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Brewerton TD, Dennis K, Wiss DA. Dismantling the myth of "all foods fit" in eating disorder treatment. J Eat Disord 2024; 12:60. [PMID: 38760858 PMCID: PMC11102136 DOI: 10.1186/s40337-024-01017-9] [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: 03/09/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
We call for a reevaluation of the long-standing dogmatic nutritional principle that "all foods fit" for all cases of eating disorders (EDs) and its corollary, "there are no bad foods" (for anyone ever) during ED treatment. Based on accumulated scientific research, we challenge these ideologies as outdated, confusing, and potentially harmful to many patients. We review the evidence that indicates the folly of these assumptions and show there are a variety of exceptions to these rules, including (1) food allergies, sensitivities, and intolerances, (2) religious and spiritual preferences or doctrines, and (3) the ubiquitous emergence and widespread availability of ultra-processed foods leading to the potential development of addiction-like eating and a higher prevalence of various medical and psychiatric comorbidities, as well as higher mortality. This evidence supports a nutritional psychiatry approach that should be integrated into (rather than dissociated from) ED treatment research and practice.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
| | - Kim Dennis
- SunCloud Health, Chicago, IL, USA
- Department of Psychiatry, University of Illinois Chicago College of Medicine, Chicago, IL, USA
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2
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Abstract
BACKGROUND Binge eating disorder (BED) is the most common eating disorder, and is associated with significant comorbidity, with university students being particularly vulnerable. We aimed to assess associations of BED with a wide range of comorbidities and measures of impulsivity and compulsivity in university students, to gain better understanding of its prevalence, correlates and pathophysiology. METHODS We carried out an internet-based survey, assessing presence of BED using a validated structured self-report diagnostic tool, demographics, substance use, impulsive behaviors, psychiatric history, and measures of impulsivity and compulsivity. Approximately 10 000 students were invited to take part. Group differences between students with current BED and students without BED were investigated. RESULTS A total of 3415 students completed the survey, with 83 (2.4%) screening positive for BED. BED was associated with female gender, hazardous/harmful alcohol use, depression and anxiety symptoms, low self-esteem, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, treatment for psychological/emotional problems (including prescribed medication) and trait impulsivity and compulsivity. However, the largest effect sizes were evident for associations with trait impulsivity and compulsivity. CONCLUSIONS The associations of BED with trait impulsivity and compulsivity implicate these latent phenotypes in its pathophysiology. The identified links between BED and a wide range of mental disorders highlight the need to screen for disordered eating in student populations, including when students present with other mental health conditions.
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3
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Villa FM, Crippa A, Rosi E, Nobile M, Brambilla P, Delvecchio G. ADHD and eating disorders in childhood and adolescence: An updated minireview. J Affect Disord 2023; 321:265-271. [PMID: 36356347 DOI: 10.1016/j.jad.2022.10.016] [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: 11/09/2021] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders with overactivity, inattention, and impulsivity as core characteristics. Recent studies suggest that 20 % of children with ADHD also develop eating disorders (EDs), including anorexia nervosa, bulimia nervosa and binge eating disorder. However, little is still known about the association between ADHD and EDs through childhood and adolescence. Therefore, in the present work, we aimed at summarizing the studies investigating ADHD and EDs in childhood and adolescence over the last 10 years. METHODS A bibliographic search on PubMed was performed and only studies that considered participants with a clinical diagnosis of ADHD, patients with an additional diagnosis of EDs and patients under 18 years old were included. A total of 7 studies were retrieved and included in the review. RESULTS The majority of the reviewed studies (N = 5) found an association between ADHD and EDs, while the remaining, which focused on EDs symptomatology, reported either lower ED symptoms in ADHD sample or no association between ADHD and EDs. LIMITATIONS the majority of studies were cross-sectional and therefore did not allow to explore the longitudinal casual relation between ADHD and EDs in the developmental age range considered. CONCLUSIONS This review suggests that children and adolescents with ADHD should be monitored for EDs. However, more work is still needed to better understand the clinical implications of the comorbidity between ADHD and EDs and its prospective impact on the life of children and adolescents with ADHD.
