Selfless self-transcendence in the clinical setting as a source of self-enhancement.

This paper examines the paradox of Selfless-Self-Transcendence, that is, how the self is enriched through self-renunciation. The article discusses what enables being carried away without forethought into selfless-self-transcendence and how, eventually, these inadvertent surrenders create therapeutic shifts. Using clinical vignettes, we suggest that the selfless move towards patients is part of a latent mutual process, with them, and it enables the restoration of the self to an enriched form. These depictions imply that like the patients, the analysts also encounter themselves in a truer way which allows them to become who they really are, through selflessly transcending themselves.

Selflessness as a predictor of remission from an eating disorder: 1-4 year outcomes from an adolescent day-care unit.

OBJECTIVE: To assess the potential role of selflessness in predicting remission from an eating disorder (ED) following discharge from an adolescent day-care unit. METHOD: Participants were 95 female patients (aged 13-19 years) with an ED diagnosis across the spectrum admitted to an adolescent day-care unit for EDs between 2008 and 2012. Forty-one of these participants completed the follow-up assessment, between 12 and 46 months following discharge. No significant differences were found in Time 1 variables between patients who participated in Time 2 and those who did not. At both time points, ED and psychiatric comorbidity diagnoses were made using standard structured interviews. Patients were also administered the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), The Eating Attitude Test (EAT-26), The Eating Disorder Inventory (EDI-2) and the Selflessness Scale (SS)*. RESULTS: Only baseline Selflessness Scale was significant in predicting the continuous variable of ED symptomatology level in follow-up. When dividing EDI total score into its subscales at baseline, one of those, maturity fears, was found, together with the SS, significant in the prediction. In predicting remission (this time as a dichotomized variable) in follow-up, only the SS, maturity fears, EDI total, and EAT-26, at baseline, predicted remission at follow-up, but the strength of selflessness was the greatest. CONCLUSIONS: Psychological features are not the main target of the important search for predictors of remission from ED. The findings of the present study add the psychological feature of selflessness to this search. Psychotherapy can be enriched by identifying psychological features such as selflessness as one of its foci. The present findings might also renew interest in maturity fears as an additional focus in psychotherapy. LEVEL OF EVIDENCE: Level III, cohort study.

Weight Trajectories of Israeli Pediatric Cancer Survivors.

Objective: Cross-national replication of the high rates of overweight/obesity among U.S. pediatric cancer survivors (PCS) is limited. Predictors of weight trajectories of Israeli PCS were examined from diagnosis and end of active cancer treatment to 3 years posttreatment. Methods: World Health Organization-derived body mass index (z-BMI) values were calculated at each time point from medical records of 135 Israeli PCS ( M diagnosis age = 11.4). A three-section piecewise multilevel model including age, ethnicity, gender, treatment length, and diagnosis as predictors was used to estimate z-BMI trajectories. Results: Most participants remained at a healthy weight at all time points. Differing weight trajectories emerged for PCS diagnosed with lymphoma/leukemia versus other cancer diagnoses from diagnosis to end of treatment, but similar weight change patterns were observed posttreatment. Conclusion: Replication of U.S. PCS weight trajectories was not observed in Israeli PCS, suggesting the importance of exploring environmental risk factors contributing to obesity among PCS.

Verbal Versus Figural Fluency Tests in Currently Ill and Weight Restored Anorexia Nervosa Patients.

Fluency tests allow domain-specific assessment of verbal and non-verbal executive functions (EF) comparison and also enable utilizing of both quantitative and qualitative scoring methods. Thirty-five currently ill anorexia nervosa patients (PANs), 33 weight-restored patients (WRAN) and 47 healthy controls (HCs) were administered the word fluency test and the five-point test. Results show that WRANs tended to perseverate more than HCs in the verbal-fluency test. In addition, PANs produced significantly less correct figures and perseverated more than HCs and WRANs; HCs used more strategy methods than PANs and WRANs. Additionally, a positive correlation was found in the HC group between the total number of words in the verbal phonemic test and the number of designs produced and the number of correct designs. No such correlations were found in both anorexia groups. In conclusion, there is a differentiation between verbal and non-verbal EF in PANs and WRANs, showing a deficiency in the non-verbal domain. These findings may contribute to our understanding of the cognitive nature of the disorder.

