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Kirkpatrick RH, Breton E, Biorac A, Munoz DP, Booij L. Non-suicidal self-injury among individuals with an eating disorder: A systematic review and prevalence meta-analysis. Int J Eat Disord 2024; 57:223-248. [PMID: 38041221 DOI: 10.1002/eat.24088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE This study aimed to quantify the prevalence of non-suicidal self-injury across eating disorders (EDs) and within diagnostic categories through systematic review and proportional, or so-called prevalence, meta-analysis. METHOD Included studies had to contain individuals with a verified diagnosis of an ED. The last literature search was conducted on September 11, 2023, for studies published on or before September 2023 without a restriction on earliest publication year. Results were synthesized and analyzed using the "metaprop" package in R and presented using forest plots. Bias was assessed by a Peters' regression test and funnel plot. RESULTS 79 studies published between 1985 and 2023 were included encompassing 32,334 individuals with an ED. Importantly, 42 studies were not included in any other meta-analyses on self-injury in EDs to date. Overall prevalence of non-suicidal self-injury was 34.59% (95%CI = 30.49-38.81). Prevalence in anorexia nervosa restrictive type, binge/purge type, bulimia nervosa, binge eating disorder and other specified feeding/eating disorder were 23.19% (95%CI = 16.96-30.03%), 41.98% (95%CI = 32.35-51.91%), 36.97% (95%CI = 30.69-43.46%), 21.21% (95%CI = 14.93-28.12%) and 37.65% (95%CI = 28.59-47.09%), respectively. Prevalence estimations could not be estimated for other ED categories due to lack of a sufficient number of studies. DISCUSSION Non-suicidal self-injury is prevalent across both binge/purge and restrictive EDs. Considering the transdiagnostic nature of self-injurious behaviors in ED, the results highlight the importance of assessment and monitoring of self-injury in people with ED, irrespective of specific diagnoses. The method of determining self-injury varied across studies and may limit this study. PUBLIC SIGNIFICANCE This study highlights the prevalence of self-injury across eating disorders irrespective of diagnosis and within specific EDs. While diagnoses known to exhibit self-injurious behaviors (e.g., bulimia nervosa, anorexia nervosa binge/purge subtype) demonstrated the highest prevalence of self-injury, all diagnoses were found to have a prevalence greater than 20%. These findings suggest the importance of assessing and monitoring all individuals with an eating disorder for the presence of self-injury.
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Affiliation(s)
- Ryan H Kirkpatrick
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Edith Breton
- Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, University of Oslo & Oslo University Hospital, Oslo, Norway
| | - Aleksandar Biorac
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated Health and Social Services Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Quebec, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. Bodies out of control: Relapse and worsening of eating disorders in pregnancy. Front Psychol 2022; 13:986217. [PMID: 36248571 PMCID: PMC9554489 DOI: 10.3389/fpsyg.2022.986217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE).ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.
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Affiliation(s)
- Bente Sommerfeldt
- Institute of Eating Disorders, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- *Correspondence: Bente Sommerfeldt,
| | - Finn Skårderud
- Institute of Eating Disorders, Oslo, Norway
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kjersti S. Gulliksen
- Institute of Eating Disorders, Oslo, Norway
- The Norwegian Psychological Association, Oslo, Norway
| | - Arne Holte
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
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Sjögren M, Støving RK. Anorexia Nervosa: Reduction in Depression during Inpatient Treatment Is Closely Related to Reduction in Eating Disorder Psychopathology. J Pers Med 2022; 12:jpm12050682. [PMID: 35629105 PMCID: PMC9145215 DOI: 10.3390/jpm12050682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Anorexia nervosa (AN) is a severe mental disorder frequently associated with high scores of depressiveness. We examined the short-term effects of inpatient treatment on depressiveness and eating disorder (ED) psychopathology using the self-rating Major Depression Inventory (MDI) and Eating Disorder Examination questionnaire (EDEq) for patients with AN. Material: Forty-nine patients with AN, all part of the PROspective Longitudinal all-comer inclusion study on EDs (PROLED), were observed over eight weeks with baseline psychometric measures, EDE-q at baseline and endpoint, and weekly MDI self-scoring. Methods: Apart from the weekly Body Mass Index (BMI) measurements, patients were assessed at baseline using the Eating Disorder Inventory (EDI) and the Symptom Check List 92 (SCL-92). Results: Inpatient treatment reduced MDI consistently over 8 weeks (Wilks Lambda = 0.59, F = 4.1, p < 0.01) and this reduction in MDI was positively correlated with a reduction in EDEq (r = 0.44; p < 0.01) during inpatient treatment. Baseline medication did not predict changes in MDI during the inpatient treatment. BMI increased from 14.9 (week 1) to 17.2 (week 8). Conclusions: Inpatient treatment of AN is associated with a reduction in depressiveness. This improvement in depressiveness scores correlates with an improvement in ED psychopathology but not with weight gain.
