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Wade TD, Shafran R, Cooper Z. Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. Int J Eat Disord 2024; 57:1291-1299. [PMID: 37278186 DOI: 10.1002/eat.24008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, South Australia, Australia
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Zafra Cooper
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Oxford University, Oxford, UK
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Sharma J, Brodt M, Osborn KD, Nelson LJ, Copeland GJ, Hammer TR. Exploring Sociocultural Influences Affecting Body Image in Survivors of Childhood Sexual Assault. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:731-744. [PMID: 37593065 PMCID: PMC10427573 DOI: 10.1007/s40653-023-00551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 08/19/2023]
Abstract
This phenomenological study explored the lived experiences of survivors of childhood sexual assault, their meaning making process of the assault, and how messages from their sociocultural environment affected their relationship with, and perception of, their bodies. Utilizing a social constructivist framework, the research team interviewed eleven (n = 11) participants from a variety of backgrounds who were gender assigned female at birth and had survived childhood sexual assault (CSA). Four major themes emerged from the narratives collected. These include sociocultural impacts which included four subthemes: family relationships, peer relationships, societal and environmental influences, and cultural and ethnic influences; meaning making of the critical event, i.e., childhood sexual assault; self-perception of their bodies; internal processes that have shaped their perceptions and meaning making, i.e., thoughts, feelings, and behaviors. Findings indicate major influence of sociocultural factors in shaping participant's internal processes as survivors of CSA, meaning making, and subsequently self-perceptions of, and relationship with, their bodies. We discuss CSA and body image keeping the intersectionality of the individual, their experiences, and the impact of sociocultural contexts on that intersectionality.
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Affiliation(s)
- Jyotsana Sharma
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
| | - Madeline Brodt
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
| | - Kimberly D. Osborn
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
| | - Laina J. Nelson
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
| | - Gillian J. Copeland
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
| | - Tonya R. Hammer
- Department of Community Health Sciences, Counseling and Counseling Psychology, Oklahoma State University, 700 N Greenwood Ave, Main Hall 2441, Tulsa, OK 74106 USA
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Chuku BA, Obi NJ, Anats CJ, Hambolu OZ, Aderibigbe FD, Akpabio NN, Odion-Omonhimin LO. The Relationship Between Childhood Sexual Abuse and Eating Disorders Among African American Adolescents in the United States. Cureus 2023; 15:e37949. [PMID: 37220440 PMCID: PMC10200295 DOI: 10.7759/cureus.37949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Childhood sexual abuse (CSA) is one of the numerous adverse childhood experiences. CSA involves coercing a child to engage in sexual acts and is especially heinous as children are unable to consent or advocate for themselves. The formative years of a child are very crucial; therefore, the influence of sexual abuse could be irreversible. The development of an eating disorder is one of the identified consequences of sexual abuse. Using African American adolescents as the sample group, we explored the association between sexual abuse and eating disorders. METHODS A cross-sectional study was done with secondary data from the National Survey of American LifeAdolescent Supplement (NSAL-A), 2001-2004. Multivariable logistic regression was used to determine the association between CSA and eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorders) while adjusting for weight satisfaction. RESULTS In our sample of 824 African American adolescents, one of whom was also of Caribbean descent, 3.5% reported a history of CSA, while 2.2% reported having an eating disorder. Only about 5.6% of those with a history of CSA reported having an eating disorder. However, other psychiatric disorders were noted among those with a history of abuse, notably panic attacks, which were present in 44.8% of CSA survivors. Our study found no significant association between CSA and eating disorders (OR= 1.14, 95% CI (0.06, 6.20)). CONCLUSION While we sought to relate CSA with the development of eating disorders, we noted no direct association between the two but instead found an association between panic attacks and CSA. The mediating effect of other psychiatric disorders on the development of ED in CSA survivors should be further researched. It is imperative that survivors of CSA undergo immediate psychiatric evaluation. Primary care providers of survivors of CSA should maintain a high index of suspicion and screen for mental health disorders in these patients.
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Affiliation(s)
- Blessing Adanda Chuku
- Medicine and Surgery, University of Port Harcourt College of Health Sciences, Port Harcourt, NGA
| | - Nkiru J Obi
- Public Health, Washington University in St. Louis, St. Louis, USA
| | - Chioma J Anats
- Pediatrics, University of Ghana Medical School, Accra, GHA
| | | | | | - Nsikan N Akpabio
- Medicine and Surgery, Bingham University Teaching Hospital, Jos, NGA
| | - Lilian O Odion-Omonhimin
- Medicine and Surgery, University of Benin, Benin, NGA
- Clinical Research, Mercury Clinical Research, Inc., Houston, USA
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4
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Shin S, You IJ, Jeong M, Bae Y, Wang XY, Cawley ML, Han A, Lim BK. Early adversity promotes binge-like eating habits by remodeling a leptin-responsive lateral hypothalamus-brainstem pathway. Nat Neurosci 2023; 26:79-91. [PMID: 36510113 PMCID: PMC9829538 DOI: 10.1038/s41593-022-01208-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/14/2022] [Indexed: 12/14/2022]
Abstract
Early-life trauma (ELT) is a risk factor for binge eating and obesity later in life, yet the neural circuits that underlie this association have not been addressed. Here, we show in mice that downregulation of the leptin receptor (Lepr) in the lateral hypothalamus (LH) and its effect on neural activity is crucial in causing ELT-induced binge-like eating and obesity upon high-fat diet exposure. We also found that the increased activity of Lepr-expressing LH (LHLepr) neurons encodes sustained binge-like eating in ELT mice. Inhibition of LHLepr neurons projecting to the ventrolateral periaqueductal gray normalizes these behavioral features of ELT mice. Furthermore, activation of proenkephalin-expressing ventrolateral periaqueductal gray neurons, which receive inhibitory inputs from LHLepr neurons, rescues ELT-induced maladaptive eating habits. Our results identify a circuit pathway that mediates ELT-induced maladaptive eating and may lead to the identification of novel therapeutic targets for binge eating and obesity.
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Affiliation(s)
- Sora Shin
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA.
- FBRI Center for Neurobiology Research, Roanoke, VA, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA.
| | - In-Jee You
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- FBRI Center for Neurobiology Research, Roanoke, VA, USA
| | - Minju Jeong
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Yeeun Bae
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- FBRI Center for Neurobiology Research, Roanoke, VA, USA
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Xiao-Yun Wang
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA
| | - Mikel Leann Cawley
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- FBRI Center for Neurobiology Research, Roanoke, VA, USA
| | - Abraham Han
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- FBRI Center for Neurobiology Research, Roanoke, VA, USA
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Byung Kook Lim
- Neurobiology Section, Division of Biological Sciences, University of California, San Diego, La Jolla, CA, USA.
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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: 11] [Impact Index Per Article: 5.5] [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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6
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Borg SL, Schaefer LM, Hazzard VM, Herting N, Peterson CB, Crosby RD, Crow SJ, Engel SG, Wonderlich SA. Relationships Between Childhood Abuse and Eating Pathology Among Individuals with Binge-Eating Disorder: examining the Moderating Roles of Self-Discrepancy and Self-Directed Style. Eat Disord 2022; 30:355-369. [PMID: 33734931 PMCID: PMC8448781 DOI: 10.1080/10640266.2020.1864588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Childhood maltreatment appears to increase the risk for eating disorders (EDs). The current study examined potential moderating factors (i.e., self-discrepancy and negative self-directed style), which may increase or decrease the impact of maltreatment (i.e., emotional abuse, physical abuse, sexual abuse) on later ED symptoms. One hundred seven men and women with binge-eating disorder (BED) completed semi-structured interviews and questionnaires assessing childhood maltreatment, self-discrepancy, negative self-directed style, and ED pathology. Linear regression was used to examine the moderating role of self-discrepancy and negative self-directed style in the associations between each type of abuse and level of ED severity. Actual:ought self-discrepancy (i.e., the difference between one's self and who one believes they ought to be) moderated the relationships between ED pathology and emotional abuse (β =.26 p =.007), as well as physical abuse (β =.23, p =.02). Results suggest that the relationship between childhood abuse (i.e., emotional abuse, physical abuse) and ED pathology may be stronger for those with higher levels of actual:ought self-discrepancy. Further clarification of the relationships between actual:ought self-discrepancy and distinct forms of childhood abuse is needed, as well as intervention studies examining whether targeting actual:ought self-discrepancy provides an additional benefit for trauma-exposed individuals with BED.