The Role of Narcissistic Vulnerability in Predicting Adult Posttraumatic Symptoms from Childhood Sexual Abuse.

The aim of the present study is to determine whether narcissistic vulnerability can aid in clarifying the debate regarding the relationship between childhood sexual abuse (CSA) and adulthood adjustment to traumatic events. 157 survivors (mean age = 31.1, SD = 10.9) of a traumatic event (war activities and road and work accidents) were assessed 1 week, 1, and 4 months following the event. Of the 157 participants, 15 reported experiencing CSA, and 26 reported experiencing childhood physical abuse (CPA). In the first-week assessment, patients were administered the Narcissistic Vulnerability Scale (NVS) and the Beck Depression Inventory (BDI). In the follow-up assessments, subjects were interviewed on the Clinician-Administered PTSD Scale. Narcissistic vulnerability was found, both in 1- and 4-month follow-ups, to increase the likelihood of participants who experienced CSA to develop PTSD symptoms later in their adult life, when exposed to other additional trauma. Narcissistic vulnerability, in both follow-ups, did not increase the likelihood of participants who experienced CPA to develop PTSD symptoms later in their life when exposed to other additional trauma. The NVS predicted the development of PTSD symptoms in the whole sample, both in the 1- and 4-month follow-ups, above and beyond the prediction of the BDI. In other words, narcissistic vulnerability can add additional information above and beyond general negative emotionality. In conclusion, it is recommended to take into consideration the interplay between CSA and the individual's narcissistic vulnerability when assessing the long term effects of CSA such as acute or chronic PTSD.

The sorting test of the D-KEFS in current and weight restored anorexia nervosa patients.

OBJECTIVE: Efforts have been made to characterize executive functions (EF) in anorexia nervosa (AN) both in the acute stage of the illness and after weight gain, yet many questions remain. The question of verbal versus visuo-perceptual stimuli in this regard has not been adequately addressed. The aim of this study is to further examine EF in women with past and present AN and to compare their performances in verbal and visual modalities with women who have never suffered from an eating disorder. METHOD: Thirty-five underweight AN patients, 33 weight-restored patients symptom-free for at least 2 years, and 48 healthy female controls completed the Delis-Kaplan Executive Function System Sorting Test, so as to evaluate their EF. RESULTS: No differences were observed between the scores of women with current and past AN. Both groups scored lower than controls on most test variables. However, while in the visuo-perceptual domain the performance of the AN groups was worse than that of controls, in the verbal domain they performed similarly to them. DISCUSSION: Women with a past or present diagnosis of AN show difficulties in visuo-perceptual EF, whereas verbal EF seem to be preserved. There may be a dissociation between verbal and visuo-perceptual EF that persists after weight restoration.

Employing executive functions of perceptual and memory abilities in underweight and weight-restored anorexia nervosa patients.

PURPOSE: Executive functions (EF) have been widely investigated in anorexia nervosa (AN) revealing difficulties in various aspects. We aimed at testing the effects of EF on stimuli perception and its representations in memory. METHODS: Thirty AN underweight patients, 30 weight-restored AN patients, and 44 control participants, were recruited. Various EF were assessed using the Rey-Osterrieth Complex Figure Test, analyzed with the Boston Qualitative Scoring System. RESULTS: No differences were found in visuo-constructional measures in either AN groups compared to controls on the copy and memory stages. However, both groups performed significantly worse than controls on most EF variables in the copy stage, while in the immediate and delayed memory stages the difference was less substantial. CONCLUSIONS: Difficulties in EF among AN patients, current and weight restored, are more pronounced in the perceptual module and less so when employed through memory retrieval. The pattern, which is apparent after weight gain, suggests that there is no ameliorative effect on these difficulties.

