A kötődési jellemzők és multiimpulzív tünetek kapcsolata evészavarokban

Absztrakt: Bevezetés: A kötődési diszfunkciók meghatározzák a borderline személyiségzavart, amely a multiimpulzivitás gyakori háttértényezője. A kötődés és a multiimpulzív evészavarok kapcsolata mégis szinte feltáratlan. Célkitűzés: Multiimpulzív és klasszikus evészavarosok, illetve evészavartól mentes személyek kötődésének összehasonlítása; továbbá feltárni, hogy a kötődés mennyire magyarázza a multiimpulzív tüneteket. Módszer: Keresztmetszeti online kérdőíves vizsgálat (148 nő, átlagéletkor: 30,9 év), amely e három csoportban mérte az anyai, apai és felnőtt kötődést, a depressziót, a szorongást, az evészavar- és multiimpulzív tüneteket. Eredmények: Az evészavartól mentes csoport 41,3%-a, a klasszikus evészavarosok 17,6%-a, a multiimpulzív csoport 11,8%-a biztonságosan kötődött. A legsúlyosabb evészavartünetek (F(2) = 17,733) és legalacsonyabb apai gondoskodás (F(2) = 3,443) a multiimpulzív evészavarosokat jellemezték. A kötődési aggodalmaskodás és bizalmatlanság a multiimpulzív tünetek 14,5%-át magyarázta, ám a depresszióra korrigálva csak utóbbi bizonyult a multiimpulzivitás prediktorának (t = 5,166, p<0,01). Következtetés: A multiimpulzív személyek tüneti és kötődési szempontból is az evészavarosok különálló csoportját alkotják. A negatív hangulatok kezelése terápiás potenciállal bírhat esetükben. Az apai gondoskodás, kötődési aggodalmaskodás, bizalmatlanság terápiás jelentőségének feltárásához longitudinális vizsgálatok szükségesek. Orv Hetil. 2017; 158(27): 1058–1066. | Abstract: Introduction: Attachment dysfunctions determine borderline personality disorder, which is a frequent background factor of multi-impulsivity; however, the relationship between attachment and multi-impulsive eating disorders is almost unexplored. Aim: To compare attachment features of multi-impulsive and classical eating disorder patients with individuals without eating disorders, and to test attachment as a predictor of multi-impulsivity. Method: A cross-sectional survey (148 females, mean age: 30.9 years) investigated maternal, paternal and adult attachment, depression, anxiety, eating disorder and multi-impulsive symptoms in these groups. Results: Altogether 41.3% of the individuals without eating disorders, 17.6% of classical and 11.8% of multi-impulsive eating disorder patients had secure attachment. Multi-impulsive patients had the most severe eating disorder symptoms (F(2) = 17.733) and the lowest paternal care (F(2) = 3.443). Preoccupied and fearful attachment explained 14.5% of multi-impulsive symptoms; however, with adjustment for depression only latter one remained the predictor of multi-impulsivity (t = 5.166, p<0.01). Conclusion: Multi-impulsives are a distinct subgroup of eating disorder patients from the aspects of both symptoms and attachment. Handling their negative moods may hold therapeutic potentials. Longitudinal studies are required to investigate the therapeutic value of paternal care, attachment preoccupation and fearfulness. Orv Hetil. 2017; 158(27): 1058–1066

Cognitive-behavioral and attachment interventions in the transdiagnostic treatment of bulimia nervosa and binge eating disorder

Background The transdiagnostic model of eating disorders provides an evidence-based cognitive-behavioral treatment approach, emphasizing the maintaining factors of low selfesteem, perfectionism, mood intolerance and interpersonal difficulties. Although attachment quality is associated with these factors, there is no treatment model focusing on both attachment-related and cognitive-behavioral maintaining factors of the symptoms. Aims The aim was to construct and test a multilevel treatment model, which integrates attachment interventions into the transdiagnostic treatment of eating disorders. Methods Relevant aspects of attachment functioning were joined together with the four cognitive-behavioral maintaining factors of the symptoms, and attachment interventions were incorporated into an extended transdiagnostic treatment of a bulimia nervosa and a binge eating disorder patient. Results Attachment domains could be integrated into the transdiagnostic model of eating disorders at both the case conceptualization and treatment level. The improvement of attachment functioning was related to treatment outcomes at a one month follow-up. Conclusions When attachment dysfunctions contribute to precipitating or maintaining mechanisms of eating disorder symptoms a multilevel treatment targeting both the relevant aspects of attachment and cognitive-behavioral functioning can be suggested. Randomized controlled studies with different intervention groups are required to confirm the result of these case studies. | Elméleti háttér Az evészavarok transzdiagnosztikus modellje egy bizonyított kognitív viselkedésterápiás megközelítést kínál, amely az alacsony önértékelés, perfekcionizmus, hangulatintolerancia és interperszonális zavarok szerepét hangsúlyozza. Bár a kötődés minősége összefüggést mutat e tényezőkkel, egyetlen evészavar-kezelési modell sem fókuszál a tünetek kötődéssel kapcsolatos és kognitív-viselkedéses fenntartó tényezőire egyaránt. Cél A cél egy hipotetikus többszintű kezelési modell építése és tesztelése volt, amely kötődési intervenciókat integrál az evészavarok transzdiagnosztikus kezelésébe. Módszerek A kötődés releváns aspektusait és a tünetek négy kognitív-viselkedéses fenntartó tényezőjét összekapcsolva kötődési intervenciókat alkalmaztunk egy bulimia nervosa és egy falászavaros beteg kibővített transzdiagnosztikus kezelésében. Eredmények A kötődés aspektusai illeszkedtek az evészavarok transzdiagnosztikus modelljébe, az esetkonceptualizációk és a kezelés szintjén egyaránt. A kötődési funkciók javulása kapcsolatot mutatott a kezelés eredményeivel egy hónap után is. Következtetések Ha a kötődési diszfunkciók hozzájárulnak az evészavar-tünetek kiváltó- vagy fenntartó mechanizmusaihoz, többszintű kezelés lehet ajánlott, amely a kötődés releváns aspektusait és a kognitív-viselkedéses funkciókat egyaránt célozza. Különböző intervenciós csoportokon végzett, randomizált, kontrollált vizsgálatok szükségesek a jelen esettanulmányok eredményeinek megerősítéséhez