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Affiliation(s)
- Magnus Sjögren
- Psychiatric Center Ballerup, 2750 Ballerup, Denmark
- Institute for Clinical Science, Umeå University, 90185 Umeå, Sweden
- Correspondence:
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, 5000 Odense, Denmark;
- Research Unit for Medical Endocrinology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Ali AM, Hendawy AO, Abd Elhay ES, Ali EM, Alkhamees AA, Kunugi H, Hassan NI. The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders. BMC Womens Health 2022; 22:99. [PMID: 35361186 PMCID: PMC8968775 DOI: 10.1186/s12905-022-01677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/15/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Facebook addiction is increasing, giving rise to limited real-life social networks, loneliness, poor work and academic performance, psychopathology, and low well-being. Facebook entails numerous factors that increase the risk for disordered eating attitudes and behaviors (e.g., use time and Facebook activities such as social grooming and photo sharing). This study aimed to evaluate the psychometric properties of the Bergen Facebook Addiction Scale (BFAS) among patients with eating disorders (EDs) given lack of validation of Facebook addiction measures in this population. METHODS A cross-sectional study involving 123 inpatient and outpatient women with EDs (Mean age = 27.3, SD = 10.6, range = 14-59 years) used confirmatory factor analysis (CFA), multigroup CFA, structural equation modeling (SEM), Spearman's rho Spearman's analysis, McDonald's Omega (ω), Cronbach's alpha (α), and item-total correlations to examine the structure, invariance, criterion validity, reliability, and discriminant validity of the BFAS. RESULTS Correlating the residuals of items 2, 3, and 5 resulted in an excellent fit of a one-factor structure of the BFAS (χ2(7) = 8.515, p = .289, CFI = .998, TLI = .996, RMSEA = .042, SRMR = .0099). The BFAS was invariant at the configural, metric, and scalar levels across groups of EDs, age, education, and marital status. High values of ω and α (.96) as well as item-total correlations (.851-.929) indicated excellent reliability and high discrimination index of the BFAS. Criterion validity is noted by strong positive correlation with the Six-item Internet Addiction Test (S-IAT, r = .88) and SEM using the S-IAT to predict the BFAS (χ2(49) = 103.701, p = .001, CFI = .975, TLI = .966, RMSEA = .096, SRMR = .0317).. CONCLUSION The BFAS is a reliable unidimensional measure. Its high discrimination index and invariance across different groups make it useful for detecting Facebook addiction among patients with ED.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria, 21527 Egypt
| | - Amin Omar Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, 183-8538 Japan
- Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour, 22516 Egypt
| | - Eman Sameh Abd Elhay
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, 30016 Egypt
| | - Esraa Mohammed Ali
- Department of Basic and Educational Sciences, Faculty of Education for Early Childhood, Alexandria University, Mostafa Kamel, Alexandria, 21646 Egypt
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, 52571 Al Qassim Saudi Arabia
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502 Japan
| | - Nagia I. Hassan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Damanhour University, Damanhour, 22511 Egypt
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Nutritional status and anxious and depressive symptoms in anorexia nervosa: a prospective study. Sci Rep 2021; 11:771. [PMID: 33436652 PMCID: PMC7804178 DOI: 10.1038/s41598-020-79410-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
The interweaving of malnutrition and symptoms of anxiety and depression in anorexia Nervosa (AN) is mentioned without any consensus regarding the course of anxious-depressive symptoms in relation to nutritional status in the course of treatment of patients with AN. The objectives of the current study in a large sample of AN inpatients were to assess the relationships between anxiety and depression symptoms and nutritional status both over the course of inpatient treatment and at discharge. 222 consecutive inpatients with AN (DSM-IV TR) were assessed (entrance and discharge) for duration of illness, psychiatric treatments, sociodemographic data and with psychometric scales for different psychopathological symptoms [depressive (BDI), anxiety and depressive (HAD scale), obsessive-compulsive (MOCI) and social phobia (LSAS fear score)]. Nutritional status was assessed with Body Mass Index (BMI) and body composition by bioelectrical impedance. The Fat free mass index [FFMI = FFM (kg)/height (m2)] was considered for the analysis. Two models were developed where the dependent variables were each psychopathological score at discharge (BDI, HAD anxiety, MOCI, and LSAS fear) in the cross-sectional model, and their variation in the longitudinal model (where a positive score reflected symptom decrease at discharge). A fixed set of predictors, defined on presumed clinical and statistical relevance (FFMI in the cross-sectional model and Variation of FFMI in the longitudinal model), were considered in each model, without any model selection procedure. This is the first study to confirm a positive relationship between the course of eating disorder symptoms and that of anxious-depressive symptoms during inpatient treatment of AN even after adjustment on a vast array of possibly confounding factors.