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Affiliation(s)
- Skylar L. Borg
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Lauren M. Schaefer
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Vivienne M. Hazzard
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
| | - Nicola Herting
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- Red River Children’s Advocacy Center, Fargo, North Dakota, USA
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, USA
| | - Ross D. Crosby
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
| | - Scott J. Crow
- University of Minnesota, Department of Psychiatry and Behavioral Sciences, Minneapolis, Minnesota, USA
- The Emily Program, St. Paul, Minnesota, USA
| | - Scott G. Engel
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
| | - Stephen A. Wonderlich
- Sanford Research, Center for Bio-behavioral Research, Fargo, North Dakota, USA
- University of North Dakota School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Science, Fargo, North Dakota, USA
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A Retrospective Literature Review of Eating Disorder Research (1990–2021): Application of Bibliometrics and Topical Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137710. [PMID: 35805366 PMCID: PMC9265657 DOI: 10.3390/ijerph19137710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 12/24/2022]
Abstract
Despite the growing importance of eating disorders in society and academic literature, only a few bibliometric review studies using bibliometric analysis were available. Hence, this study aimed to explore and uncover hidden research topics and patterns in articles in terms of eating disorders over the last 30 years. In total, 4111 articles on eating disorders were analyzed using bibliometrics, network analyses, and structural topic modeling as the basis of mixed methods. In addition to general statistics about the journal, several key research topics, such as eating disorder (ED) treatment, ED symptoms, factors triggering ED, family related factors, eating behaviors, and social factors, were found based on topic correlations. This study found the key research variables that are frequently studied with EDs, such as AN, BN, BED, and ARFID. This study may help clinicians comprehend important risk factors associated with EDs. Moreover, the findings about key ED research topics and their association can be helpful for future studies to construct a comprehensive ED research framework. To our knowledge, this is the first study to use topic modeling in an academic journal on EDs and examine the diversity in ED research over 30 years of published research.
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8
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Pechtel P, Harris J, Karl A, Clunies-Ross C, Bower S, Moberly NJ, Pizzagalli DA, Watkins ER. Emerging ecophenotype: reward anticipation is linked to high-risk behaviours after sexual abuse. Soc Cogn Affect Neurosci 2022; 17:1035-1043. [PMID: 35438797 PMCID: PMC9629466 DOI: 10.1093/scan/nsac030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 01/12/2023] Open
Abstract
Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA + major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA.
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Affiliation(s)
- Pia Pechtel
- Correspondence should be addressed to Pia Pechtel, Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter EX4 4QQ, UK. E-mail:
| | - Jennifer Harris
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Anke Karl
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Caroline Clunies-Ross
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Susie Bower
- Child and Adolescent Mental Health Services, Children and Family Health Devon, Exeter EX2 4NU, UK
| | - Nicholas J Moberly
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
| | - Diego A Pizzagalli
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont MA 02478, USA,Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA,McLean Imaging Center, McLean Hospital, Belmont, MA 02478 USA
| | - Edward R Watkins
- Department of Psychology, College of Life and Environmental Sciences (CLES), University of Exeter, Exeter EX4 4QG, UK
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Tobar-Santamaria A, Kiefer R, Godin J, Contractor AA, Weiss NH. Sexual victimization and disordered eating among community individuals: The influence of negative and positive emotion dysregulation. Eat Behav 2021; 43:101567. [PMID: 34562858 PMCID: PMC8629879 DOI: 10.1016/j.eatbeh.2021.101567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Individuals with a history of sexual victimization are at increased odds of developing an eating disorder in their lifetime. Emotion dysregulation has been identified as an outcome of sexual victimization and a vulnerability factor in the emergence and maintenance of disordered eating. However, research in this area has been limited by its narrow focus on dysregulation stemming from negative emotions. The aim of the current study was to explore the potential moderating roles of negative and positive emotion dysregulation in the relations between sexual victimization and disordered eating. METHOD Study participants included 473 community individuals who endorsed a history of sexual assault (Mage = 34.66; 44.8% male; 78.4% White). Participants completed measures assessing sexual victimization, negative and positive emotion dysregulation, and disordered eating. Data was collected from January to April of 2020 via Amazon's Mechanical Turk. RESULTS Results indicated significant positive relations among sexual victimization, negative and positive emotion dysregulation, and disordered eating. Sexual victimization was found to be more strongly associated with disordered eating at high (vs. low) levels of negative and positive emotion dysregulation. DISCUSSION This study provides evidence for the strengthening roles of both high negative and positive emotion dysregulation in the relation between sexual victimization and disordered eating, suggesting the potential utility of targeting both negative and positive emotion dysregulation in disordered eating interventions among individuals with a history of sexual victimization.
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Hurst TE. Prevention of Child Sexual Exploitation: Insights From Adult Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7350-NP7372. [PMID: 30688542 DOI: 10.1177/0886260519825881] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This qualitative retrospective study explores the prevention of the commercial sexual exploitation of children (CSEC) from the perspectives of adult survivors. These participants represent a subsample (n = 17) of a larger sample of adult female survivors (n = 40) who took part in a research study concerning the influence of childhood emotional maltreatment on the vulnerability of CSEC. Participants learned of the study through CSEC-specific agencies and survivor listservs. All are United States' citizens over the age of 18 years who were sexually exploited during their youth between the ages of 1 year and 17 years while residing in the United States. Six themes with relevance to vulnerability to recruitment and barriers to prevention emerged after analysis. These themes include difficulty trusting medical and mental health professionals; difficulty trusting law enforcement; protection of family members; self-destructive behaviors; a need for CSEC awareness in educational settings; and a need for CSEC awareness among at-risk youth. Extant literature previously identifies similar themes as areas of vulnerability to recruitment, however, these findings are specifically related to prevention programs. Implications for developing or improving prevention programs are discussed.
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Affiliation(s)
- Tamara E Hurst
- The University of Southern Mississippi, Hattiesburg, USA
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11
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Rossi E, Cassioli E, Gironi V, Idrizaj E, Garella R, Squecco R, Baccari MC, Maggi M, Vignozzi L, Comeglio P, Ricca V, Castellini G. Ghrelin as a possible biomarker and maintaining factor in patients with eating disorders reporting childhood traumatic experiences. EUROPEAN EATING DISORDERS REVIEW 2021; 29:588-599. [PMID: 33939220 PMCID: PMC8251850 DOI: 10.1002/erv.2831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The recent conceptualization of ghrelin as a stress hormone suggested that its chronic alterations may have a role in maintaining overeating behaviors in subjects with eating disorders (EDs) reporting childhood traumatic experiences. The aim of this study was to investigate the alterations of ghrelin levels in patients with EDs, their associations with early trauma, binge and emotional eating, and possible moderation/mediation models. METHOD Sixty-four patients with EDs and 42 healthy controls (HCs) had their plasma ghrelin levels measured and completed questionnaires evaluating general and ED-specific psychopathology, emotional eating, and childhood traumatic experiences. RESULTS Participants with anorexia nervosa had higher ghrelin levels than HCs in body mass index (BMI)-adjusted comparisons. Moreover, patients reporting a history of childhood trauma had higher ghrelin levels. Childhood sexual abuse (CSA), BMI, and self-induced vomiting were independent predictors of ghrelin levels. Moderation analyses showed that ghrelin levels were associated with binge and emotional eating only for higher levels of childhood trauma. Elevated ghrelin was a significant mediator for the association of CSA with binge eating. CONCLUSIONS These results support the hypothesis that chronic alterations in ghrelin levels following childhood traumatic experiences could represent a neurobiological maintaining factor of pathological overeating behaviors in 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
| | - Veronica Gironi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eglantina Idrizaj
- Section of Physiological Sciences, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rachele Garella
- Section of Physiological Sciences, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberta Squecco
- Section of Physiological Sciences, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Caterina Baccari
- Section of Physiological Sciences, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Paolo Comeglio
- Sexual Medicine and Andrology Unit, Department of Experimental, Clinical, and Biomedical Sciences "Mario Serio", 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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Hazzard VM, Crosby RD, Crow SJ, Engel SG, Schaefer LM, Brewerton TD, Castellini G, Trottier K, Peterson CB, Wonderlich SA. Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder. EUROPEAN EATING DISORDERS REVIEW 2021; 29:611-621. [PMID: 33660906 DOI: 10.1002/erv.2823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help. METHOD In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted. RESULTS Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. CONCLUSIONS Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.
