic events on the developing brain.
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Affiliation(s)
- Ronald A Cohen
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA.
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16
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Loas G, Guilbaud O, Perez-Diaz F, Verrier A, Stephan P, Lang F, Bizouard P, Venisse JL, Corcos M, Flament MF, Jeammet P. Dependency and suicidality in addictive disorders. Psychiatry Res 2005; 137:103-11. [PMID: 16233920 DOI: 10.1016/j.psychres.2004.06.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 04/24/2004] [Accepted: 06/16/2004] [Indexed: 11/17/2022]
Abstract
Excessive interpersonal dependency has been described in depression and addictive disorders. Moreover, excessive dependency and suicidality are linked in psychiatric subjects, but their relationships have not been studied in specific addictions. Separate samples of female anorectic patients (n=150), female bulimic patients (n=95), male (n=150) or female (n=68) alcoholics, male (n=94) or female (n=54) drug abusers and non-psychiatric control subjects (n=683) were included in the study. On the basis of a structured interview, suicidal ideations, number of previous suicide attempts and diagnoses of dependent personality disorder (DSM-IV) were collected, and the subjects completed the Interpersonal Dependency Inventory and the Beck Depression Inventory. Logistic regression analysis revealed that excessive dependency and notably dependent personality disorder increased the likelihood of suicidal ideation or suicide attempts with a range of 2.65 to 9.42 in bulimic patients, female alcoholics and male drug abusers. Excessive dependency in specific addictive disorders as well as in male non-psychiatric subjects could constitute a risk factor for suicide. This hypothesis must be confirmed using prospective studies.
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Affiliation(s)
- Gwenolé Loas
- University Department of Psychiatry of Amiens, CHS P Pinel, Route de Paris, Dury, 80044 Amiens cedex 01, France.
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17
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Kelly SD, Howe CJ, Hendler JP, Lipman TH. Disordered eating behaviors in youth with type 1 diabetes. DIABETES EDUCATOR 2005; 31:572-83. [PMID: 16100333 DOI: 10.1177/0145721705279049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Eating disorders are a significant health problem for many adolescents and are described as occurring along a spectrum of symptoms including disordered eating behaviors and clinical eating disorders. Poor self-esteem and body image, intense fear of gaining weight or refusal to maintain weight, and purging unwanted calories are clinical features of some eating disorders. Type 1 diabetes is a chronic illness with marked insulin deficiency. Chronic hyperglycemia creates a state of glucosuria with subsequent weight loss. Diabetes treatment focuses on intensive daily management of blood glucose by balancing insulin, food intake, and physical activity. Insulin omission offers an easy method for the purging of unwanted calories. The combination of these 2 illnesses is potentially deadly and also leads to an increased risk of poor diabetes outcomes. This includes poor metabolic control (measured by elevated hemoglobin A1C), increased risk of diabetic ketoacidosis, and microvascular complications such as retinopathy and nephropathy. Diabetes clinicians should be aware of the potential warning signs in an adolescent with diabetes as well as assessment and treatment options for eating disorders with concomitant type 1 diabetes. This article reviews the available data on the prevalence, screening tools, assessment guidelines, and treatment options for eating disorders in youth with type 1 diabetes.
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Affiliation(s)
- Sarah Dion Kelly
- The Diabetes Center for Children, Division of Endocrinology, the Children’s Hospital of Philadelphia, Pennsylvania (Ms Kelly, Ms Howe, Dr Lipman)
| | - Carol J Howe
- The Diabetes Center for Children, Division of Endocrinology, the Children’s Hospital of Philadelphia, Pennsylvania (Ms Kelly, Ms Howe, Dr Lipman)
| | | | - Terri H Lipman
- The University of Pennsylvania, School of Nursing, Philadelphia (Dr Lipman)
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Konstantynowicz J, Kadziela-Olech H, Kaczmarski M, Zebaze RMD, Iuliano-Burns S, Piotrowska-Jastrzebska J, Seeman E. Depression in anorexia nervosa: a risk factor for osteoporosis. J Clin Endocrinol Metab 2005; 90:5382-5. [PMID: 15941868 DOI: 10.1210/jc.2005-0026] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Both anorexia nervosa (AN) and depression are associated with osteoporosis. We hypothesized that adolescent girls with AN and depression will have lower bone mineral density (BMD) than anorexic girls without depression. OBJECTIVE The objective of this study was to investigate whether depression is an independent risk factor for osteoporosis in anorexic adolescent girls. DESIGN This study was cross-sectional. SETTING This study was conducted at the University Children's Hospital (Bialystok, Poland) from October 2002 through September 2003. PARTICIPANTS Forty-five Caucasian anorexic girls aged 13-23 yr, matched by age, Tanner stage, weight, height, calcium intake, and duration of AN, were studied, including 14 with comorbid depression (based on Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale) and 31 anorexic girls without depression. MAIN OUTCOME MEASURES Total body and lumbar spine (LS) BMD, fat mass, and lean mass assessed using dual-energy x-ray absorptiometry were compared between AN girls with and without depression. RESULTS BMD was reduced in both groups, relative to reference data, but girls with AN and depression had lower BMD than those with AN alone (LS Z-scores, -2.6 +/- 0.3 vs. -1.7 +/- 0.3; P = 0.02) (mean +/- sem). Quantitative assessment of depression correlated independently with total body BMD (r = -0.4; P < 0.05) and LS BMD (r = -0.6; P < 0.001). CONCLUSION Anorexic girls with depression are at higher risk of osteoporosis than those without depression. The mechanisms responsible for decreased BMD in depression are not known. Independent treatment of the depressive disorder in AN may partly alleviate the bone fragility.
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Affiliation(s)
- Jerzy Konstantynowicz
- Department of Pediatrics and Auxology, Medical University of Bialystok, University Children's Hospital Dr. Ludwik Zamenhof, 15-274 Bialystok, Poland.
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Honkalampi K, Hintikka J, Haatainen K, Koivumaa-Honkanen H, Tanskanen A, Viinamäki H. Adverse childhood experiences, stressful life events or demographic factors: which are important in women's depression? A 2-year follow-up population study. Aust N Z J Psychiatry 2005; 39:627-32. [PMID: 15996145 DOI: 10.1080/j.1440-1614.2005.01636.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to simultaneously test adverse background factors, namely adverse childhood experiences (ACEs), stressful life events and prior depressive symptoms, for their ability to predict recovery and non-recovery from depression in women among the general population. METHOD A stratified random sample of women (n = 835) from the general population was collected at baseline in 1999. Depression (Beck Depression Inventory, BDI-21), ACEs and background factors were assessed by postal questionnaire at baseline. Two years later, stressful life events during the study phase, social support, use of health services and current depression (BDI > or = 13) were similarly assessed. RESULTS Adverse childhood experiences were common among depressed women and these past experiences together with the use of health services were associated with recovery from depression. Financial difficulties and a poor subjective health status associated with non-recovery and current stressful life events increased the likelihood of depression on follow-up. Furthermore, the important variables explaining depression on follow-up were the quality of social support and the existence of prior depressive symptoms at baseline. CONCLUSIONS Our results suggest that women's current depression especially associates with stressful life events, insufficient social support, poor subjective health and financial difficulties. It seems possible that past adverse experiences predispose women to depression, but current stressful events actualize these symptoms. In addition, use of health services are associated with recovery in women who had ACEs.
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Affiliation(s)
- Kirsi Honkalampi
- Department of Psychiatry, Research and Development Unit, Kuopio University Hospital, P.O. Box 1777, FIN-70211, Kuopio, Finland.
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