Obsessive-compulsive symptoms in female patients with an eating disorder with or without impulsive non-suicidal self-injury.

BACKGROUND AND AIMS: In the present study, we investigated differences in obsessive-compulsive (OC) symptoms in patients with an eating disorder (ED) with or without recent/lifetime impulsive non-suicidal self-injury (NSSI). We included 429 female inpatients with an ED, of whom 31.9% engaged in recent impulsive NSSI and 56.4% in lifetime impulsive NSSI. MATERIALS: They filled out the Eating Disorder Evaluation Scale, the Self-Injury Questionnaire-Treatment Related and the Padua Inventory-Revised (OC symptoms). METHODS AND RESULTS: Patients with anorexia nervosa, binge-eating/purging type (AN-BP) and bulimia nervosa (BN) engaged more frequently in recent/lifetime impulsive NSSI compared to patients with anorexia nervosa, restrictive-type (AN-R). Two MANCOVAs with OC symptoms as dependent variables, and ED subtypes and recent/lifetime impulsive NSSI as independent variables controlling for age and body mass index showed the main effects of ED subtypes and recent/lifetime impulsive NSSI. Patients with AN-BP reported significantly more impulses (i.e., being afraid of losing control over motor behaviours) compared to patients with AN-R and BN. ED patients with impulsive recent/lifetime NSSI scored significantly higher on all OC scales compared to patients without NSSI. DISCUSSION AND CONCLUSION: In sum, the presence of recent/lifetime impulsive NSSI in patients with an ED seems to be related to more severe OC symptoms. Hence, this comorbidity needs to be addressed in psychotherapy, such as in transdiagnostic cognitive behavioural therapy for EDs.

An Adjunctive Multi-family Group Intervention with or without Patient Participation during an Inpatient Treatment for Adolescents with an Eating Disorder: A Pilot Study.

This study reports on a pilot study of a family group intervention with or without patient participation adjunctive to a specialized inpatient treatment for eating disorders (EDs). Participants were 112 female adolescent ED inpatients and one or both of their parents. The parents were invited to participate in an adjunctive multi-family group with patient (MFT) or in a similar multi-parent group without patient participation (MPT). Questionnaires assessing ED symptoms, family functioning and caregiving experiences were administered before and after intervention. Post-intervention results obtained from both patient and parent(s) indicated that improvement in ED symptoms and parental burden occurred after both types of interventions. Family functioning improved differently according to the informant: fathers reported an improvement of general family functioning, patients reported an improvement of problem solving and mothers reported a decrease in problem solving across both formats. This study emphasized the importance of including a multi-informant approach in family interventions. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

The Role of Non-suicidal Self-Injury and Binge-Eating/Purging Behaviours in the Caregiving Experience Among Mothers and Fathers of Adolescents with Eating Disorders.

This study investigated the caregiving experiences of mothers and fathers of restrictive and binge-eating/purging eating disordered (ED) inpatients with and without non-suicidal self-injury (NSSI). Sixty-five mothers and 65 fathers completed the Experience of Caregiving Inventory. All inpatients completed the Self-Injury Questionnaire-Treatment Related to assess NSSI and the Eating Disorder Evaluation Scale to assess eating disorder symptoms. Mothers reported significant more negative and more positive caregiving experiences compared with fathers. Mothers (but not fathers) of restrictive ED patients reported more positive caregiving experiences compared with mothers of binge-eating/purging patients. The presence of NSSI in ED patients was associated with more negative caregiving experiences of both parents. Mothers and fathers of ED inpatients differ in caregiving experiences, and both binge-eating behaviours and NSSI negatively affect their caregiving experience. Therefore, supportive interventions for parents of ED patients are necessary, especially of those patients who engage in NSSI.

The Role of Non-Suicidal Self-Injury and Binge-Eating/Purging Behaviours in Family Functioning in Eating Disorders.

This study aimed to investigate family functioning of restrictive and binge-eating/purging eating disordered adolescents with or without non-suicidal self-injury (NSSI), as perceived by the patients and their parents (mothers and fathers). In total, 123 patients (between 14 and 24 years), 98 mothers and 79 fathers completed the Family Assessment Device. Patients completed the Self-Injury Questionnaire-Treatment Related and the Symptom Checklist 90-Revised. No main effects were found of restrictive versus binge-eating/purging behaviour nor of presence/absence of NSSI. For the parents, a significant interaction between binge-eating/purging behaviour and NSSI emerged: Mothers and fathers reported worse family functioning in the binge-eating/purging group in presence of NSSI, whereas mothers reported worse family functioning in the restrictive group without NSSI. Parental perception of family functioning is affected by the combined presence of binge-eating/purging behaviour and NSSI. This finding should be taken into account when treating families living with eating disorders.

Are Sensitivity to Punishment, Sensitivity to Reward and Effortful Control Transdiagnostic Mechanisms Underlying the Eating Disorder/Obesity Spectrum?

Although it has been postulated that eating disorders (EDs) and obesity form part of a broad spectrum of eating- and weight-related disorders, this has not yet been tested empirically. In the present study, we investigated interindividual differences in sensitivity to punishment, sensitivity to reward, and effortful control along the ED/obesity spectrum in women. We used data on 286 patients with eating disorders (44.6% AN-R, 24.12% AN-BP, and 31.82% BN), 126 healthy controls, and 640 Class II/III obese bariatric patients (32.81% Class II and 67.19% Class III) with and without binge eating. Participants completed the behavioral inhibition and behavioral activation scales, as well as the effortful control scale, to assess sensitivity to punishment and reward and effortful control. Results showed that patients with EDs scored significantly higher on punishment sensitivity (anxiety) compared to healthy controls and Class II/III obese patients; the different groups did not differ significantly on reward sensitivity. Patients with binge eating or compensatory behaviors scored significantly lower on effortful control than patients without binge eating. Differences in temperamental profiles along the ED/obesity spectrum appear continuous and gradual rather than categorical. This implies that it may be meaningful to include emotion regulation and impulse regulation training in the treatment of both EDs and obesity.

Temperament and Character Traits of Female Eating Disorder Patients with(out) Non-Suicidal Self-Injury.

Eating disorder (ED) patients show alarmingly high prevalence rates of Non-Suicidal Self-Injury (NSSI). Adolescents seem to be particularly at risk, as EDs and NSSI both have their onset in mid-adolescence. It has been suggested that personality could be a transdiagnostic mechanism underlying both EDs and NSSI. However, little attention has been given to adolescent clinical samples compared to adult and/or community samples. Therefore, the current study investigated the role of personality in a sample of 189 female inpatients with an ED (M = 15.93, SD = 0.98). Our results confirmed the high prevalence of NSSI in EDs, specifically in patients with bingeing/purging behaviours (ED-BP). Temperamental differences were found between ED-BP and the restrictive ED subtype (ED-R). Namely, ED-BP patients showed more harm avoidance and less self-directedness compared to ED-R. Temperamental differences were found in NSSI as well, regardless of ED subtype: ED patients who had engaged in NSSI during their lifetime reported less self-directedness and more harm avoidance. Interestingly, only ED patients who recently engaged in NSSI showed less novelty seeking. These temperamental profiles should be recognised as key mechanisms in the treatment of adolescent ED patients with and without NSSI.