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Affiliation(s)
- F M Villa
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - A Crippa
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - E Rosi
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - M Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - P Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - G Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Brewerton TD. Mechanisms by which adverse childhood experiences, other traumas and PTSD influence the health and well-being of individuals with eating disorders throughout the life span. J Eat Disord 2022; 10:162. [PMID: 36372878 PMCID: PMC9661783 DOI: 10.1186/s40337-022-00696-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multiple published sources from around the world have confirmed an association between an array of adverse childhood experiences (ACEs) and other traumatic events with eating disorders (EDs) and related adverse outcomes, including higher morbidity and mortality. METHODS In keeping with this Special Issue's goals, this narrative review focuses on the ACEs pyramid and its purported mechanisms through which child maltreatment and other forms of violence toward human beings influence the health and well-being of individuals who develop EDs throughout the life span. Relevant literature on posttraumatic stress disorder (PTSD) is highlighted when applicable. RESULTS At every level of the pyramid, it is shown that EDs interact with each of these proclaimed escalating mechanisms in a bidirectional manner that contributes to the predisposition, precipitation and perpetuation of EDs and related medical and psychiatric comorbidities, which then predispose to early death. The levels and their interactions that are discussed include the contribution of generational embodiment (genetics) and historical trauma (epigenetics), social conditions and local context, the ACEs and other traumas themselves, the resultant disrupted neurodevelopment, subsequent social, emotional and cognitive impairment, the adoption of health risk behaviors, and the development of disease, disability and social problems, all resulting in premature mortality by means of fatal complications and/or suicide. CONCLUSIONS The implications of these cascading, evolving, and intertwined perspectives have important implications for the assessment and treatment of EDs using trauma-informed care and trauma-focused integrated treatment approaches. This overview offers multiple opportunities at every level for the palliation and prevention of EDs and other associated trauma-related conditions, including PTSD.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
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5
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Osorio Acuña LC, Franco Zuluaga A. Behavioural and emotional symptoms of adolescents consulting a specialised eating disorders programme. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:318-325. [PMID: 36446704 DOI: 10.1016/j.rcpeng.2020.11.014] [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: 09/29/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.
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Affiliation(s)
- Lucia Carolina Osorio Acuña
- Especialista en psiquiatría infantil y del adolescente, Docente del Departamento de Psiquiatría, Universidad ICESI, Fundación Valle del Lili, Cali, Colombia.
| | - Alvaro Franco Zuluaga
- Especialista en psiquiatría infantil y del adolescente, Docente de psiquiatría de la Universidad El Bosque, Bogotá, Colombia
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6
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Hambleton A, Pepin G, Le A, Maloney D, Touyz S, Maguire S. Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature. J Eat Disord 2022; 10:132. [PMID: 36064606 PMCID: PMC9442924 DOI: 10.1186/s40337-022-00654-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders. METHODS This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised. RESULTS A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED. CONCLUSIONS This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.
