Does ADHD Symptomatology Influence Treatment Outcome and Dropout Risk in Eating Disorders? A longitudinal Study

Attention-deficit/hyperactivity disorder (ADHD) and its symptoms have been shown to be present in patients with eating disorders (EDs) and are associated with increased psychopathology and more dysfunctional personality traits. This study aimed to assess if the presence of ADHD symptoms in patients with EDs affects their short and long-term therapy outcome. A total of 136 consecutively treated ED patients were considered in this study. Baseline pre-treatment evaluation included the Adult ADHD Self-Report Scale (ASRS v1.1) for ADHD symptoms and the assessment of eating symptomatology using the Eating Disorders Inventory (EDI-2). Treatment outcome was evaluated in terms of ED symptoms after cognitive behavioral therapy (CBT) and dropout rate during treatment. Furthermore, we evaluated ED symptoms in treatment completers after a follow-up of 8 years on average. Path analyses assessed the potential mediational role of the EDI-2 total score in the relationship between ADHD and treatment outcome. Results showed that baseline symptoms of ADHD indirectly affected treatment outcome after CBT; the ASRS positive screening was related to higher eating symptomatology (standardized coefficient B = 0.41, p = 0.001, 95% CI: 0.26 to 0.55), and the presence of high ED levels contributed to the increase of dropout (B = 0.15, p = 0.041, 95% CI: 0.03 to 0.33) and a worse treatment outcome (B = 0.18, p = 0.041, 95% CI: 0.01 to 0.35). No direct effect was found between the ASRS positive screening with the risk of dropout (B = −0.08, p = 0.375) and worse treatment outcome (B = −0.07, p = 0.414). These results suggest the relevance of identifying specific treatment approaches for patients with ADHD symptoms and severe eating symptomatolog

Comparación de rasgos de personalidad entre pacientes con trastorno de la conducta alimentaria y sus hermanas sanas

Los objetivos del presente estudio con pacientes-hermanas fueron: 1) Analizar diferencias existentes en sintomatología alimentaria y psicopatología general entre pacientes con trastorno alimentario (TCA) y hermanas discordantes para el trastorno, 2) Identificar en qué medida pacientes y hermanas presentan vulnerabilidades de personalidad diferenciales; 3) Identificar factores predictores de aparición de un trastorno alimentario. La muestra estuvo formada por 92 participantes mujeres (46 pacientes TCA vs 46 hermanas sanas). Todos los pacientes cumplían criterios DSM-IV-TR para el TCA. Los resultados mostraron diferencias significativas en todas las escalas de sintomatología alimentaria y psicopatología general entre ambos grupos. En términos de rasgos de personalidad, las pacientes con TCA presentaban una mayor evitación del daño (p<.001) y menor autodirección (p<.001) al ser comparadas con sus hermanas discordantes para el trastorno. Finalmente, los resultados mostraron que haber tenido historia previa de obesidad o sobrepeso (p=.027) y rasgos específicos de temperamento (elevada evitación al daño; p=.025) y carácter (baja autodirección; p=.009) se asociaban al posterior desarrollo de un TCA. La combinación de factores ambientales no compartidos, tales como obesidad con vulnerabilidades específicas de personalidad, influyen en la posterior aparición de un trastorno de la conducta alimentariaThe aims of the study were threefold: 1) analyze differences in symptomatology and general psychopathology among eating disorder (ED) patients and their sisters discordant for eating disorders, 2) identify differential personality vulnerabilities between ED patients and their healthy sisters and 3) identify predictors of developing an eating disorder. The sample consisted of 92 female participants (46 ED patients fulfilling DSM-IV-TR criteria for eating disorders vs 46 healthy sisters). The results showed significant differences in eating symptomatology and general psychopathology. In terms of personality traits, ED patients had higher harm avoidance (p<.001) and lower self-directedness (p<.001) compared with their discordant sister. Finally, the results showed that having a history of obesity or overweight (p=.027), and specific traits of temperament (high scores on harm avoidance; p=.025) and character (low self-directedness; p=.009) were associated with the development of an ED. These findings allow to conclude that the combination of non-shared environmental factors such as obesity with specific vulnerabilities of personality, influence the subsequent emergence of an eating disorder

Mecanismos de negación en el infarto de miocardio: su relación con las variables psicológicas y la evolución a corto plazo

A partir de una muestra seleccionada de 97 varones con primer infarto de miocardio, se han estudiado 67 pacientes para aclarar la influencia de los mecanismos de negación (MN) en la evolución psicológica y cardiológica. No hubo diferencias entre los negadores y los no negadores en cuanto a la evolución cardiológica, pero los negadores presentaron menos ansiedad y menos reacciones depresivas en la unidad coronaria y un mes después, así como menos psicopatología en general. En la última evaluación, un año después del alta hospitalaria (n: 52) no hubo diferencias entre los negadores y los no negadores en lo que respecta a la petición de asistencia psiquiátric