Parental and Adult Attachment and Eating Symptomology in Eating Disorder Patients and Sine Morbo Individuals

Attachment can contribute to eating disorder symptomology through various paths, including emotion regulation. However, the relationship between parental and adult attachment and emotional eating and other eating disorder symptoms have been barely investigated on comparative samples. This cross-sectional, questionnaire-based online survey aimed to assess the relationship between parental and adult attachment qualities with the eating behavior severity, emotional eating, and the level of depression in 67 female anorexia nervosa, bulimia nervosa, and binge eating disorder patients, compared to 67 female sine morbo individuals. Eating disorder patients less frequently had secure attachment, and were more often fearful or preoccupied than sine morbo individuals. In sine morbo individuals lower adult attachment security, but in patients, lower parental care was related to eating disorder symptoms. In sine morbo individuals, higher preoccupation, but in patients, higher fearfulness and lower care was related to emotional eating. Lower attachment security (OR = 0.54), younger age (OR = 0.93) and higher depression (OR = 1.04) explained 36.6% of the variance of diagnosed eating disorders. A complex interplay could be highlighted between dysfunctional attachment dimensions and eating symptomology in both groups—but with different patterns. Perceived parental care may be influential for eating disorder patients, whilst the degree of adult attachment security can be influential for sine morbo individuals. Lower attachment security was a predictor of eating disorders, which suggests the protective value of enhancing attachment security. However, further attachment-based interventions are required

Treatment methods of avoidant/restrictive food intake disorder: Review with therapeutic implications

Background: The introduction of Avoidant/Restrictive Food Intake Disorder (ARFID) have refined childhood and adolescent eating disorders, however it meant a significant change in the diagnostics. Hardly anything is known about its effective interventions and there is a lack of specific treatment guidelines. Thus, our aim was to review the risk factors, assessment methods, and chiefly the treatment methods of ARFID to support its clinical management and psychotherapy. Method: The reviewing process was conducted in two steps, with the primary focus on the literature since the introduction of ARFID using the term of 'avoidant/restrictive food intake disorder' with dates 2012 -2015. The PRISMA flow algorithm was applied to filter results. Results and discussion: Assessment methods involve structured DSM -V interview, supplemented with Bryant-Waugh's diagnostic guideline, and the Children's Eating Disorder Examination-Questionnaire, or the Eating Disturbances in Youth-Questionnaire. The heterogeneous treatment shall fit the patients' and families individual needs, and the different presentations ARFID (e.g. sensory-based selective eating, of chocking or vomiting phobia and interactional difficulties). A combination of medical treatment with the primary focus on the weight recovery, nutritional management, and psychotherapeutic interventions are suggested; in children parents should be involved. Behavior therapy with exposure, systematic desensitization, CBT with cognitive restructuring, anxiety management, and family based interventions seemed to be the most useful psychotherapeutic interventions. Conclusions: Studies should start assessing the effectiveness of different treatment approaches based on longitudinal researches to describe strict evidence-based guidelines for each presentations of ARFID

Review of attachment interventions in eating disorders: Implications for psychotherapy

Background Attachment theory has been used in personalized treatments since decades. It is a major framework for understanding images of the self, affect regulation, reflective functions and interpersonal relationships. The improvement of attachment functioning is associated with positive treatment outcomes in eating disorders. However, attachment interventions have not been summarized in their psychotherapy. Aims The aim was to review the relevance of attachment features in the psychotherapy of eating disorders. Methods A literature review was carried out for empirical review and case studies, using the terms “eating disorder” and “attachment” from 1987 until 2017. From the 320 matches, 50 relevant studies were integrated into this review. Results The relationship between dysfunctional attachment and eating disorders could be conceptualized in seven ways, including transgenerational transmissions and mediator personality traits. Attachment can mediate between early experiences and adult symptoms, between intra- and interpersonal experiences, or may moderate the relationship between the risk factors and maladaptive eating. Attachment features also display a direct relationship with eating disorders, or may underlie their maintaining mechanisms. Nine psychotherapeutically relevant mediator factors could be identified, namely the patient’s self-concept and emotion-regulation, the conflation of self-esteem and body satisfaction, a sensitive interpersonal style, levels of perfectionism, depression, alexithymia, mentalization and reflective functions. Conclusions The assessment of attachment dysfunctions in the individual symptomatology may facilitate personalized case models. For patients with severe attachment dysfunctions, multimodal psychotherapies targeting the described focal points could be recommended. Randomized, controlled studies are required to test the efficacy of the interventions summarized, and to determine indications