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Affiliation(s)
- Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Genevieve Pepin
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, VIC, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | | | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Local Health District, Camperdown, NSW, Australia
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7
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Kanarik M, Grimm O, Mota NR, Reif A, Harro J. ADHD co-morbidities: A review of implication of gene × environment effects with dopamine-related genes. Neurosci Biobehav Rev 2022; 139:104757. [PMID: 35777579 DOI: 10.1016/j.neubiorev.2022.104757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 02/07/2023]
Abstract
ADHD is a major burden in adulthood, where co-morbid conditions such as depression, substance use disorder and obesity often dominate the clinical picture. ADHD has substantial shared heritability with other mental disorders, contributing to comorbidity. However, environmental risk factors exist but their interaction with genetic makeup, especially in relation to comorbid disorders, remains elusive. This review for the first time summarizes present knowledge on gene x environment (GxE) interactions regarding the dopamine system. Hitherto, mainly candidate (GxE) studies were performed, focusing on the genes DRD4, DAT1 and MAOA. Some evidence suggest that the variable number tandem repeats in DRD4 and MAOA may mediate GxE interactions in ADHD generally, and comorbid conditions specifically. Nevertheless, even for these genes, common variants are bound to suggest risk only in the context of gender and specific environments. For other polymorphisms, evidence is contradictory and less convincing. Particularly lacking are longitudinal studies testing the interaction of well-defined environmental with polygenic risk scores reflecting the dopamine system in its entirety.
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Affiliation(s)
- Margus Kanarik
- Chair of Neuropsychopharmacology, Institute of Chemistry, University of Tartu, Ravila 14A Chemicum, 50411 Tartu, Estonia
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Nina Roth Mota
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Jaanus Harro
- Chair of Neuropsychopharmacology, Institute of Chemistry, University of Tartu, Ravila 14A Chemicum, 50411 Tartu, Estonia; Psychiatry Clinic, North Estonia Medical Centre, Paldiski Road 52, 10614 Tallinn, Estonia.
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Honkasilta J, Koutsoklenis A. The (Un)real Existence of ADHD-Criteria, Functions, and Forms of the Diagnostic Entity. FRONTIERS IN SOCIOLOGY 2022; 7:814763. [PMID: 35707639 PMCID: PMC9189308 DOI: 10.3389/fsoc.2022.814763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The contemporary conceptualization of Attention Deficit Hyperactivity Disorder (ADHD) as a complex, multifactorial neurodevelopmental disorder cannot be understood as such without a complex assemblage of political, economic, and cultural processes that deem the conceptualization to be valuable and useful. In this article we use the notion of psychiatrization as a lens through which to see parts of these processes that make up ADHD what it is. In the first part of the article, we critically assess the scientific basis of the ADHD diagnosis via examining its diagnostic criteria as presented in the current fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM), the so called "Bible" of modern psychiatry. The second part of the article asks what is done with the ADHD diagnostic entity and with the idea that it represents a natural neurodevelopmental state within an individual-something an individual has-as represented in the DSM-5. Drawn from our previous research, we analyze how ADHD becomes real in discourse practice as a powerful semiotic mediator through analysis of the various functions and forms in which it takes shape in institutional, social, and individual levels. We conclude that the frequent changes in the diagnostic criteria of ADHD do not reflect any real scientific progress. Among other reasons, they change to match better the maneuvers of individuals when navigating an increasingly psychiatrized society in the search for recognition, support, category membership, immunity, sympathy, and sense of belonging.
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Affiliation(s)
- Juho Honkasilta
- Department of Education, Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
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9
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Keshen A, Bartel S, Frank GKW, Svedlund NE, Nunes A, Dixon L, Ali SI, Kaplan AS, Hay P, Touyz S, Romo-Nava F, McElroy SL. The potential role of stimulants in treating eating disorders. Int J Eat Disord 2022; 55:318-331. [PMID: 34846763 DOI: 10.1002/eat.23650] [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: 09/12/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. METHOD To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. RESULTS We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on "loss of control" eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. DISCUSSION Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.