Cognitive behaviour therapy response and dropout rate across purging and nonpurging bulimia nervosa and binge eating disorder: DSM-5 implications

BACKGROUND: With the imminent publication of the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there has been a growing interest in the study of the boundaries across the three bulimic spectrum syndromes [bulimia nervosa-purging type (BN-P), bulimia nervosa-non purging type (BN-NP) and binge eating disorder (BED)]. Therefore, the aims of this study were to determine differences in treatment response and dropout rates following Cognitive Behavioural Therapy (CBT) across the three bulimic-spectrum syndromes. METHOD: The sample comprised of 454 females (87 BED, 327 BN-P and 40 BN-NP) diagnosed according to DSM-IV-TR criteria who were treated with 22 weekly outpatient sessions of group CBT therapy. Patients were assessed before and after treatment using a food and binging/purging diary and some clinical questionnaires in the field of ED. 'Full remission' was defined as total absence of binging and purging (laxatives and/or vomiting) behaviors and psychological improvement for at least 4 (consecutive). RESULTS: Full remission rate was found to be significantly higher in BED (69.5%) than in both BN-P (p < 0.005) and BN-NP (p < 0.001), which presented no significant differences between them (30.9% and 35.5%). The rate of dropout from group CBT was also higher in BED (33.7%) than in BN-P (p < 0.001) and BN-NP (p < 0.05), which were similar (15.4% and 12.8%, respectively). CONCLUSIONS: Results suggest that purging and non-purging BN have similar treatment response and dropping out rates, whereas BED appears as a separate diagnosis with better outcome for those who complete treatment. The results support the proposed new DSM-5 classification

Impulsivity, emotional dysregulation and executive function deficits could be associated with alcohol and drug abuse in eating disorders

Background: Empirical data suggests a high comorbid occurrence of eating disorders (EDs) and substance use disorders (SUDs), as well as neurological and psychological shared characteristics. However, no prior study has identified the neuropsychological features of this subgroup. This study examines the prevalence of alcohol and/or drug abuse (A/DA) symptoms in ED patients. It also compares the clinical features and neuropsychological performance of ED patients with and without A/DA symptoms. Methods: 145 participants (74.5% females) with various forms of diagnosed EDs underwent a comprehensive clinical (TCI-R, SCL-90-R and EDI-2) and neuropsychological assessment (Stroop, WCST and IGT). Results: Approximately 19% of ED patients (across ED subtypes) had A/DA symptoms. Those with A/DA symptoms showed more impulsive behaviours and higher levels of interoceptive awareness (EDI-2), somatisation (SCL-90-R) and novelty seeking (TCI-R). This group also had a lower score in the Stroop-words measure, made more perseverative errors in the WCST and showed a weaker learning trajectory in the IGT. Conclusions: ED patients with A/DA symptoms display a specific phenotype characterised by greater impulsive personality, emotional dysregulation and problems with executive control. Patients with these temperamental traits may be at high risk of developing a SUD

Development of a VR application for binge eating treatment: identification of contexts and cues related to bingeing behavior in spanish italian patients

The objective of this study was to identify frequent situations and specific cues that produce the craving to binge in Spanish and Italian samples of patients with eating disorders (ED). There were two main aims: to assess transcultural differences in the contexts and cues that elicit food craving; and to develop valid, reliable VR environments for effective cue-exposure therapy (CET) for patients from both countries. Twenty-six Spanish and 75 Italian ED patients completed an ad hoc questionnaire to assess contexts and cues that trigger the craving to binge. No differences between groups were found. All patients reported experiencing higher levels of craving in the afternoon/early evening and in the late evening/night, between meals, when alone, and more frequently at the end of the week. Being in the dining room, the kitchen, the bedroom, the bakery and the supermarket were the specific situations that produced the highest levels of craving to binge. We used the questionnaire results to develop a virtual reality application for CET

Personality traits comparison between eating disorder patients and their healthy siblings / Comparación de rasgos de personalidad entre pacientes con trastorno de la conducta alimentaria y sus hermanas sanas