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Affiliation(s)
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,The Emily Program, St. Paul, Minnesota, USA
| | - Scott G Engel
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | | | - Timothy D Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Giovanni Castellini
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Kathryn Trottier
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
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13
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Scharff A, Ortiz SN, Forrest LN, Smith AR. Comparing the clinical presentation of eating disorder patients with and without trauma history and/or comorbid PTSD. Eat Disord 2021; 29:88-102. [PMID: 31348724 DOI: 10.1080/10640266.2019.1642035] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined whether clinical characteristics among patients presenting to residential eating disorder (ED) treatment differed according to patients' trauma history and current PTSD diagnostic status. Participants (699 girls and women) completed surveys at treatment onset. One-way analysis of covariance (ANCOVA) tests assessed cross-sectional differences between three groups of patients: those reporting no trauma history (No Trauma, n = 185), those with trauma history but without PTSD (Trauma, n = 263), and those with current PTSD (PTSD, n = 251). Relative to the No Trauma group, the combined Trauma and PTSD groups reported greater ED symptoms, anxiety and depressive symptoms, experiential avoidance, anxiety sensitivity, and lower mindfulness. The PTSD group reported greater ED, anxiety, and depressive symptoms, greater anxiety sensitivity, and lower mindfulness, relative to the Trauma group. In sum, ED patients with any history of trauma experienced more symptoms and other psychopathology relative to patients who did not report trauma history. Among patients reporting trauma, those with current PTSD experienced even greater symptom severity. Interventions focused on improving emotional functioning could be especially beneficial for ED patients with trauma histories.
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Affiliation(s)
- Adela Scharff
- Department of Psychology, University at Albany - State University of New York , Albany, USA
| | - Shelby N Ortiz
- Department of Psychology, Miami University , Oxford, OH, USA
| | | | - April R Smith
- Department of Psychology, Miami University , Oxford, OH, USA
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14
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Groth T, Hilsenroth M, Boccio D, Gold J. Relationship between Trauma History and Eating Disorders in Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:443-453. [PMID: 33269044 PMCID: PMC7683676 DOI: 10.1007/s40653-019-00275-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Reasons for developing an eating disorder (ED) are complex, yet one plausible risk factor gaining more relevance in adolescents with EDs is childhood trauma. The current study is the first to examine the presence of childhood trauma in relation to ED symptomatology in adolescents using DSM-5 criteria. It was hypothesized that patients with more traumatic experiences also have more severe ED symptoms. 112 therapists currently treating adolescent patients diagnosed with an ED completed an online survey consisting of a DSM-5 ED symptom checklist and a childhood trauma questionnaire on a current adolescent patient whom they have seen for at least eight sessions. Children with multiple traumatic experiences and the severity of those experiences demonstrated a relationship to overall ED (r = .179, p = .059) and bulimia symptoms (r = .183, p = .054), specifically binging (r = .188, p = .047). and purging (r = .217, p = .021). In addition, logistic regression analyses indicated that adolescents high on bulimia nervosa (B = 4.694, p = .044) were more likely to have been traumatized victims of violence. Exploratory analyses support prior literature that suggest similarities between adolescents' lack of control of the experienced trauma(s) with lack of control of ED symptoms. These findings highlight the importance of exploring trauma history when treating an adolescent with an ED, especially bulimia.
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Affiliation(s)
- Taylor Groth
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Dana Boccio
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
| | - Jerold Gold
- Derner School of Psychology, Adelphi University, 158 Cambridge Avenue, Room 302, Garden City, NY 11530 USA
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15
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Latzer Y, Rozenstain-Hason M, Kabakov O, Givon M, Mizrachi S, Alon S, Tzischinsky O. Childhood maltreatment in patients with binge eating disorder with and without night eating syndrome vs. control. Psychiatry Res 2020; 293:113451. [PMID: 32977048 DOI: 10.1016/j.psychres.2020.113451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/07/2020] [Indexed: 01/06/2023]
Abstract
This study compared women with binge eating disorders or bulimia nervosa with and without night eating syndrome regarding childhood maltreatment and psychopathology relative to healthy controls. The 426 participants (aged 18-60) were divided into two groups: eating disorders (n = 158) and healthy controls (n = 268). Eating disorders was divided into bulimia nervosa, binge eating disorder, and night eating syndrome with binge eating. Participants completed questionnaires: childhood trauma, eating disorders, self-esteem, and psychopathology. No significant differences were found for most variables in the eating disorders subgroups except physical neglect, which was more prevalent in night eating syndrome with binge eating. All variables differed significantly between eating disorders and healthy controls. Significant correlations emerged between childhood maltreatment, psychopathology, emotional abuse, and self-esteem in eating disorders. Regression showed that emotional abuse significantly predicted self-esteem in eating disorders, and group significantly moderated the effect of emotional abuse on psychopathology. Results emphasize that in this specific sample and variables, night eating syndrome with binge eating may be a variant of binge eating disorder or bulimia nervosa and not a separate diagnostic entity. The results highlight the importance of early assessment of childhood maltreatment, particularly emotional abuse, in patients with night eating syndrome.
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Affiliation(s)
- Yael Latzer
- University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa Israel; Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel
| | - Michal Rozenstain-Hason
- Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel
| | - Orna Kabakov
- Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel
| | - Miri Givon
- Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel
| | - Shiran Mizrachi
- University of Haifa, Faculty of Social Welfare and Health Sciences, Haifa Israel
| | - Sigal Alon
- Eating Disorders Institution, Psychiatric Division, Rambam, Health, Care, Campus, Haifa, Israel
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16
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Brewerton TD, Ralston ME, Dean M, Hand S, Hand L. Disordered Eating Attitudes and Behaviors in Maltreated Children and Adolescents Receiving Forensic Assessment in a Child Advocacy Center. JOURNAL OF CHILD SEXUAL ABUSE 2020; 29:769-787. [PMID: 32866068 DOI: 10.1080/10538712.2020.1809047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 04/16/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Previous studies have indicated that childhood sexual abuse (CSA) and other forms of child maltreatment (CM), as well as their subsequent posttraumatic symptoms, are significant risk factors for the development of disordered eating behaviors and attitudes and eating disorders (EDs). However, there are no known reports of CM based on forensic interview and assessment that have been linked to disordered eating behaviors and attitudes, or eating disorders (EDs), especially in children and adolescents. We, therefore, examined the hypothesis that ED-related symptoms would be significantly associated with trauma-related symptoms in children with reported maltreatment. Girls (n = 179, 11.9 ± 2.4 years) and boys (n = 99, 11.7 ± 2.8 years) referred for forensic assessment of alleged maltreatment completed the Kids' Eating Disorders Survey, the Eating Disorders Inventory for Children (EDI-C), the Trauma Symptom Checklist for Children, and the Adolescent Dissociative Experiences Scale, among others. Significant positive correlations between most EDI-C subscale scores and most TSC-C subscale scores (PTSD, dissociation, anxiety, depression, sexual concerns) were found (p ≤.001) in the total sample and girls alone. Participants with credible, substantiated disclosures had significantly higher scores on several ED-related measures than those with non-credible, non-substantiated disclosures. Linear regression analysis indicated that PTSD and dissociative symptoms were significant predictors of EDI-C scores in those with substantiated disclosures (p ≤.001). Findings support the hypothesis that ED-related symptoms are significantly linked to authenticated CM.
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Affiliation(s)
- Timothy D Brewerton
- Medical University of South Carolina , Charleston, South Carolina, USA
- Dee Norton Child Advocacy Center , Charleston, South Carolina, USA
| | | | - Michelle Dean
- Dee Norton Child Advocacy Center , Charleston, South Carolina, USA
| | - Sarah Hand
- University of North Carolina , Chapel Hill, South Carolina, USA
| | - Lisa Hand
- Medical University of South Carolina , Charleston, South Carolina, USA
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17
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Hicks White AA, Pratt KJ, Cottrill C. The relationship between trauma and weight status among adolescents in eating disorder treatment. Appetite 2018; 129:62-69. [PMID: 29969660 DOI: 10.1016/j.appet.2018.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
A relationship between trauma and eating disorders in adolescence is well established, though less is known about how different types of trauma, apart from childhood sexual abuse, associate with eating disorders. The purpose of this study is to describe the prevalence of various trauma types in a clinical sample of adolescents presenting at an outpatient eating disorder treatment facility (N = 182). Thirty-five percent of the sample reported experiencing one or more traumatic events during their lifetime. Bullying was the most prevalent type of trauma (10%), followed by significant death/loss (9%), and sexual abuse (8%). Adolescents with any trauma exposure had higher body mass index (BMI), BMI percentile, and percent expected body weight (%EBW) compared to those without any trauma exposure. Specifically, patients who were exposed to bullying and domestic violence reported a significantly higher %EBW than those who were not exposed. On average, adolescents exposed to bullying had a %EBW that was 7 percentage points higher than their non-exposed peers. Patients with bulimia nervosa were more likely to report trauma exposure than those with other eating disorder diagnosis. Providers working with adolescents diagnosed with eating disorders of all weight statuses should consider assessing for past and current trauma, including bullying and exposure to domestic violence. Trauma informed approaches to eating disorder treatment are needed to avoid potentially activating or exacerbating trauma related distress for adolescents in eating disorder treatment.