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Affiliation(s)
- Aaron Keshen
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Bartel
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guido K W Frank
- Department of Psychiatry, University of California at San Diego, San Diego, California, USA.,Rady Children's Hospital San Diego, San Diego, California, USA
| | - Nils Erik Svedlund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet-Stockholm Health Care Services, Stockholm, Sweden
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarrah I Ali
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Allan S Kaplan
- Centre for Addiction and Mental Health, Department of Psychiatry, Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Stephan Touyz
- School of Psychology and Inside Out Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Francisco Romo-Nava
- Lindner Center of HOPE, Mason, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L McElroy
- Lindner Center of HOPE, Mason, Ohio, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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El Archi S, Brunault P, De Luca A, Cortese S, Hankard R, Bourbao-Tournois C, Ballon N, Réveillère C, Barrault S. Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates? Front Psychol 2021; 12:745857. [PMID: 34867628 PMCID: PMC8641657 DOI: 10.3389/fpsyg.2021.745857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Addictive-like eating and attention-deficit/hyperactivity disorder (ADHD) are both common among persons seeking treatment for severe obesity. Given that ADHD and addictive-like eating, especially binge eating (BE) and food addiction (FA), are both strongly associated with personality dimensions and emotion dysregulation, it is possible emotional and personality characteristics contribute to the link between addictive-like eating behaviors and ADHD in people with severe obesity. This study aimed to investigate the psychological factors associated with BE and FA in bariatric surgery candidates, and to explore the mediational role of emotional factors (emotion dysregulation and alexithymia) and personality dimensions in the association between ADHD and BE. Method: Two hundred and eighty-two (n = 282) bariatric surgery candidates were recruited during the systematic preoperative psychiatric assessment (University Hospital of Tours, France). We assessed significant BE (Binge Eating Scale), probable adult ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (Yale Food Addiction Scale 2.0, YFAS 2.0), emotion dysregulation (Difficulties in Emotion Regulation Scale-16), alexithymia (Toronto Alexithymia Scale-20) and personality dimensions (Big Five Inventory). Mediation analyses were performed using the PROCESS macro for IBM SPSS Statistics 22. Results: Prevalence of probable adult ADHD, significant BE and FA were 8.2, 19.1, and 26.6%, respectively. Participants who screened positive for addictive-like eating showed higher prevalence of probable adult ADHD, as well as higher scores on adult and childhood ADHD symptoms. They also reported lower conscientiousness, but higher emotion dysregulation, higher alexithymia, and higher neuroticism. Only BE (as opposed to FA) was also associated with lower scores on agreeableness and openness. Analysis of the association between adult ADHD and BE suggests that emotion dysregulation, conscientiousness, agreeableness, and neuroticism are total mediators and alexithymia a partial mediator. Conclusion: Our findings suggest a significant association between ADHD and addictive-like eating among bariatric surgery candidates, and also suggest a significant role of emotion dysregulation and personality dimensions in this association. For individuals with ADHD and obesity, eating may be a way to cope with negative emotions, potentially increasing the risk for addictive-like eating behavior.
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Affiliation(s)
| | - Paul Brunault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | - Arnaud De Luca
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | - Samuele Cortese
- Academic Unit of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Régis Hankard
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | | | - Nicolas Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | | | - Servane Barrault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Centre de Soins d'Accompagnement et de Prévention en Addictologie d'Indre-et-Loire (CSAPA-37), Tours, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France
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11
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Samela T, Innamorati M, Lester D, Raimondi G, Giupponi G, Claudio I, Contardi A, Fabbricatore M. The association between adult ADHD and food addiction: A mediation analysis. Appetite 2021; 167:105613. [PMID: 34332003 DOI: 10.1016/j.appet.2021.105613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the association between food addiction severity (FA) and ADHD symptomatology. Furthermore, we investigated whether emotional distress, and the mentalization deficits could mediate this relationship. METHODS Three hundred eighty-five Italian adults (307 women and 78 men) participated in the study and completed the Italian versions of the Modified Yale Food Addiction Scale version 2.0, the Adult ADHD Self-Report Scale, the Depression Anxiety Stress Scales 21 and the Mentalization Questionnaire. RESULTS ADHD symptoms severity and general distress were significantly and independently associated with FA. Emotional distress partly mediated the relationship between FA and ADHD symptoms severity. In addition, mentalization deficits partly mediated this relationship only when evaluating the influence of FA on ADHD symptoms severity. LIMITATIONS This is a cross-sectional study and causal interpretations of the relationships among the variables are speculative. CONCLUSIONS It is important to assess emotional distress and mentalization deficits in individuals at risk of ADHD and FA because these conditions could increase the risk for the presence of disordered eating patterns.