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Price T, Zebitz M, Giraldi A, Lokind TS, Treasure J, Sjögren JM. Sexual function and dysfunction among women with anorexia nervosa: A systematic scoping review. Int J Eat Disord 2020; 53:1377-1399. [PMID: 32449544 DOI: 10.1002/eat.23299] [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: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research suggests that a variety of biological and psychosocial factors are associated with the sexual health of women diagnosed with anorexia nervosa (AN). This systematic scoping review, conducted in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines, synthesizes the current literature concerning sexual function and dysfunction in women with AN. METHOD We searched PubMed, EMBASE, and PsychInfo for literature published until April 2020. All study designs were eligible for inclusion, providing they focused on sexual function and dysfunction in women with AN. Studies that only included outcomes related to gender identity or sexual orientation were excluded. RESULTS N = 28 studies met criteria for inclusion in the review. All studies were conducted in Western countries and the majority employed either a cohort or cross-sectional design. Although measures of sexual function and dysfunction varied markedly across studies, most studies adopted a biopsychosocial framework. Libido may be linked to body mass index (BMI), while other aspects of sexual functioning and behavior might not be specifically associated with weight status. Limited data are available on evidence-based interventions. DISCUSSION Sexual dysfunction in women with AN is common. Although some of the variance is explained by low BMI, associated physiological sequelae and other psychosocial factors are also involved. Sexual dysfunction is a relevant clinical problem and clinicians should sensitively incorporate questions related to sexual function into their eating disorder assessments. Future research, using more robust designs and validated outcome measures, is needed to better understand causal pathways between the biological and psychosocial correlates of AN and sexual dysfunction. Identifying predictors of sexual function and dysfunction in more diverse groups of people with AN will support the development of evidence-based therapies.
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Affiliation(s)
- Tom Price
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Martin Zebitz
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet Capitol Region of Denmark Psychiatry Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thea Stine Lokind
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Jan Magnus Sjögren
- Research Unit Eating Disorders, Psychiatric Center BALLERUP, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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7
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Towe M, La J, El-Khatib F, Roberts N, Yafi FA, Rubin R. Diet and Female Sexual Health. Sex Med Rev 2020; 8:256-264. [DOI: 10.1016/j.sxmr.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/18/2019] [Accepted: 08/18/2019] [Indexed: 01/23/2023]
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8
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Eating Disorders and Sexual Function Reviewed: A Trans-diagnostic, Dimensional Perspective. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00236-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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McNabney SM, Wiese GN, Rowland DL. From Table to Bedroom: Nutritional Status, Dietary Interventions, and Women’s Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00224-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Castellini G, Lelli L, Cassioli E, Ricca V. Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours. Mol Cell Endocrinol 2019; 497:110429. [PMID: 31026479 DOI: 10.1016/j.mce.2019.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy.
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Maier S, Spiegelberg J, Zutphen L, Zeeck A, Tebartz van Elst L, Hartmann A, Holovics L, Reinert E, Sandholz A, Lahmann C, Domschke K, Glauche V, Tüscher O, Joos AA. Neurobiological signature of intimacy in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2019; 27:315-322. [DOI: 10.1002/erv.2663] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/08/2018] [Accepted: 12/27/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Simon Maier
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Julia Spiegelberg
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Linda Zutphen
- Department of Clinical Psychological ScienceMaastricht University Maastricht The Netherlands
| | - Almut Zeeck
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Ludger Tebartz van Elst
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Armin Hartmann
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Lukas Holovics
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Elke Reinert
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Angelika Sandholz
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Claas Lahmann
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Katharina Domschke
- Faculty of Medicine, Department of Psychiatry and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
| | - Volkmar Glauche
- Faculty of Medicine, Department of NeurologyMedical Center—University of Freiburg Freiburg Germany
| | - Oliver Tüscher
- Department of Psychiatry and PsychotherapyUniversity of Mainz Mainz Germany
| | - Andreas A.B. Joos
- Faculty of Medicine, Department of Psychosomatic Medicine and PsychotherapyMedical Center—University of Freiburg Freiburg Germany
- Department of Psychotherapeutic NeurologyKliniken Schmieder Gailingen Germany
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12
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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13
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Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017; 14:1036-1045. [PMID: 28666657 DOI: 10.1016/j.jsxm.2017.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several studies have suggested a relevant overlap between eating disorders and sexual dysfunction involving the emotional component of body image esteem and dissociative experiences. AIM To evaluate the common maintaining factors of sexual dysfunction and vulnerability to pathologic eating behaviors and their relation to a physiologic stress response. METHODS In the present cross-sectional study, we evaluated a non-clinical sample of 60 heterosexual women (25-35 years old) for dissociation during sex with a partner, body image disturbance, and tendency toward pathologic eating behaviors. We also evaluated the stress-induced hypothalamic-pituitary-adrenal axis activation in response to a sexual stimulus and its association with binge eating and dissociation. OUTCOMES Participants completed the Clinician-Administered Dissociative States Scale, the Sexual Satisfaction Scale-Women, the Body Esteem Scale for Adolescents and Adults, and the Eating Attitudes Test Short Version. Furthermore, we assessed cortisol levels before, during, and after exposure to explicit sexual stimuli shown within a laboratory setting. RESULTS Dysfunctional body image esteem and a tendency toward binge-eating behaviors were associated with greater sexual distress in women. In particular, body esteem was significantly associated with greater dissociation during sex with a partner. Moreover, women who reported greater dissociation during sex with a partner and a tendency toward binge-eating behaviors showed higher levels of cortisol in response to sexual stimuli. CLINICAL IMPLICATIONS These results support further research based on trans-diagnostic treatments targeted to dissociation and body image esteem, which could lessen sexual dysfunction and vulnerability to pathologic eating behaviors. STRENGTHS AND LIMITATIONS Despite the small sample and self-reported questionnaires, this is the first study to consider the association of the stress response during sexual stimuli with sexual distress and with pathologic eating behaviors adopting a dimensional approach. CONCLUSION Body uneasiness and dissociation represented factors underlying pathologic eating behaviors and sexual dysfunction. Women reporting a tendency toward binge-eating episodes and dissociation during sexual experiences represented a subpopulation with a higher stress response during sexual stimuli. Castellini G, Lo Sauro C, Ricca V, Rellini AH. Body Esteem as a Common Factor of a Tendency Toward Binge Eating and Sexual Dissatisfaction Among Women: The Role of Dissociation and Stress Response During Sex. J Sex Med 2017;14:1036-1045.