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Affiliation(s)
- Ashley A Hicks White
- The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA.
| | - Keeley J Pratt
- Human Development and Family Science, The Ohio State University, Department of Human Sciences, 1787 Neil Ave., Columbus, OH, 40210, USA
| | - Casey Cottrill
- Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatrics, The Ohio State University, 410 W 10th Avenue, Columbus, OH, 43210, USA
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18
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Pulverman CS, Kilimnik CD, Meston CM. The Impact of Childhood Sexual Abuse on Women's Sexual Health: A Comprehensive Review. Sex Med Rev 2018; 6:188-200. [DOI: 10.1016/j.sxmr.2017.12.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/26/2017] [Accepted: 12/03/2017] [Indexed: 01/23/2023]
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19
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Calugi S, Franchini C, Pivari S, Conti M, El Ghoch M, Dalle Grave R. Anorexia nervosa and childhood sexual abuse: Treatment outcomes of intensive enhanced cognitive behavioural therapy. Psychiatry Res 2018; 262:477-481. [PMID: 28927864 DOI: 10.1016/j.psychres.2017.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/25/2017] [Accepted: 09/11/2017] [Indexed: 09/30/2022]
Abstract
Sexual abuse has been widely studied as a risk factor in anorexia nervosa, but data on its influence on treatment outcomes are scarce. Hence, we compared short- and long-term outcomes of inpatient enhanced cognitive-behavioural therapy (CBT-E) in patients with anorexia nervosa who had and had not suffered sexual abuse. Eighty-one patients were recruited, and body mass index (BMI), Eating Disorder Examination, Brief Symptom Inventory, and Work and Social Adjustment Scale scores were recorded before and after treatment, and at 6- and 12-month follow-ups. Twenty patients (24.7%) reported experiencing childhood sexual abuse before anorexia nervosa onset, while 61 (75.3%) reported none. Both groups displayed similar characteristics before treatment, and similarly large increases in BMI, eating-disorder, general psychopathology, and work and social functioning from baseline to 12-month follow-up. Based on these findings, childhood sexual abuse does not appear to compromise outcomes in patients with anorexia nervosa treated via intensive CBT-E.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy.
| | - Cecilia Franchini
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Silvia Pivari
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Maddalena Conti
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
| | - Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016 Garda, VR, Italy
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20
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Larsen JT, Munk-Olsen T, Bulik CM, Thornton LM, Koch SV, Mortensen PB, Petersen L. Early childhood adversities and risk of eating disorders in women: A Danish register-based cohort study. Int J Eat Disord 2017; 50:1404-1412. [PMID: 29105808 DOI: 10.1002/eat.22798] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/21/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Previous studies evaluating the association between early childhood adversities and eating disorders have yielded conflicting results. The aim of this study is to examine the association between a range of adversities and risk of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) in 495,244 women. METHOD In this nationwide, register-based cohort study, nine types of early childhood adversity (family disruption, residential instability, placement in out-of-home care, familial death, parental somatic illness, parental psychiatric illness, parental disability, severe parental criminality, and parental substance use disorder) were defined and exposure during the first 6 years of life was determined. Hazard ratios for eating disorders were calculated using Cox regression. RESULTS Few adversities were significantly associated with AN, and for each, the presence of the adversity was associated with lower risk for AN. BN, and EDNOS were positively associated with several types of adversities. AN rates were unchanged or reduced by up to 54% by adversities, whereas rates of BN and EDNOS were unchanged or increased by adversities by up to 49 and 89%, respectively. DISCUSSION Our findings indicate that childhood adversities appear to be associated with an increased risk of BN and in particular EDNOS, whereas they seem to be either unassociated or associated with a decreased risk of AN.
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Affiliation(s)
- Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Susanne Vinkel Koch
- Mental Health Centre for Child and Adolescent Psychiatry, Copenhagen Region, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Liselotte Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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21
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Brewerton TD. Food addiction as a proxy for eating disorder and obesity severity, trauma history, PTSD symptoms, and comorbidity. Eat Weight Disord 2017; 22:241-247. [PMID: 28361213 DOI: 10.1007/s40519-016-0355-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Food addiction (FA) is a newly defined yet still controversial condition that has important etiological, developmental, treatment, prevention, and social policy implications. In this review, the case is made that FA (or high scores on the Yale Food Addiction Scale) may be used as a proxy measure for a matrix of interrelated clinical features, including greater eating disorder severity, greater obesity severity, more severe trauma histories, greater symptoms of posttraumatic stress disorder (PTSD), greater psychiatric comorbidity, as well as greater medical morbidity and mortality. METHODS A Medline search was undertaken using the following terms: food addiction cross-referenced with eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and binge eating), obesity, trauma, posttraumatic stress disorder, and comorbidity. RESULTS The thesis is that the identification and acknowledgment of the concept of FA, when integrated into an overall, trauma-focused and transdiagnostic treatment approach, are supported and can be useful in understanding clinically the "big picture." CONCLUSIONS Food addiction (FA) may be used as a proxy for (1) bulimic eating disorder severity, (2) complex trauma histories, (3) severity of PTSD and PTSD symptoms, (4) intensity of psychiatric comorbidity, (5) severity of obesity, as well as (6) their combination. Implications for developing treatment strategies are discussed. The case for a comprehensive management that requires careful attention to medical and psychiatric assessment and integrated care that incorporates trauma-focused treatment is made.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA. .,, 216 Scott Street, Mount Pleasant, SC, 29464, USA.
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22
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Abstract
Anorexia nervosa has the highest mortality rate among all psychiatric illnesses, as it can result in significant psychopathology along with life-threatening medical complications. Atypical anorexia nervosa is a new variant described in the latest DSM edition, which has much in common with anorexia nervosa and also can result in significant morbidity and mortality. The evolution of the criteria for these illnesses is reviewed, and the two are compared and contrasted in this article. Important labs to monitor for in those with these illnesses, along with an emphasis on the monitoring of vital signs and weight, are reviewed here. The necessity for close psychiatric monitoring of safety concerns, including suicidal thoughts, is also stressed. The etiology and the treatment of these illnesses are reviewed from a biopsychosocial approach; and lastly, the prognosis of these illnesses is discussed.
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Affiliation(s)
- Lindsay Moskowitz
- Department of Psychiatry, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
| | - Eric Weiselberg
- Division of Adolescent Medicine, Cohen Children׳s Medical Center, Northwell Health, New Hyde Park, NY; Hofstra-Northwell School of Medicine, Hempstead, NY
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23
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Thaler L, Steiger H. Eating Disorders and Epigenetics. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 978:93-103. [PMID: 28523542 DOI: 10.1007/978-3-319-53889-1_5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) are characterized by intense preoccupation with shape and weight and maladaptive eating practices. The complex of symptoms that characterize EDs often arise through the activation of latent genetic potentials by environmental exposures, and epigenetic mechanisms are believed to link environmental exposures to gene expression. This chapter provides an overview of genetic factors acting in the etiology of EDs. It then provides a background to the hypothesis that epigenetic mechanisms link stresses such as obstetric complications and childhood abuse as well as effects of malnutrition to eating disorders (EDs). The chapter then summarizes the emerging body of literature on epigenetics and EDs-mainly studies on DNA methylation in samples of anorexia and bulimia. The available evidence base suggests that an epigenetically informed perspective contributes in valuable ways to the understanding of why people develop EDs.
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Affiliation(s)
- Lea Thaler
- Eating Disorders Continuum, Douglas Institute, Montreal West Island Integrated University Health and Social Services Centre, 6875 LaSalle Blvd, Verdun, QC, Canada, H4H 1R3. .,Psychiatry Department, McGill University, Montréal, QC, Canada, H3A 1Y2.