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Affiliation(s)
- Tonia Samela
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy.
| | - Marco Innamorati
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | | | - Giulia Raimondi
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | - Giancarlo Giupponi
- Department of Psychiatry, Azienda Sanitaria Dell'Alto Adige, 39100, Bolzano, Italy
| | - Imperatori Claudio
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
| | - Anna Contardi
- Department of Human Sciences, Università Europea di Roma, 00163, Rome, Italy
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12
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Post-traumatic stress disorder may set the neurobiological stage for eating disorders: A focus on glutamatergic dysfunction. Appetite 2021; 167:105599. [PMID: 34271078 DOI: 10.1016/j.appet.2021.105599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/23/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a trauma and stress-related disorder which has been shown to be highly comorbid with, and commonly a precedent of, the eating disorders anorexia nervosa, bulimia nervosa, and binge eating disorder. The objective of this review is to discuss a potential overlapping neurobiological mechanism for this comorbidity. Alterations in glutamatergic neurotransmission have been observed in all four of the aforementioned disorders. Excessive excitation via glutamate contributes to excitotoxicity, and over-activation of the hypothalamic-pituitary-adrenal axis, both of which have implications for the deterioration of various brain structures. Prominent structures impacted include the hippocampus, hypothalamus, and prefrontal cortex, all of which are integral to the regulation of stress and eating. The current review suggests that altered glutamate function by trauma or extreme stress may facilitate PTSD and subsequent eating disorder onset, and that glutamatergic modulation may be a key treatment for individuals suffering from these conditions. This overlapping mechanism may help inform future research on individuals with comorbid PTSD and eating disorders, and it could also help inform ways to potentially prevent the onset of these conditions.
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Osorio Acuña LC, Franco Zuluaga A. Behavioural and Emotional Symptoms of Adolescents Consulting a Specialised Eating Disorders Programme. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(21)00044-5. [PMID: 33962787 DOI: 10.1016/j.rcp.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/13/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. METHODS Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. RESULTS Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6±1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. CONCLUSIONS Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.
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Affiliation(s)
- Lucia Carolina Osorio Acuña
- Especialista en psiquiatría infantil y del adolescente, Docente del Departamento de Psiquiatría, Universidad ICESI, Fundación Valle del Lili, Cali, Colombia.
| | - Alvaro Franco Zuluaga
- Especialista en psiquiatría infantil y del adolescente, Docente de psiquiatría de la Universidad El Bosque, Bogotá, Colombia
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Şahan E, Zengin Eroğlu M, Sertçelik S. Eating behaviors, depression, and anxiety levels of pre bariatric surgery patients with obesity comorbid with or without Attention deficit and hyperactivity disorder: ADHD or Major Depression? Which is more related with eating behaviors? Brain Behav 2021; 11:e01915. [PMID: 33118314 PMCID: PMC7821566 DOI: 10.1002/brb3.1915] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/02/2020] [Accepted: 10/09/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE A high rate of attention deficit and hyperactivity disorder (ADHD) has been reported in patients undergoing obesity treatment. It is controversial whether ADHD solely or its comorbid disorders account for eating behaviors associated with obesity. METHODS After presurgery psychiatric assessment, 100 severely obese patients (50 with ADHD and 50 without ADHD) were administered Adult Attention Deficit Hyperactivity Disorder Self-Report Scale(ASRS), Wender Utah Rating Scale(WURS), Three-Factor Eating Questionnaire(TFEQ), and Beck Depression Inventory(BDI) and Beck Anxiety Inventory(BAI). RESULTS Patients with obesity and ADHD had significantly greater emotional eating, susceptibility to hunger, depression, and anxiety but less restraint of eating scores than those without ADHD. Disinhibition of eating scores and presence of Binge Eating Disorder(BED) did not differ significantly between ADHD and non-ADHD groups. Obese patients with major depression had significantly higher ASRS, WURS, TFEQ, BAI scores, disinhibition of eating control, emotional eating, susceptibility to hunger, and diagnosis of BED than nondepressed ones. CONCLUSIONS Major depression and anxiety disorder have associations with disinhibition of eating control, emotional eating, susceptibility to hunger and BED, ADHD. Disinhibition of eating and BED did not differ according to the presence of ADHD; thus, depression was associated with eating control on more constructs than ADHD in our study.