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Affiliation(s)
- Giovanni Castellini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy; Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy.
| | - Carolina Lo Sauro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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14
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Tolosa-Sola I, Gunnard K, Giménez Muniesa C, Casals L, Grau A, Farré JM. Body dissatisfaction and eating disorder symptomatology: Which factors interfere with sexuality in women with eating disorders? J Health Psychol 2017; 24:1526-1535. [PMID: 28810426 DOI: 10.1177/1359105317695425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Body dissatisfaction is a relevant aspect in both eating disorders and sexuality. Using Stice's model, this study aimed to evaluate the relationship between these variables in eating disorder patients compared with healthy controls. Statistically significant correlations between body dissatisfaction and sexuality were found in the whole sample. The clinical group had higher rates of body dissatisfaction and sexual impairment. Within the clinical group, the participants with a greater drive for thinness showed higher sexual dysfunctions. These results suggest that sexuality should be systematically explored in eating disorders. Higher rates of drive for thinness may be associated with greater sexual impairment.
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Affiliation(s)
| | | | | | | | - Antoni Grau
- 3 Institut de Trastorns Alimentaris (ITA), Spain
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15
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Dunkley CR, Gorzalka BB, Brotto LA. Disordered eating and sexual insecurities in young women. CANADIAN JOURNAL OF HUMAN SEXUALITY 2016. [DOI: 10.3138/cjhs.252-a6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There has long been a proposed clinical link between sexuality and eating disorders; however, little empirical evidence exists regarding this relationship. The limited body of research on sexuality in eating disorders supports the occurrence of considerable sexual concerns. The aim of the present study was to expand on the dearth of empirical literature exploring altered sexuality in relation to disordered eating. This research examines disordered eating in relation to sexual insecurities. Undergraduate female UBC students (n=789) completed a series of online questionnaires assessing sexual insecurities and eating habits. Several domains of sexual insecurities were associated with disordered eating symptom severity. Mean differences in sexual self-efficacy, as well as body- and performance-based cognitive distractions during sexual activity emerged among women categorized as being at elevated, typical, or low eating disorder risk, with those at greater risk reporting greater sexual difficulties. Sexuality is rarely considered in the context of eating disorder treatment unless a history of sexual abuse is present. The results of this study suggest that sexual insecurities should be addressed during eating disorder care.
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Affiliation(s)
- Cara R. Dunkley
- Department of Psychology, University of British Columbia, Vancouver, BC
| | - Boris B. Gorzalka
- Department of Psychology, University of British Columbia, Vancouver, BC
| | - Lori A. Brotto
- Department of Gynaecology, University of British Columbia, Vancouver, BC
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Kimmel M, Ferguson E, Zerwas S, Bulik C, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 2016; 49:260-75. [PMID: 26711005 PMCID: PMC5683401 DOI: 10.1002/eat.22483] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. METHOD We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. RESULTS Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. DISCUSSION We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.
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Affiliation(s)
- M.C. Kimmel
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina,Correspondence to: M.C. Kimmel, Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina.
| | - E.H. Ferguson
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - S. Zerwas
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - C.M. Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
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Gonidakis F, Kravvariti V, Fabello M, Varsou E. Anorexia Nervosa and Sexual Function. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0064-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Castellini G, Lelli L, Ricca V, Maggi M. Sexuality in eating disorders patients: etiological factors, sexual dysfunction and identity issues. A systematic review. Horm Mol Biol Clin Investig 2016; 25:71-90. [DOI: 10.1515/hmbci-2015-0055] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/24/2015] [Indexed: 11/15/2022]
Abstract
AbstractThe scientific community appears to be less interested in sexuality of eating disorders (EDs) as compared to other psychiatric or medical comorbidities. However, a clear association between sexual problems and ED psychopathology was reported from different perspectives. The overarching goal of this systematic review was to evaluate the general approach of the scientific literature toward the topic of sexuality and EDs. In particular, four different categories of research have been individuated, encompassing the role of puberty, and sexual abuse in the pathogenesis of the disorders, sexual dysfunctions, and the association between sexual orientation and EDs psychopathology. Timing of puberty with its hormonal consequences and the changes in the way persons perceive their own body represent a crucial period of life for the onset of the disorder. Sexual abuse, and especially childhood sexual abuse are well-recognized risk factors for the development of ED, determining a worse long-term outcome. Recent research overcome the approach that considers sexual activity of EDs patients, in terms of hypersexuality and dangerous sexual behaviors, considering the sexuality of EDs persons in terms of sexual desire, satisfaction, orgasm and pain. Results from this line of research are promising, and describe a clear relationship between sexual dysfunction and the core psychopathological features of EDs, such as body image disturbances. Finally, the analysis of the literature showed an association between sexual orientation and gender dysphoria with EDs psychopathology and pathological eating behaviors, confirming the validity of research developing new models of maintaining factors of EDs related to the topic of self-identity.