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Institute, Montreal West Island Integrated University Health and Social Services Centre, 6875 LaSalle Blvd, Verdun, QC, Canada, H4H 1R3.,Psychiatry Department, McGill University, Montréal, QC, Canada, H3A 1Y2
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24
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Eubanks JR, Kenkel MY, Gardner RM. Body-Size Perception, Body-Esteem, and Parenting History in College Women Reporting a History of Child Abuse. Percept Mot Skills 2016; 102:485-97. [PMID: 16826671 DOI: 10.2466/pms.102.2.485-497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the relations among physical, emotional, and sexual abuse up to adolescence and subsequent perception of body size, detection of changes in body size, and body-esteem. The role of parenting history in abused participants was also examined. 38 college undergraduate women, half of whom had been abused, reported instances of abuse, childhood parenting history, and current body-esteem. A recently developed software program of Gardner and Boice was used to present a series of distorted frontal profiles of each participant's own body for the women to rate as being too wide or too thin. A psychophysical procedure called adaptive probit estimation was used to measure the amount of over- and underestimation of these ratings and whether these changes were statistically significant. Analysis showed abused participants had distorted perceptions of body size, although the direction of the distortion was not consistent. There was no difference in detection of changes in body size. Abused and nonabused participants differed on measures of body-esteem and on ratings of most parenting experiences, including experiences with both mothers and fathers.
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25
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Kilimnik CD, Meston CM. Role of Body Esteem in the Sexual Excitation and Inhibition Responses of Women With and Without a History of Childhood Sexual Abuse. J Sex Med 2016; 13:1718-1728. [PMID: 27692843 DOI: 10.1016/j.jsxm.2016.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Women's sexuality is influenced by their perceptions of their bodies. Negative body appraisals have been implicated in the development and maintenance of sexual concerns in women with a history of childhood sexual abuse (CSA). The sexuality of these women is often expressed in extremes of approach and avoidant sexual tendencies, which have been related to the sexual inhibition and sexual excitation pathways of the dual control model. AIM To test the influence of body esteem on the sexual excitation and inhibition responses of women with and without a history of CSA. METHODS One hundred thirty-nine women with CSA and 83 non-abused women reported on their abuse history, depressive symptomology, sexual response, and affective appraisals of their body. MAIN OUTCOME MEASURES Validated self-report measurements of sexual excitation and inhibition responses (Sexual Excitation/Sexual Inhibition Inventory for Women) and body esteem (Body Esteem Scale) were administered. RESULTS Body esteem was significantly associated with sexual inhibition responses of women regardless of CSA history status but was significantly related only to the sexual excitation responses of women with a CSA history. Perceived sexual attractiveness was a unique predictor of sexual excitation in women with a history of CSA. CONCLUSION Women with a history of CSA have lower body esteem than non-abused women, particularly in self-perceived sexual attractiveness, and these perceptions appear to influence their sexual responses by acting on the sexual excitation and inhibition response pathways.
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Affiliation(s)
- Chelsea D Kilimnik
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Cindy M Meston
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA.
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Eating disorders, gene-environment interactions and the epigenome: Roles of stress exposures and nutritional status. Physiol Behav 2016; 162:181-5. [DOI: 10.1016/j.physbeh.2016.01.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/22/2016] [Accepted: 01/29/2016] [Indexed: 01/07/2023]
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Reijonen JH, Pratt HD, Patel DR, Greydanus DE. Eating Disorders in the Adolescent Population:. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558403018003002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although eating disorders often begin during adolescence, characteristics of this population can complicate early detection by clinicians. The purpose of this article is to selectively review the literature on the diagnostic criteria for eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder) as described in Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and International Classification of Diseases (10th ed.). The prevalence and course of eating disorders, theories regarding their etiology, and issues of comorbidity and differential diagnosis are also discussed.
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Pratt HD, Phillips EL, Greydanus DE, Patel DR. Eating Disorders in the Adolescent Population:. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558403018003007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents become vulnerable to developing eating disorders as they mature. Very little is known about the prevalence, etiology, assessment, treatment, and outcome of eating disorders among adolescents. In general, research on eating disorders continues to be plagued with design flaws. Future studies need to be prospective research based on larger, more diverse samples of adolescents that represent all developmental stages of adolescence. Consistent diagnostic criteria and definitions of treatment interventions and outcomes also need to be employed. In addition, research should address the identification of protective and risk factors that predict who will actually develop an eating disorder.
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Cachelin FM, Schug RA, Juarez LC, Monreal TK. Sexual Abuse and Eating Disorders in a Community Sample of Mexican American Women. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986305279022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to examine the association between sexual abuse and eating disorders in a voluntary community sample of Mexican American women. Eighty eating disorder cases were compared to 110 healthy controls on presence of sexual abuse and on characteristics of the abuse. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) and the Eating Disorder Examination were used to determine diagnoses and psychiatric comorbidity. Results indicated that compared to controls, cases were more likely to report sexual abuse and had experienced more instances and longer duration of abuse. For the majority of cases, sexual abuse occurred before onset of eating disorder symptoms. There was no relationship between sexual abuse and type of eating disorder or psychiatric comorbidity. Sexual abuse seems to be a risk factor for disordered eating in Mexican Americans. Prolonged abuse and revictimization may increase this risk.
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Mutlu H, Bilgiç V, Erten S, Aras Ş, Tayfur M. Evaluation of the Relationship between Childhood Traumas and Adulthood Obesity Development. Ecol Food Nutr 2016; 55:390-401. [PMID: 27399037 DOI: 10.1080/03670244.2016.1198791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to delineate the relationship between childhood traumas and adulthood obesity. A total of 314 individuals (157 obese and 157 nonobese) were recruited in the study. After obtaining anthropometric and sociodemographic variables, the Childhood Trauma Questionnaire (CTQ) was administered to the participants. Overall scores of CTQ were determined to be 42.6 ± 10.5 (higher trauma) in obese group and 37.2 ± 6.6 (lower trauma) in nonobese group (P < 0.001). Frequency rates of childhood traumatic experience were found to be 68.8% for obese people and 38.8% for nonobese people. In conclusion, an increased risk for adulthood obesity development was significantly associated with childhood traumatic experience.
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Affiliation(s)
- Hayrettin Mutlu
- a Fatih University Hospital , Center for Nutrition and Dietetics , Istanbul , Turkey
| | - Vedat Bilgiç
- b Department of Psychiatry , Fatih University Medical School , Istanbul , Turkey
| | - Sebahattin Erten
- c Department of Internal Medicine , Fatih University Hospital , Istanbul , Turkey
| | - Şükrü Aras
- d Department of Nutrition and Dietetics , Şifa University , Izmir , Turkey
| | - Muhittin Tayfur
- e Department of Nutrition and Dietetics , Başkent University , Ankara , Turkey
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Abstract
More than 2 million female Americans have a clinically relevant eating disorder. Although the prevalence and seriousness of this problem has gained increasing attention in recent years, relatively little is known about eating disorder prevention. This article addresses a number of issues related to prevention efforts applied to eating disorders. An overview of putative risk factors that have been identified is presented. In particular, the article emphasizes the importance of understanding the psychological and physical developmental processes during adolescence and the sociocultural context in which eating disorders develop. A summary of empirical investigations of the efficacy of eating disorder prevention programs follows, including an illustration of one of the more promising strategies that has been reported to date. The role of counseling psychologists in further refining eating disorder prevention efforts is discussed.
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Nicholls D, Statham R, Costa S, Micali N, Viner RM. Childhood risk factors for lifetime bulimic or compulsive eating by age 30 years in a British national birth cohort. Appetite 2016; 105:266-73. [PMID: 27263069 DOI: 10.1016/j.appet.2016.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 05/17/2016] [Accepted: 05/28/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether previously identified childhood risk factors for bulimia or compulsive eating (BCE) predict self-reported lifetime BCE by age 30 years in a prospective birth cohort. METHOD Using data from the 1970 British Cohort Study at birth, 5, and 10 years, associations between 22 putative childhood risk factors and self-reported lifetime BCE at 30 years were examined, adjusting for sex and socioeconomic status. RESULTS Only female sex (odds ratio (OR): 9.2; 95% confidence interval (CI): 1.9-43.7; p = 0.005), low self-esteem (OR:2.9; 95%CI: 1.1-7.5; p = 0.03) and high maternal education (OR:5.4; 95%CI: 2.0-14.8; p = 0.001) were significantly associated with higher risk of BCE, whereas high SES at 10 years was significantly protective (OR:0.2; 95%CI: 0.1-0.8; p = 0.022) of BCE in fully adjusted multivariable logistic regression analysis. DISCUSSION Our findings do not support a strong role for childhood weight status and eating behaviours in the development of bulimia and compulsive eating pathology, rather suggesting a focus on self esteem may have greater relative importance. Findings in relation to maternal education and SES need further exploration.