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Affiliation(s)
- Ebru Şahan
- Department of PsychiatryMarmara UniversityİstanbulTurkey
| | - Meliha Zengin Eroğlu
- Department of PsychiatryHaydarpaşa Numune Training and Research HospitalİstanbulTurkey
| | - Sencan Sertçelik
- Department of PsychiatryHaydarpaşa Numune Training and Research HospitalİstanbulTurkey
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Adolescents and young adults engaged with pro-eating disorder social media: eating disorder and comorbid psychopathology, health care utilization, treatment barriers, and opinions on harnessing technology for treatment. Eat Weight Disord 2020; 25:1681-1692. [PMID: 31679144 PMCID: PMC7195229 DOI: 10.1007/s40519-019-00808-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/23/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The purpose of this study was to examine exposure (i.e., seeing, following, posting) to body image content emphasizing a thin ideal on various social media platforms and probable eating disorder (ED) diagnoses, ED-related quality of life, and psychiatric comorbidities (i.e., depression, anxiety) among adolescents and young adult females recruited via social media who endorsed viewing and/or posting pro-ED online content. We also investigated health care utilization, treatment barriers, and opinions on harnessing technology for treatment. METHODS Participants were 405 adolescent and young adult females engaged with pro-ED social media. We reported on study constructs for the sample as a whole, as well as on differences between age groups. RESULTS Eighty-four percent of participants' self-reported symptoms were consistent with a clinical/subclinical ED, and this was slightly more common among young adults. Participants endorsed reduced ED-related quality of life, as well as comorbid depression and anxiety. Among those with clinical/subclinical EDs, only 14% had received treatment. The most common treatment barriers were believing the problem was not serious enough and believing one should help themselves. The majority of participants approved of harnessing technology for treatment. CONCLUSIONS Results provide support for engagement with pro-ED online content serving as a potential indicator of ED symptoms and suggest promise for facilitating linkage from social media to technology-enhanced interventions. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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El Archi S, Cortese S, Ballon N, Réveillère C, De Luca A, Barrault S, Brunault P. Negative Affectivity and Emotion Dysregulation as Mediators between ADHD and Disordered Eating: A Systematic Review. Nutrients 2020; 12:nu12113292. [PMID: 33121125 PMCID: PMC7693832 DOI: 10.3390/nu12113292] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022] Open
Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with disordered eating, especially addictive-like eating behavior (i.e., binge eating, food addiction, loss of control overeating). The exact mechanisms underlying this association are unclear. ADHD and addictive-like eating behavior are both associated with negative affectivity and emotion dysregulation, which we hypothesized are mediators of this relationship. The purpose of this systematic review was to review the evidence related to this hypothesis from studies assessing the relationship between childhood or adulthood ADHD symptomatology, negative affectivity, emotion dysregulation and addictive-like eating behavior. The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed and PsycINFO (publication date: January 2015 to August 2020; date of search: 2 September 2020). Out of 403 potentially relevant articles, 41 were retained; 38 publications reported that ADHD and disordered eating or addictive-like eating behavior were significantly associated, including 8 articles that suggested a mediator role of negative affectivity or emotion dysregulation. Sixteen publications reported that the association between ADHD symptomatology and disordered eating or addictive-like eating behavior differed according to gender, eating behavior and ADHD symptoms (hyperactivity, impulsivity and inattention). We discuss the practical implications of these findings and directions future research.