Abstract. The aims of the study were threefold: 1) analyze differences in symptomatology and general psychopathology among eating disorder (ED) patients and their sisters discordant for eating disorders, 2) identify differential personality vulnerabilities between ED patients and their healthy sisters and 3) identify predictors of developing an ED. The sample consisted of 92 female participants (46 ED patients fulfilling DSM-IV-TR criteria vs. 46 healthy sisters). The results showed significant differences in eating symptomatology and general psychopathology among the groups. In terms of personality traits, ED patients had higher harm avoidance (p<.001) and lower self-directedness (p<.001) compared with their discordant sister. Finally, the results showed that having a history of obesity or overweight (p=.027), and specific traits of temperament (high scores on harm avoidance; p=.025) and character (low self-directedness; p=.009) were associated with the development of an ED. These findings suggest that the combination of non-shared environmental factors, such as obesity with specific vulnerabilities of personality, influence the subsequent emergence of an eating disorder. Key words: Eating disorders, Personality traits, Siblings, Predictors, Obesity. Resumen. Los objetivos del presente estudio con pacientes-hermanas fueron: 1) Analizar diferencias existentes en sintomatología alimentaria y psicopatología general entre pacientes con trastorno alimentario (TCA) y hermanas discordantes para el trastorno, 2) Identificar en qué medida pacientes y hermanas presentan vulnerabilidades de personalidad diferenciales; 3) Identificar factores predictores de aparición de TCA. La muestra estuvo formada por 92 participantes mujeres (46 pacientes TCA vs 46 hermanas sanas). Todos los pacientes cumplían criterios DSM-IV para el TCA. Los resultados mostraron diferencias significativas en todas las escalas de sintomatología alimentaria y psicopatología general entre ambos grupos. En términos de rasgos de personalidad, las pacientes con TCA presentaban una mayor evitación del daño (p<.001) y menor auto-dirección (p<.001) al ser comparadas con sus hermanas discordantes para el trastorno. Finalmente, los resultados mostraron que haber tenido historia previa de obesidad o sobrepeso (p=.027) y rasgos específicos de temperamento (elevada evitación al daño; p=.025) y carácter (baja auto-dirección; p=.009) se asociaban al posterior desarrollo de un TCA. La combinación de factores ambientales no compartidos, tales como obesidad con vulnerabilidades específicas de personalidad, influyen en la posterior aparición de un trastorno de la conducta alimentaria. Palabras clave: Trastornos alimentarios, Rasgos de personalidad, Hermanas, Predictores, Obesidad.

Treatment outcome of patients with comorbid type 1 diabetes and eating disorders

Background: Co-morbidity between Type 1 Diabetes Mellitus (T1DM) and eating disorders (ED) has been previously described; however the effect of this illness on the outcomes for conventional ED treatments has not been previously investigated. This study aims to compare clinical, psychopathological and personality features between two samples of ED individuals: those with comorbid T1DM and those without (No-DM); and to identify differences in treatment outcomes between the groups. Methods: This study compares treatment outcome, dropouts, ED psychopathology and personality characteristics for 20 individuals with ED and T1DM and 20 ED patients without diabetes, matched for diagnostic and treatment type. Results: The study found higher dropout rates from therapy in individuals with T1DM and worse treatment outcome in spite of having no significant differences in eating disorder psychopathology, although individuals with T1DM report misusing insulin. Conclusions: The low levels of motivation to change, and insulin abuse in T1DM patients, may suggest that treatment for patients with ED and T1DM should consider the individual's personality and role of insulin abuse when determining the appropriate intervention

Dorsolateral prefrontal cortex and amygdala function during cognitive reappraisal predicts weight restoration and emotion regulation impairment in anorexia nervosa

Background: although deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes. Methods: we investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement. Results: compared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWE<0.05, threshold-free cluster enhancement (TFCE) corrected]. Importantly, psycho-physiological interaction analysis revealed reduced functional connectivity between the dlPFC and the amygdala in AN patients during emotion regulation (pFWE<0.05, TFCE corrected), and dlPFC-amygdala uncoupling was associated with emotion regulation deficits (r = -0.511, p = 0.018) and eating disorder severity (r = -0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment. Conclusions: taken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity

Food addiction in eating disorders and obesity: Analysis of clusters and implications for treatment

Food addiction (FA) has been associated with greater psychopathology in individuals with eating disorders (ED) and obesity (OBE). The current study aims to provide a better phenotypic characterization of the FA construct by conducting a clustering analysis of FA in both conditions (ED and OBE). The total sample was comprised of 234 participants that scored positive on the Yale Food Addiction Scale 2.0. (YFAS-2) (119 bulimia nervosa (BN), 50 binge eating disorder (BED), 49 other specified feeding or eating disorder (OSFED) and 16 OBE). All participants completed a comprehensive battery of questionnaires. Three clusters of FA participants were identified. Cluster 1 (dysfunctional) was characterized by the highest prevalence of OSFED and BN, the highest ED severity and psychopathology, and more dysfunctional personality traits. Cluster 2 (moderate) showed a high prevalence of BN and BED and moderate levels of ED psychopathology. Finally, cluster 3 (adaptive) was characterized by a high prevalence of OBE and BED, low levels of ED psychopathology, and more functional personality traits. In conclusion, this study identified three distinct clusters of ED-OBE patients with FA and provides some insight into a better phenotypic characterization of the FA construct when considering psychopathology, personality and ED pathology. Future studies should address whether these three food addiction categories are indicative of therapy outcome