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Affiliation(s)
- D Nicholls
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital, London, WC1N 3JH, UK; UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - R Statham
- Department of Child and Adolescent Mental Health, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - S Costa
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - N Micali
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - R M Viner
- UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Smith CE, Pisetsky EM, Wonderlich SA, Crosby RD, Mitchell JE, Joiner TE, Bardone-Cone A, Le Grange D, Klein MH, Crow SJ, Peterson CB. Is childhood trauma associated with lifetime suicide attempts in women with bulimia nervosa? Eat Weight Disord 2016; 21:199-204. [PMID: 26462683 PMCID: PMC4833682 DOI: 10.1007/s40519-015-0226-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to explore the association between specific forms of childhood abuse and neglect with lifetime suicide attempts in women with bulimia nervosa (BN). METHODS Two hundred and four women aged 18-65 (mean 25.6 years, SD 9.13) with full or subclinical BN were recruited in five US Midwestern communities and specialized eating disorder clinics. Participants completed questionnaires including the Childhood Trauma Questionnaire (CTQ) and self-reported whether they had ever had a lifetime suicide attempt. Logistic regression analyses were used to predict lifetime suicide attempts from each subscale of the CTQ. RESULTS Childhood emotional, physical, and sexual abuse were significantly associated with the presence of a lifetime suicide attempt in women with BN. Childhood emotional and physical neglect were not associated with suicide attempts. CONCLUSIONS Individuals with BN who have experienced childhood emotional and sexual abuse are at increased risk of a lifetime suicide attempt. Future research is needed to understand the mechanism to address in treatment and prevention efforts. It is important for clinicians to be aware of the potential increased risk of suicide in individuals with BN with a history of childhood abuse.
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Affiliation(s)
- Christina E Smith
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA.
| | - Stephen A Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Ross D Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.,Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Anna Bardone-Cone
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Marjorie H Klein
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA
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Gordon KH, Simonich H, Wonderlich SA, Dhankikar S, Crosby RD, Cao L, Kwan MY, Mitchell JE, Engel SG. Emotion Dysregulation and Affective Intensity Mediate the Relationship Between Childhood Abuse and Suicide-Related Behaviors Among Women with Bulimia Nervosa. Suicide Life Threat Behav 2016; 46:79-87. [PMID: 26052753 PMCID: PMC8711241 DOI: 10.1111/sltb.12172] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
Abstract
Self-harm and suicide attempts occur at elevated rates among individuals with bulimia nervosa, particularly among those who have experienced childhood abuse. This study investigated the potential mediating roles of emotion dysregulation and affective intensity in the relationship between these variables in 125 women with bulimia nervosa. Analyses revealed that emotion dysregulation mediated the relationship between sexual and emotional abuse with both self-harm and suicide attempts. Negative affective intensity mediated the relationship between abuse and suicide attempts. The findings may advance the understanding of mechanisms underlying suicide-related behaviors in women with bulimia nervosa who experienced abuse and suggest potential clinical targets.
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Affiliation(s)
- Kathryn H. Gordon
- Department of Psychology, North Dakota State University, Fargo, ND and Neuropsychiatric Research Institute, Fargo, ND, USA
| | | | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Swati Dhankikar
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Mun Yee Kwan
- Department of Psychology, North Dakota State University, Fargo, ND, USA
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, ND and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, ND and Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med 2016; 78:79-90. [PMID: 26461853 DOI: 10.1097/psy.0000000000000233] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to estimate the association between distinct types of child abuse--sexual (CSA), physical (CPA), and emotional (CEA)--and different eating disorders (EDs). METHODS Electronic databases were searched through January 2014. Studies reporting rates of CSA, CPA, and CEA in people with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), as compared with individuals without EDs, were included. Pooled analyses were based on odds ratios (ORs), with relevant 95% confidence intervals (CIs), weighting each study with inverse variance models with random effects. Risk of publication bias was estimated. RESULTS Thirty-two of 1714 studies assessed for eligibility met the inclusion criteria, involving more than 14,000 individuals. The association between EDs and any child abuse showed a random-effects pooled OR of 3.21 (95% CI = 2.29-4.51, p < .001) with moderate heterogeneity (I2 = 57.2%, p = .005), whereas for CSA, this was 1.92 (95% CI = 1.13-3.28, p = .017), 2.73 (95% CI = 1.96-3.79, p < .001), and 2.31 (95% CI = 1.66-3.20, p < .001), for AN, BN, and BED, respectively. However, adjusting for publication bias, the estimate for CSA and AN was not significant (OR = 1.06, 95% CI = 0.59-1.88, p = .85). Although CPA was associated with AN, BN, and BED, CEA was associated just with BN and BED. CONCLUSIONS BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs. TRIAL REGISTRATION The protocol was registered in PROSPERO (an international prospective register of systematic reviews) with the reference number CRD42014007360.
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Schirk DK, Lehman EB, Perry AN, Ornstein RM, McCall-Hosenfeld JS. The impact of social support on the risk of eating disorders in women exposed to intimate partner violence. Int J Womens Health 2015; 7:919-31. [PMID: 26648759 PMCID: PMC4664489 DOI: 10.2147/ijwh.s85359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are often found among women exposed to intimate partner violence (IPV). The role of social support (SS) as a protective factor against ED among IPV-exposed women is not firmly established. OBJECTIVE The objective of this study is to determine the distribution of risk of EDs among women exposed to IPV and to examine the impact of SS on risk of ED among IPV-exposed women. METHODS Women (aged 18-64 years) exposed to IPV during their lifetimes (defined by the Humiliation-Afraid-Rape-Kick instrument) were recruited from primary care and domestic violence service agencies and surveyed on demographics, mood/anxiety disorders, psychosocial/community factors, and strategies used in response to IPV. The Eating Disorder Screen for Primary Care assessed the risk of ED. A modified Medical Outcomes Study Social Support Survey assessed overall functional support (scale range: 0-32; categorized into quartiles). Ordinal logistic regression examined the risk of ED based on SS, controlling for prespecified demographics (age, race/ethnicity, marital status, near-poverty level), and health-related factors significant in bivariate analyses (risky alcohol use). RESULTS Among 302 women with lifetime IPV, 41 (14%) were at high risk, 127 (42%) were at moderate risk, and 134 (44%) were at low risk of an ED. In bivariate analyses, high risk of an ED was significantly more frequent among women with a low SS score (<19, 24%) versus a high SS score (≥30, 12%) (P=0.03). High risk of an ED was significantly associated with risky alcohol use (18%) versus non-risky alcohol use (13%; P=0.008). In multivariable analysis, a 5-unit increase in overall SS was significantly associated with decreased odds of ED risk (P=0.007). CONCLUSION Among IPV-exposed women, low SS is associated with an increased risk of ED. SS may protect against ED by reducing anxiety and promoting positive actions, but further study is needed to confirm this.
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Affiliation(s)
- Dana K Schirk
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik B Lehman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amanda N Perry
- Department of Agricultural Economics, Sociology, and Education, Division of Rural Sociology, College of Agriculture, Pennsylvania State University, University Park, Hershey, PA, USA
| | - Rollyn M Ornstein
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jennifer S McCall-Hosenfeld
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA ; Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Kothari R, Easter A, Lewis R, Howard LM, Micali N. Intimate partner violence among women with eating disorders during the perinatal period. Int J Eat Disord 2015; 48:727-35. [PMID: 26032597 PMCID: PMC4737194 DOI: 10.1002/eat.22429] [Citation(s) in RCA: 7] [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] [Accepted: 05/04/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Prevalence of intimate partner violence (IPV) during pregnancy is estimated to be 4%-8%. Women with mental health difficulties are at increased risk for IPV during the perinatal period. Prevalence of IPV is high among women with eating disorders (ED); however, prevalence of IPV during the perinatal period among women with ED is unknown. METHOD We studied women from a population-based cohort, the Avon Longitudinal Study of Parents and Children. Prevalence and odds of physical and emotional IPV during and after the perinatal period was investigated among women with lifetime ED, with (n = 174) or without pregnancy shape and weight concern and/or purging behaviors (n = 189), and women with no ED (n = 8723). RESULTS Women with lifetime ED showed higher prevalence of IPV during and after the perinatal period (physical = 9.6%-14.3% and emotional = 24.1%-28.1%). Lifetime ED was associated with higher odds of physical IPV during the perinatal period (odds ratio: 2.34, 95% confidence interval: 1.11-4.93, p = .03). Lifetime ED with and without pregnancy shape and weight concerns and/or purging was associated with higher odds of IPV after the perinatal period, and higher odds of reporting emotional IPV at all time points. Associations were moderated by partner's response to pregnancy and maternal experience of childhood sexual abuse. DISCUSSION Mothers with ED and their children may be vulnerable to negative effects due to maternal ED and IPV combined, both of which have been associated with severe and long-lasting harmful consequences. Partner's response to pregnancy and maternal experience of childhood sexual abuse might contribute to the association between ED and IPV perinatally.