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Affiliation(s)
- Sarah El Archi
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK;
- Solent NHS Trust, Southampton SO19 8BR, UK
- New York University Child Study Center, New York, NY 10016, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG72UH, UK
| | - Nicolas Ballon
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France;
- UMR 1253, iBrain, Université de Tours, INSERM, 37032 Tours, France
| | - Christian Réveillère
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
| | - Arnaud De Luca
- CHRU de Tours, Centre Spécialisé de l’Obésité, 37044 Tours, France;
- UMR 1069, Nutrition, Croissance et Cancer, Université de Tours, INSERM, 37032 Tours, France
| | - Servane Barrault
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
- CHRU de Tours, Service d’Addictologie Universitaire, Centre de Soins d’Accompagnement et de Prévention en Addictologie d’Indre-et-Loire (CSAPA-37), 37000 Tours, France
| | - Paul Brunault
- Qualipsy, EE 1901, Université de Tours, 37041 Tours, France; (S.E.A.); (C.R.); (S.B.)
- CHRU de Tours, Service d’Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France;
- UMR 1253, iBrain, Université de Tours, INSERM, 37032 Tours, France
- Correspondence: ; Tel.: +33-2-18-37-05-81
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Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients 2020; 12:E2937. [PMID: 32992768 PMCID: PMC7600542 DOI: 10.3390/nu12102937] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.
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Affiliation(s)
- David Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90025, USA
| | - Timothy Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
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Wiss DA, Brewerton TD. Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies. Physiol Behav 2020; 223:112964. [DOI: 10.1016/j.physbeh.2020.112964] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
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Díaz-Román A, Buela-Casal G. Shorter REM latency in children with attention-deficit/hyperactivity disorder. Psychiatry Res 2019; 278:188-193. [PMID: 31207456 DOI: 10.1016/j.psychres.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/19/2023]
Abstract
The discrepancies in prior research about the actual sleep problems underlying attention-deficit/hyperactivity disorder (ADHD) demand more studies of children with this disorder. This study aimed to compare the subjective and objective sleep characteristics of 20 children with ADHD (DSM-IV criteria) and 20 typically developing children (aged 7-11 years). We assessed the children using sleep questionnaires and polysomnography recordings and analysed differences between the two groups using two-tailed Mann-Whitney U exact tests and Rosenthal's r as effect size measure. We also assessed associations between sleep measures and psychopathology using Spearman's correlation coefficients. No significant difference was found between the groups in almost any objective sleep variable, except for shorter REM latency in the ADHD group. Children with ADHD also showed significantly higher levels of daytime sleepiness and greater general sleep problems than control children, as reported by their parents, after discarding the primary sleep problems commonly associated with ADHD. Significant correlations were found between psychopathology and sleep measures. Our findings might support the link between narcolepsy-like sleep phenotype and ADHD. However, longitudinal research combining objective and subjective assessments should further explore the involvement of other variables, such as ADHD subtypes, medication, and comorbid symptoms in this relationship.
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Affiliation(s)
- Amparo Díaz-Román
- Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Spain.
| | - Gualberto Buela-Casal
- Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Spain
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Abstract
Binge-eating disorder (BED), first included as a diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, is characterized by recurrent episodes of binge eating without regular compensatory behaviors to prevent weight gain. With a complex multifactorial etiology, BED is the most frequent eating disorder co-occuring with significant psychopathology, mental and physical comorbidity, obesity, and life impairment. Despite its significance, BED is not sufficiently diagnosed or treated. Evidence-based treatments for BED include psychotherapy and structured self-help treatment, with cognitive-behavioral therapy as most well-established approach, and pharmacotherapy with lisdexamfetamine as FDA approved medication with a limitation of use.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Strasse 27, Leipzig 04103, Germany.