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Kezelman S, Touyz S, Hunt C, Rhodes P. Does anxiety improve during weight restoration in anorexia nervosa? A systematic review. J Eat Disord 2015; 3:7. [PMID: 25874111 PMCID: PMC4396079 DOI: 10.1186/s40337-015-0046-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
Weight restoration is considered a principal outcome for treatment of Anorexia Nervosa (AN) due to the significant physiological disturbances resultant from acute states of malnutrition. Treatment outcomes for populations with AN are relatively poor, with increasing evidence suggesting that weight restoration alone is insufficient for long-term recovery. Research aimed at understanding the psychological sequaele of AN, in particular during weight restoration, nevertheless remain scarce. This systematic review aimed to evaluate existing research regarding anxiety symptoms during treatment for AN, and the relationship of anxiety symptomology and weight restoration. Twelve articles were identified from a systematic search of three electronic databases (PsycINFO, MEDLINE, and Web of Science), and were eligible for inclusion. Study methodology, results and quality were reviewed. Results regarding change in anxiety symptomology were inconsistent, though evidence did not support a relationship between anxiety change and weight restoration. Reasons for these inconsistencies and limitations of included studies were reviewed. Further research is warranted to elucidate the role of anxiety in AN and its implications for treatment and longer-term outcome.
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Affiliation(s)
- Sarah Kezelman
- School of Psychology, University of Sydney, Sydney, Australia
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, Australia
| | - Caroline Hunt
- School of Psychology, University of Sydney, Sydney, Australia
| | - Paul Rhodes
- School of Psychology, University of Sydney, Sydney, Australia
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20
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Pakpour AH, Zeidi IM, Ziaeiha M, Burri A. Cross-cultural adaptation of the Female Genital Self-Image Scale (FGSIS) in Iranian female college students. JOURNAL OF SEX RESEARCH 2013; 51:646-53. [PMID: 24168018 DOI: 10.1080/00224499.2013.821441] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The aim of the present study was to investigate the psychometric properties of a translated and culturally adapted Iranian version of the Female Genital Self-Image Scale (FGSIS-I) in a sample of college women. Further, the relationship between women's self-image, body appreciation, sexual functioning, and gynecological exam behavior was explored. A sample of 1,877 female students from five different universities across Qazvin and Tehran completed the Female Sexual Function Index (FSFI), the Body Appreciation Scale (BAS), the Rosenberg Self-Esteem Scale (RSES), the FGSIS-I, and a gynecological exam behavior questionnaire. Good to excellent internal consistency reliability, test-retest reliability, and convergent and construct validity were found. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) both provided a two-factor structure for the FGSIS-I. The validity of the FGSIS-I in predicting gynecological exam behavior of college women was tested using structural equation modeling (SEM). The final model accounted for 33% of the variance in gynecological exam behavior (p < 0.01). In conclusion, the FGSIS-I was found to be a highly valid and reliable instrument to assess female genital self-image in Iranian women.
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Affiliation(s)
- Amir H Pakpour
- a Qazvin Research Center for Social Determinants of Health
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21
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Castellini G, Lo Sauro C, Lelli L, Godini L, Vignozzi L, Rellini AH, Faravelli C, Maggi M, Ricca V. Childhood Sexual Abuse Moderates the Relationship Between Sexual Functioning and Eating Disorder Psychopathology in Anorexia Nervosa and Bulimia Nervosa: A 1-Year Follow-Up Study. J Sex Med 2013; 10:2190-200. [DOI: 10.1111/jsm.12232] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Castellini G, Lelli L, Lo Sauro C, Vignozzi L, Maggi M, Faravelli C, Ricca V. Childhood abuse, sexual function and cortisol levels in eating disorders. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 81:380-2. [PMID: 22964754 DOI: 10.1159/000337176] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/11/2012] [Indexed: 12/11/2022]
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Brockmeyer T, Holtforth MG, Bents H, Kämmerer A, Herzog W, Friederich HC. Interpersonal motives in anorexia nervosa: the fear of losing one's autonomy. J Clin Psychol 2012; 69:278-89. [PMID: 23280636 DOI: 10.1002/jclp.21937] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examined the widely held but insufficiently studied hypothesis of autonomy disturbances in anorexia nervosa. METHOD A total sample of 112 participants comprising patients with acute anorexia nervosa (AN), women recovered from anorexia nervosa (REC), clinical controls (CC), and healthy controls (HC) completed measures of dependency and intimacy strivings, as well as measures of frustrations of these same strivings. RESULTS In comparison to HC and CC, AN showed a stronger motivation to avoid dependency and lower strivings for intimacy. Compared with HC, but not with CC, AN also showed stronger frustrations of the same motives. Whereas REC did not differ from AN regarding avoidance of dependency, they reported lower frustration of dependency avoidance (i.e., less actual experiences of dependency). Finally, REC reported higher intimacy motivation as well as better satisfaction of intimacy motivation as compared with AN. CONCLUSIONS The present findings suggest that a pronounced motive of avoiding dependency may be a vulnerability factor for anorexia nervosa that is disorder-specific and trait-like. Frustrations of this motive seem to be associated with psychopathology.