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Affiliation(s)
- Radha Kothari
- Behavioural and Brain Sciences Unit, UCL Institute of Child HealthUCL Division of Psychology and Language SciencesLondonUnited Kingdom
| | - Abigail Easter
- Behavioural and Brain Sciences Unit, UCL Institute of Child HealthUCL Division of Psychology and Language SciencesLondonUnited Kingdom
| | - Rebecca Lewis
- Behavioural and Brain Sciences Unit, UCL Institute of Child HealthUCL Division of Psychology and Language SciencesLondonUnited Kingdom
| | - Louise M. Howard
- Section for Women's Mental HealthKCL Institute of PsychiatryLondonUnited Kingdom
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, UCL Institute of Child HealthUCL Division of Psychology and Language SciencesLondonUnited Kingdom
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A Statewide Trauma-Focused Cognitive Behavioral Therapy Network: Creating an Integrated Community Response System. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2015. [DOI: 10.1007/s10879-015-9305-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kimbrel NA, DeBeer BB, Meyer EC, Silvia PJ, Beckham JC, Young KA, Morissette SB. An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans' psychiatric health. Psychiatry Res 2015; 226:78-83. [PMID: 25541538 PMCID: PMC4795819 DOI: 10.1016/j.psychres.2014.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/05/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
The objective of the present research was to test the hypotheses that: (1) Iraq/Afghanistan war veterans experience a wide range of psychiatric symptomatology (e.g., obsessive-compulsive symptoms, hypochondriasis, somatization); and (2) general psychiatric symptomatology among Iraq/Afghanistan war veterans is associated with their warzone experiences. To achieve this objective, Iraq/Afghanistan war veterans (N=155) completed a screening questionnaire that assessed a wide range of psychiatric symptoms along with a measure of warzone experiences. As expected, returning veterans reported significant elevations across a wide range of clinical scales. Approximately three-fourths screened positive on at least one clinical subscale, and a one-third screened positive on five or more. In addition, nearly all of these conditions were associated with veterans' warzone experiences (average r=0.36); however, this association was much stronger among veterans with posttraumatic stress disorder (PTSD) (average r=0.33) than among veterans without PTSD (average r=0.15). We also observed that approximately 18% of the variance in total psychiatric symptomatology was attributable to warzone experiences above and beyond the effects of childhood trauma and demographic factors. Taken together, these findings suggest that returning veterans experience a broad array of psychiatric symptoms that are strongly associated with their warzone experiences.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center; Durham, NC, USA, Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA, Duke University Medical Center, Durham, NC, USA, Correspondence concerning this article should be sent to: Dr. Nathan A. Kimbrel, Durham Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC, 27705. Phone: (919) 286-0411, ext. 6759.
| | - Bryann B. DeBeer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA, Central Texas Veterans Health Care System, Temple, Texas, USA, Texas A&M University Health Science Center, Temple, Texas, USA
| | - Eric C. Meyer
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA, Central Texas Veterans Health Care System, Temple, Texas, USA, Texas A&M University Health Science Center, Temple, Texas, USA
| | - Paul J. Silvia
- University of North Carolina at Greensboro, Greensboro, NC USA
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center; Durham, NC, USA, Mid-Atlantic Mental Illness Research, Education, and Clinical Center; Durham, NC, USA, Duke University Medical Center, Durham, NC, USA
| | - Keith A. Young
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA, Central Texas Veterans Health Care System, Temple, Texas, USA, Texas A&M University Health Science Center, Temple, Texas, USA
| | - Sandra B. Morissette
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas, USA, Central Texas Veterans Health Care System, Temple, Texas, USA, Texas A&M University Health Science Center, Temple, Texas, USA
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41
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Affiliation(s)
- Dallong Han
- Department of Nursing, College of Health Sciences, Cheongju University, Cheongju, Korea
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42
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Mills P, Newman EF, Cossar J, Murray G. Emotional maltreatment and disordered eating in adolescents: testing the mediating role of emotion regulation. CHILD ABUSE & NEGLECT 2015; 39:156-166. [PMID: 25129874 DOI: 10.1016/j.chiabu.2014.05.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 06/03/2023]
Abstract
The present study aimed to determine if emotion regulation mediates the relationship between emotional maltreatment and disordered eating behavior in adolescents. Participants were 222 secondary school pupils (aged 14-18 years) from a state high school in the UK. Standardized questionnaire measures were used to gather self-report data on emotional abuse and emotional neglect, functional and dysfunctional emotion regulation strategies and disordered eating behavior. Results showed that disordered eating was associated with emotional abuse, dysfunctional emotion regulation and being female. Multiple mediation analysis found an indirect relationship between emotional abuse and disordered eating through dysfunctional emotion regulation. Interestingly, emotional neglect predicted lower levels of functional emotion regulation. The findings support previous research showing emotion regulation to mediate the relationship between childhood abuse and disordered eating in adults and a differential effect of abuse and neglect on emotion regulation. Longitudinal studies are required to confirm the direction of relationships; however these data suggest that dysfunctional emotion regulation is a significant variable in the development of disordered eating and may be a useful target for intervention.
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Affiliation(s)
- Pamela Mills
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK; NHS Borders Child and Adolescent Mental Health Service, The Andrew Lang Unit, Viewfield Lane, Selkirk TD7 4LJ, UK
| | - Emily Frances Newman
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Jill Cossar
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - George Murray
- NHS Borders Child and Adolescent Mental Health Service, The Andrew Lang Unit, Viewfield Lane, Selkirk TD7 4LJ, UK
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Monteleone P, Scognamiglio P, Monteleone AM, Perillo D, Maj M. Cortisol awakening response in patients with anorexia nervosa or bulimia nervosa: relationships to sensitivity to reward and sensitivity to punishment. Psychol Med 2014; 44:2653-2660. [PMID: 25055178 DOI: 10.1017/s0033291714000270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sensitivity to punishment (SP) and sensitivity to reward (SR) are personality characteristics that may have relevance for the pathophysiology of eating disorders (EDs). Moreover, personality characteristics are known to modulate the activity of the hypothalamus-pituitary-adrenal (HPA) axis, which is the main component of the endogenous stress response system. As stress has been implicated in the aetiology and the maintenance of EDs, we aimed to study the HPA axis activity in relation to SP and SR, as conceptualized by Gray's reinforcement sensitivity theory (RST), in patients with anorexia nervosa (AN) or bulimia nervosa (BN). METHOD Twenty-five women with AN, 23 women with BN and 19 healthy women volunteered for the study. HPA axis activity was assessed by measurement of the salivary cortisol awakening response (CAR). The subjects' SP and SR were measured by the behavioural inhibition system (BIS)/behavioural approach system (BAS) scales. RESULTS The CAR was significantly enhanced in AN patients, but not in BN patients, compared to healthy women. The CAR correlated significantly with BAS measures, negatively in healthy controls and positively in binge-purging AN patients and BN women. SP, measured by the BIS scale, was higher in patients than in controls. CONCLUSIONS These findings confirm the occurrence of an enhanced activity of the HPA axis in symptomatic AN, but not in symptomatic BN, and show for the first time that the CAR is associated with SR, as conceptualized by the RST, negatively in healthy subjects but positively in binge-purging ED patients.
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Affiliation(s)
- P Monteleone
- Department of Medicine and Surgery,University of Salerno,Italy
| | | | | | - D Perillo
- Department of Psychiatry,University of Naples SUN,Italy
| | - M Maj
- Department of Psychiatry,University of Naples SUN,Italy
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Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. ACTA ACUST UNITED AC 2014; 6:403-414. [PMID: 22003362 DOI: 10.1586/eog.11.31] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed.