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Jacob L, Haro JM, Koyanagi A. Attention deficit hyperactivity disorder symptoms and disordered eating in the English general population. Int J Eat Disord 2018; 51:942-952. [PMID: 30256445 DOI: 10.1002/eat.22934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) symptoms and eating problems often coexist, but many of the previous studies have not taken into account key variables which may be important in this association. Thus, the goal of this study was to assess the association between ADHD symptoms and disordered eating, while taking into account of a variety of factors. METHOD This study used cross-sectional, nationally representative data from 7,403 people aged ≥16 years from England who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener. Questions from the five-item SCOFF screening instrument were used to identify possible ED. Multivariable logistic regression analyses were conducted. RESULTS The prevalence of possible eating disorder (ED) was much higher among those with ADHD symptoms (ASRS score ≥14) compared to those without ADHD symptoms (19.2 vs. 5.7%). ADHD symptoms were associated with possible ED (odds ratio [OR] = 3.48; 95% confidence interval [CI] = 2.56-4.72) after adjustment for age, sex, and ethnicity. After further adjustment for alcohol dependence, drug use, intelligence quotient, stressful life events, perceived stress, impulsivity, depression, anxiety disorder, and borderline personality disorder (BPD) traits, the OR was attenuated to 1.32 (95% CI = 0.82-2.13). Anxiety and BPD were the factors that led to the largest degree of attenuation. DISCUSSION A high prevalence of disordered eating in individuals with ADHD was observed. Factors such as co-existing anxiety and BPD traits may be particularly important in this association. Future research should focus on the factors involved in the association between ADHD symptoms and disordered eating behavior.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
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Kaisari P, Dourish CT, Rotshtein P, Higgs S. Associations Between Core Symptoms of Attention Deficit Hyperactivity Disorder and Both Binge and Restrictive Eating. Front Psychiatry 2018; 9:103. [PMID: 29651258 PMCID: PMC5884932 DOI: 10.3389/fpsyt.2018.00103] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 03/14/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION It is unclear whether core symptoms of attention deficit hyperactivity disorder (ADHD) relate to specific types of disordered eating and little is known about the mediating mechanisms. We investigated associations between core symptoms of ADHD and binge/disinhibited eating and restrictive eating behavior and assessed whether negative mood and/or deficits in awareness and reliance on internal hunger/satiety cues mediate these relationships. METHODS In two independent studies, we used a dimensional approach to study ADHD and disordered eating. In Study 1, a community-based sample of 237 adults (72.6% female, 18-60 years [M = 26.8, SE = 0.6]) completed an online questionnaire, assessing eating attitudes/behaviors, negative mood, awareness, and reliance on internal hunger/satiety cues and ADHD symptomatology. In Study 2, 142 students (80.3% female, 18-32 years [M = 19.3, SE = 0.1]) were recruited to complete the same questionnaires and complete tasks assessing interoceptive sensitivity and impulsivity in the laboratory. RESULTS In each study, core symptoms of ADHD correlated positively with both binge/disinhibited and restrictive eating and negative mood mediated the relationships. Deficits in awareness and reliance on internal hunger/satiety signals also mediated the association between inattentive symptoms of ADHD and disordered eating, especially binge/disinhibited eating. The results from both studies demonstrated that inattentive symptoms of ADHD were also directly related to binge/disinhibited eating behavior, while accounting for the indirect pathways of association via negative mood and awareness and reliance on internal hunger/satiety signals. CONCLUSION This research provides evidence that core symptoms of ADHD are associated with both binge/disinhibited eating and restrictive eating behavior. Further investigation of the role of inattentive symptoms of ADHD in disordered eating may be helpful in developing novel treatments for both ADHD and binge eating.
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Affiliation(s)
- Panagiota Kaisari
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | | | - Pia Rotshtein
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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