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Affiliation(s)
- Timo Brockmeyer
- University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Germany.
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24
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Castellini G, Lelli L, Lo Sauro C, Fioravanti G, Vignozzi L, Maggi M, Faravelli C, Ricca V. Anorectic and Bulimic Patients Suffer from Relevant Sexual Dysfunctions. J Sex Med 2012; 9:2590-9. [DOI: 10.1111/j.1743-6109.2012.02888.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Goldzak-Kunik G, Friedman R, Spitz M, Sandler L, Leshem M. Intact sensory function in anorexia nervosa. Am J Clin Nutr 2012; 95:272-82. [PMID: 22205316 DOI: 10.3945/ajcn.111.020131] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In anorexia nervosa (AN), taste and smell are believed to be anhedonic, hunger and pain are muted, and body-image distortion obscures wasting, which together facilitate self-starvation. However, the emphasis on these deficits may be biased because other sensory systems have been sparsely investigated. OBJECTIVES Objectives of the study were to clarify whether these dysfunctions are specific or part of a pattern of sensory-perceptual deficits in AN patients and to test the gustatory senses dissociated from ingestion to clarify whether any deficit is sensory or affective. DESIGN In 15 adolescent, first-episode, hospitalized, restrictive AN patients and 15 matched healthy controls who responded to gustatory stimuli (intensity and hedonics of 5 basic tastes and tastes and odors of foods and nonfoods), size estimation (manual and oral judgment of size and shape, kinesthesia, and body size and esthetics), cold pain, and auditory and visual processing were compared. RESULTS AN patients did not differ on most tests, were better at odor recognition, were less successful in central auditory processing and oral assessment of size and shape, and may have been more sensitive to cold. Body-image dissatisfaction in AN patients was not related to dysfunctional size estimation. CONCLUSIONS There is no systematic sensory-perceptual deficit in AN patients, and specifically, not in gustatory function. The few differences shown might be due to fear of food-related stimuli or comorbidity.
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Bulik CM, Baucom D, Kirby J, Pisetsky E. Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). Int J Eat Disord 2011; 44:19-28. [PMID: 20063308 PMCID: PMC2889168 DOI: 10.1002/eat.20790] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the development of a novel couple-based cognitive-behavioral intervention for adult anorexia nervosa (AN) called Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). METHOD We review the state of the science for the treatment of adult AN, the nature of relationships in AN, our model of couple functioning in AN, and the development of the UCAN intervention. RESULTS We present the UCAN treatment for patients with AN and their partners and discuss important considerations in the delivery of the intervention. DISCUSSION With further evaluation, we expect that UCAN will emerge to be an effective, acceptable, disseminable, and developmentally tailored intervention that will serve to improve both core AN pathology as well as couple functioning.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, North Carolina.
| | - Donald Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Jennifer Kirby
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Emily Pisetsky
- Department of Psychology, University of North Carolina at Chapel Hill
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27
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Pinheiro AP, Raney TJ, Thornton LM, Fichter MM, Berrettini WH, Goldman D, Halmi KA, Kaplan AS, Strober M, Treasure J, Woodside DB, Kaye WH, Bulik CM. Sexual functioning in women with eating disorders. Int J Eat Disord 2010; 43:123-9. [PMID: 19260036 PMCID: PMC2820601 DOI: 10.1002/eat.20671] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe sexual functioning in women with eating disorders. METHOD We assessed physical intimacy, libido, sexual anxiety, partner status, and sexual relationships in 242 women from the International Price Foundation Genetic Studies relative to normative data. RESULTS Intercourse (55.3%), having a partner (52.7%), decreased sexual desire (66.9%), and increased sexual anxiety (59.2%) were common. Women with restricting and purging anorexia nervosa had a higher prevalence of loss of libido than women with bulimia nervosa and eating disorder not otherwise specified (75%, 74.6%, 39%, and 45.4%, respectively). Absence of sexual relationships was associated with lower minimum lifetime body mass index (BMI) and earlier age of onset; loss of libido with lower lifetime BMI, higher interoceptive awareness and trait anxiety; and sexual anxiety with lower lifetime BMI, higher harm avoidance and ineffectiveness. Sexual dysfunction in eating disorders was higher than in the normative sample. DISCUSSION Sexual dysfunction is common across eating disorders subtypes. Low BMI is associated with loss of libido, sexual anxiety, and avoidance of sexual relationships.