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Affiliation(s)
- Elizabeth R Hoffman
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA
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Bresin K, Sima Finy M, Verona E. Childhood emotional environment and self-injurious behaviors: the moderating role of the BDNF Val66Met polymorphism. J Affect Disord 2013; 150:594-600. [PMID: 23541842 DOI: 10.1016/j.jad.2013.01.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous theory has suggested that invalidating environments in the form of emotional maltreatment should be a specific risk factor for the development of self-injurious behaviors (Linehan, 1993, Cognitive-Behavioral Treatment of Borderline Personality Disorder, New York, Guilford Press). However, results from previous studies have been mixed, possibly indicating that this effect may not be the same for all individuals. In fact, some individuals may be more susceptible to environmental influences (i.e., phenotypic plasticity), and this susceptibility may be in part a function of genes that are involved in neuroplasticity (e.g., the brain-derived neurotrophic factor [BDNF] Val66Met polymorphism). METHOD We explored the interaction between retrospective reports of childhood emotional environment and the BDNF Val66Met polymorphism in relation to a history of two main types of self-injurious behaviors, suicide attempt and nonsuicidal self-injury (NSSI), in a sample of individuals with a history of involvement in the criminal justice system. RESULTS For individuals with two Val alleles, there was a significant direct relationship between emotional maltreatment and self-injurious behaviors. However, the relationship was not significant for Met carriers. LIMITATIONS The data are cross-sectional, which means causal inferences cannot be drawn. CONCLUSIONS The results indicate the possibility of a common etiological pathway for NSSI and suicide attempts.
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Affiliation(s)
- Konrad Bresin
- Department of Psychology, University of Illinois Urbana-Champaign, 603 East Daniel Street, Champaign, IL 61820, United States.
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Bundock L, Howard LM, Trevillion K, Malcolm E, Feder G, Oram S. Prevalence and risk of experiences of intimate partner violence among people with eating disorders: a systematic review. J Psychiatr Res 2013; 47:1134-42. [PMID: 23706537 DOI: 10.1016/j.jpsychires.2013.04.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/20/2013] [Accepted: 04/29/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To estimate the prevalence and risk of lifetime and past year intimate partner violence (IPV) among males and females with eating disorders. METHODS Systematic review. We searched 15 electronic databases, supplemented by hand searching, citation tracking, updating a review on victimisation and mental disorder and expert recommendations. RESULTS Eight papers were included, involving 6775 females and 4857 males. Individual studies reported that eating disorders are associated with a high prevalence and increased odds of lifetime IPV among both males and females. Evidence is lacking on eating disorder and past year IPV, on whether associations between eating disorder and IPV vary by type of IPV, and temporality. DISCUSSION More research is needed to investigate the strength and nature of the association between eating disorders and IPV, including with regards to the direction of causality between eating disorders and IPV, and whether associations are mediated by childhood abuse.
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Affiliation(s)
- Louise Bundock
- King's College London, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, United Kingdom
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47
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Aoun A, Garcia FD, Mounzer C, Hlais S, Grigioni S, Honein K, Déchelotte P. War stress may be another risk factor for eating disorders in civilians: a study in Lebanese university students. Gen Hosp Psychiatry 2013; 35:393-7. [PMID: 23557894 DOI: 10.1016/j.genhosppsych.2013.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/15/2013] [Accepted: 02/16/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Traumatic life events are important risk factors for eating disorders (ED). War has been associated, in military populations, with an increased post-service incidence of ED and an increased mean body mass index. We hypothesize that a modification of eating behavior (EB) related to stress during wartime may increase the risk of developing an ED later on among civilians exposed to war stress during adulthood. METHODS This descriptive cross-sectional study was performed in a group of 303 undergraduate young adult students of both sexes from Lebanon, 6 months after the July 2006 war. Modification of EB during wartime, sociodemographic and other potential risk factors were assessed retrospectively. Students were then screened for ED using the SCOFF questionnaire. RESULTS SCOFF was positive in 31.4% of the students, with a mean value 41.6% higher among subjects who reported an altered EB during the war. Among subjects with a positive SCOFF screening, 71% had experienced a change of EB during wartime. Alteration of EB during war was related to an odds ratio for a positive SCOFF screening of 2.6 (95% CI 1.54-4.34) and 1.8 (95% CI 1.01-3.21) for non-adjusted and adjusted analysis, respectively. CONCLUSIONS Modification of EB related to stress during wartime is associated with an increased risk of eating disorders. Early detection and treatment of eating disorders may be improved by routinely evaluation of EB modification in patients with a past history of war exposure.
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Affiliation(s)
- Antoine Aoun
- Saint Joseph University, Beirut 1104-2020, Lebanon
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Karr TM, Crosby RD, Cao L, Engel SG, Mitchell JE, Simonich H, Wonderlich SA. Posttraumatic stress disorder as a moderator of the association between negative affect and bulimic symptoms: an ecological momentary assessment study. Compr Psychiatry 2013; 54:61-9. [PMID: 22789761 PMCID: PMC3473110 DOI: 10.1016/j.comppsych.2012.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/10/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the potential moderating effect of posttraumatic stress disorder (PTSD) on the emotion-behavior relationship in individuals with bulimia nervosa (BN). METHOD A total of 119 women with BN were involved in the study. Participants were divided into 2 groups: those with BN and PTSD (n = 20) and those with BN only (n = 99). Ecological momentary assessment procedures were used for the examination of affect, frequency of bulimic behaviors, and the relationship of affect and bulimic behavior over time. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders was conducted for the diagnosis of BN, PTSD, mood disorders, anxiety disorders, and substance use disorders. Mood disorders, anxiety disorders, and substance use disorders functioned as covariates in all analyses. RESULTS Statistical models showed that those in the PTSD group reported a greater daily mean level of negative affect (NA) and a greater daily frequency of bulimic behaviors than those in the BN-only group. Moderation was found for the association between NA and time in that the PTSD group showed a faster acceleration in NA before purging and faster deceleration in NA after purging. The association between positive affect and time was also moderated by group, indicating that the PTSD group had a faster acceleration in positive affect after purging than the BN-only group. CONCLUSION These findings highlight the importance of recognizing PTSD when interpreting the emotion-behavior relationship in individuals with BN.
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Affiliation(s)
- Trisha M. Karr
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Ross D. Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Li Cao
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Scott G. Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | - Heather Simonich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND
| | - Stephen A. Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
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Mott JM, Menefee DS, Leopoulos WS. Treating PTSD and Disordered Eating in the Wake of Military Sexual Trauma. Clin Case Stud 2012. [DOI: 10.1177/1534650112440499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite high rates of comorbidity between posttraumatic stress disorder (PTSD) and disordered eating, there is little in the way of empirical research or practice guidelines to inform the treatment of these frequently co-occurring disorders. Clinicians who provide treatment for this patient population must navigate complicated decisions about whether these problems are best treated concurrently or sequentially, and which treatment approaches and modalities are most appropriate for the patient. The current clinical case describes the treatment of a female soldier who was admitted to a 25-day, trauma-focused inpatient program 3 months after she experienced military sexual trauma. Although treatment initially targeted her PTSD symptoms, she later disclosed her ongoing struggles with disordered eating, which raised complex questions about the most effective treatment approach. This case study illustrates the intricate link between PTSD and disordered eating, and highlights important clinical considerations relevant to the assessment and treatment of these commonly comorbid disorders.
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Affiliation(s)
- Juliette M. Mott
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
- Houston Center for Quality of Care and Utilization Studies, Houston, TX, USA
| | - Deleene S. Menefee
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Wendy S. Leopoulos
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
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50
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Hart H, Rubia K. Neuroimaging of child abuse: a critical review. Front Hum Neurosci 2012; 6:52. [PMID: 22457645 PMCID: PMC3307045 DOI: 10.3389/fnhum.2012.00052] [Citation(s) in RCA: 388] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 02/27/2012] [Indexed: 12/30/2022] Open
Abstract
Childhood maltreatment is a stressor that can lead to the development of behavior problems and affect brain structure and function. This review summarizes the current evidence for the effects of childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, working memory, attention, response inhibition and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, gray and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum (CC). Diffusion tensor imaging (DTI) studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during response inhibition, working memory, and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavioral and affect control. Future, large scale multimodal neuroimaging studies in medication-naïve subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary co-morbid conditions.
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Affiliation(s)
- Heledd Hart
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's CollegeLondon, UK
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