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Affiliation(s)
| | - TJ Raney
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
| | - Manfred M. Fichter
- Department of Psychiatry, University of Munich (LMU), Munich, Germany, and Roseneck Hospital for Behavioral Medicine, Prien, Germany
| | - Wade H. Berrettini
- Center of Neurobiology and Behavior, University of Pennsylvania, Philadelphia, PA
| | - David Goldman
- National Institute of Alcohol Abuse and Alcoholism, Rockville, MD
| | - Katherine A. Halmi
- New York Presbyterian Hospital-Westchester Division, Weill Medical College of Cornell University, White Plains, NY
| | - Allan S. Kaplan
- Department of Psychiatry, The Toronto Hospital, Toronto, Canada
| | - Michael Strober
- Semel Institute for Neuroscience, University of California at Los Angeles, Los Angeles, CA
| | | | | | - Walter H. Kaye
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC
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Abstract
The eating disorders anorexia nervosa and bulimia nervosa and eating disorders not otherwise specified disproportionately affect women, have profound effects on the overall well-being of women and their children, and can have mortality rates as high as those found with major depression. These disorders may present to obstetrician-gynecologists (ob-gyns) clinically as menstrual dysfunction, low bone density, sexual dysfunction, miscarriage, preterm delivery, or low birth weight in offspring. Ninety percent of eating disorders develop before the age of 25 in otherwise healthy young women, a group that characteristically seeks the majority of their health care from ob-gyns. For all of these reasons, ob-gyns must have a greater awareness of these disorders and a lower index of suspicion for screening their patients than they currently do. Otherwise, they may miss life-threatening illness, treat characteristic amenorrhea inappropriately, or inadvertently intervene to help these women conceive, contributing to maternal and fetal risks. As providers of both primary and specialty care for women, ob-gyns have the opportunity to play a vital role in prevention and diagnosis of eating disorders and in the multidisciplinary management required to effectively manage these disorders.
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Seal BN, Bradford A, Meston CM. The association between body esteem and sexual desire among college women. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:866-872. [PMID: 19280331 DOI: 10.1007/s10508-008-9467-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 08/27/2008] [Accepted: 11/16/2008] [Indexed: 05/27/2023]
Abstract
Relationships between body image variables and sexuality have been found among several groups of women. However, research has largely focused on generalized experiences of sexuality. With the exception of two studies which focused on specific medical populations, to our knowledge there has been no investigation of the relationship between body image and acute measures of sexual response. In the current study, we investigated the relationships between body esteem, sexual response to erotica in a laboratory-setting, and self-reported sexual functioning in a non-clinical sample of 85 college women. Women participated in one study session, during which mental sexual arousal, perceptions of physical arousal, and sexual desire were assessed. Results showed that higher body esteem was significantly positively related to sexual desire in response to erotica in the laboratory setting. Similarly, higher body esteem was positively related to self-reported measures of sexual desire, as assessed by a validated measure of sexual function. The sexual attractiveness and weight concern subscales of the Body Esteem Scale, which relate to body characteristics that are most likely to be under public scrutiny, were particularly linked to sexual desire. This is the first study to show that body esteem is related to sexual responses to a standardized erotic stimulus in a laboratory setting.
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Affiliation(s)
- Brooke N Seal
- Department of Psychology, University of Texas at Austin, 1 University Station, A8000, Austin, TX 78712, USA
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Abstract
INTRODUCTION The impact of self-awareness during sexual activity has been widely discussed. However, research has been largely focused on the effects of performance anxiety in male erectile functioning. It has been suggested that physical appearance concerns may have a similar influence on sexual function in women as does men's self-awareness about erectile function. However, the role that physical appearance or awareness of one's body may play in female sexual response has received little empiric attention. AIM To examine the effects of body awareness and self-report levels of body esteem on sexual response in 21 sexually dysfunctional women. METHODS Body awareness was induced in one of two counterbalanced sessions. A full-length mirror was placed in front of participants throughout the experimental session, and participants were instructed to use the mirror to place 10 electrodes on each side of their bodies to prepare for a possible electrocardiogram. This methodology was used to ensure that women looked at themselves in the mirror and became more aware of their bodies during the experimental session. MAIN OUTCOME MEASURES Self-reported mental arousal, perceptions of physical arousal, physiological sexual arousal, affect, anxiety, and cognitive distraction responses to erotica. RESULTS Results showed that subjective mental sexual arousal and perceptions of physical sexual arousal increased in response to erotica in the Body Awareness condition compared to in the No Body Awareness condition. These results were not accounted for by level of body esteem. There were no changes in physiological sexual arousal, affect, anxiety, or level of cognitive distraction across the two conditions. CONCLUSIONS Findings suggest that awareness of one's body is related to increased subjective sexual response in conditions where cognitive distraction does not occur. It is particularly noteworthy that the current sample was made up of sexually dysfunctional women, all of whom had relatively low body image.
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Affiliation(s)
- Brooke N Seal
- Department of Psychology, University of Texas at Austin, 1 University Station A8000, Austin, TX 78712, USA
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Newton M, Boblin S, Brown B, Ciliska D. Understanding intimacy for women with anorexia nervosa: a phenomenological approach. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Dirks AJ, Leeuwenburgh C. Caloric restriction in humans: potential pitfalls and health concerns. Mech Ageing Dev 2005; 127:1-7. [PMID: 16226298 DOI: 10.1016/j.mad.2005.09.001] [Citation(s) in RCA: 171] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 09/13/2005] [Accepted: 09/13/2005] [Indexed: 01/08/2023]
Abstract
To date, the only intervention that has consistently been shown to slow the rate of aging, and to increase mean and maximum lifespan in short-lived species, is life-long calorie restriction. It is yet unclear whether long-term calorie restriction in longer lived species (i.e. primates and humans) will have a similar effect. In humans, several studies investigating short-term calorie restriction or "weight loss" programs suggest beneficial outcomes on parameters of cardiovascular disease. Studies on long-term calorie restriction are performed on a self-selected group of human subjects and show similar effects. However, few studies are currently investigating the quality of life and potential pitfalls of long-term calorie restriction in humans. It is likely that some of the physiological and psychological effects of caloric restriction that occur in animals may impact the human life very differently. For certain, calorie restriction has a plethora of health benefits in mammals, such as a reduction in age-related diseases such as cancer. However, despite the "magic" of CR, this intervention in humans may present itself with a number of health concerns, which may not be applicable to or impact the life of experimental animals, but may do so in humans. These potential pitfalls and "side effects" are not clearly addressed in the literature and will be a focus of this review.
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Affiliation(s)
- Amie J Dirks
- Wingate University, School of Pharmacy, 316 N. Main Street, Wingate, NC 28174, USA.
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Newton M, Boblin S, Brown B, Ciliska D. Romantic relationships for women with anorexia nervosa: an integrative literature review. Eat Weight Disord 2005; 10:139-53. [PMID: 16277136 DOI: 10.1007/bf03327541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To critically appraise literature concerning romantic relationships for women with anorexia nervosa (AN), and to gain perspective on future research directives. METHOD Key electronic databases, reference lists, and journals were searched. The search was limited to features of romantic relationships and their quality. Nineteen studies were critiqued and abstracted. RESULTS All 19 studies used a quantitative design; no qualitative studies were retrieved. Methodological strengths of these studies included confounder control and appropriate statistical analyses for design. Weaknesses included a failure to declare study designs, address sources of bias, and justify study samples, as well as a lack of con-founder control. DISCUSSION The review drew attention to the varied relational experiences and marked relationship dissatisfaction expressed by women with AN. However, an understanding of relationship quality and its dynamic nature remains limited. Future research should focus on how meanings are negotiated in relationships, providing detailed descriptions of the women's experiences, which is best done with qualitative study. Well-conducted longitudinal research should address questions that cannot be answered by current research designs, such as temporality.
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Affiliation(s)
- M Newton
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada.
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Rodríguez Martín A, Novalbos Ruiz JP, Martinez Nieto JM, Escobar Jiménez L, Castro de Haro AL. Characteristics of eating disorders in a university hospital-based Spanish population. Eur J Clin Nutr 2005; 59:459-62. [PMID: 15674311 DOI: 10.1038/sj.ejcn.1602095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the personal and family antecedents and clinical characteristics of patients with eating disorders (EDs) in a population of the south of Spain; to analyse the influence of lifestyles, family functioning, socioeconomic status (SES), and psychological characteristics in these processes. DESIGN A university-based case-control study. SETTING University Hospital (Andalusia, Spain). SUBJECTS A total of 120 patients with EDs and 240 controls. INTERVENTIONS SCOFF, EDI, APGAR family, and SES questionnaires. RESULTS In all, 67.5% of patients presented anorexia (AN), 15% bulimia (BN), and 17.5% mixed forms. EDs emerged at around 18-20 y (95% CI 17.9-19.8). Factors associated with EDs are psychiatric conditions (depression OR: 4.16, anxiety OR: 4.59), more frequent use of medication (OR: 2.26), dietary fibre (OR: 2.59), and laxatives (OR: 3.47). Toxics consumption, sport activity, SES, and family antecedents of pathology are not associated with EDs. An inverse relationship was found between family functioning and the scores in various subscales of the EDI. CONCLUSIONS Eating disorders in Andalusia (Spain) are influenced significantly more by psychological, family, and cultural factors than by social factors.
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Affiliation(s)
- A Rodríguez Martín
- Area of Preventive Medicine and Public Health, University of Cádiz, Spain.
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35
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Newton M, Boblin S, Brown B, Ciliska D. ‘An engagement-distancing flux’: bringing a voice to experiences with romantic relationships for women with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2005. [DOI: 10.1002/erv.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Segraves RT. Female sexual disorders: psychiatric aspects. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:419-25. [PMID: 12085676 DOI: 10.1177/070674370204700502] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This manuscript reviews the current information concerning female sexual dysfunction that is relevant to general psychiatric practice. METHOD Research identified by the key words sexual dysfunction and prevalence, comorbidity, psychiatric drugs, or pharmacotherapy is reviewed. RESULTS Epidemiologic studies indicate that approximately 30% of female subjects between ages 18 and 59 years have sexual complaints of at least 3 months' duration in the past year. A high comorbidity with other psychiatric syndromes exists. Many psychiatric drugs are associated with sexual dysfunction. Drug treatments for female sexual dysfunction are being investigated. CONCLUSION Knowledge concerning the treatment of female sexual dysfunction is important to the general psychiatric clinician.
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Affiliation(s)
- Robert Taylor Segraves
- Department of Psychiatry, Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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