Attitudes toward life and death and suicidality among inpatient female adolescents with eating disorders.

This study investigated whether attitudes about life and death are associated with suicidal behavior in eating disorders (EDs). We examined 43 nonsuicidal inpatients with EDs, 32 inpatients with EDs who attempted suicide, and 21 control participants with scales assessing attitudes to life and death, body-related attitudes, core ED symptoms, depression, and anxiety. Both ED groups showed less attraction to life and more repulsion from life than did the control participants. The suicide attempters showed greater attraction to death, less repulsion from death, and more negative attitudes toward their body than did the nonsuicidal ED and control participants. Fear of life was associated with elevated depression, body-related problems, and childhood sexual abuse. Pathological attitudes toward death were associated with greater depression and body-related problems. Suicide attempts were found in the inpatients with EDs showing binge/purge ED pathology and maladaptive attitudes toward death. This study suggests that whereas fear of life is a core feature of an ED, maladaptive attitudes toward death appear only in ED patients who have attempted suicide.

Brain activation in individuals suffering from bulimia nervosa and control subjects during sweet and sour taste stimuli.

Introduction: Episodes of eating great quantities of extremely sweet and often aversive tasting food are a hallmark of bulimia nervosa. This unique eating pattern led researchers to seek and find differences in taste perception between patients and healthy control subjects. However, it is currently not known if these originate from central or peripheral impairment in the taste perception system. In this cross sectional study, we compare brain response to sweet and sour stimuli in 5 bulimic and 8 healthy women using functional magnetic resonance imaging (fMRI). Materials and methods: Sweet, sour and neutral (colorless and odorless) taste solutions were presented to subjects while undergoing fMRI scanning. Data were analyzed using a block design paradigm. Results: Between-group differences in brain activation in response to both sweet and sour tastes were found in 11 brain regions, including operculum, anterior cingulate cortex, midbrain, and cerebellum. These are all considered central to perception and processing of taste. Conclusion: Our data propose that sweet and sour tastes may have reward or aversion eliciting attributes in patients suffering from bulimia nervosa not found in healthy subjects, suggesting that alteration in taste processing may be a core dysfunction in bulimia nervosa (BN).

Adult patients' adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™.

This prospective study examined the adult patient's perception of recovery after insertion of three types of orthodontic appliances: Buccal, Lingual and Invisalign. The sample consisted of sixty-eight adult patients (45 females and 23 males) who comprised three groups: 28 Buccal, 19 Lingual, and 21 Invisalign patients. After appliance insertion, patients completed a Health-Related Quality of Life questionnaire daily for the first week and again on day 14, in order to assess patients' perception of pain and analgesic consumption. In addition, four areas of dysfunction were assessed: oral dysfunction, eating disturbances, general activity parameters, and oral symptoms. Lingual appliance was associated with more severe pain and analgesic consumption, the greatest oral and general dysfunction, and the most difficult and longest recovery. The Invisalign patients complained of relatively high levels of pain in the first days after insertion; however this group was characterized by the lowest level of oral symptoms and by a similar level of general activity disturbances and oral dysfunction compared to the Buccal appliance. Many Lingual and some Buccal patients did not reach a full recovery from their eating difficulties by the end of the study period. The present study provides information to adult patients and clinicians assisting them in choosing the most appropriate treatment modality in relation to Health-Related Quality of Life parameters.

Selflessness and perfectionism as predictors of pathological eating attitudes and disorders: A longitudinal study.

This paper examines the role that selflessness and perfectionism may play as possible predictors of pathological eating attitudes and eating disorders (ED). 1057 schoolgirls (seventh to ninth grade) participated in the initial screening phase. They were administered the Eating Attitudes Test (EAT-26), Selflessness Scale (SS) and Multidimensional Perfectionism Scale (MPS). Based on their EAT-26 scores, 150 girls were invited to a clinical interview 2 years later (second phase). In the third phase 4 years later, 243 girls who completed the questionnaires in the seventh grade were the target of re-administration of these scales. Seventh-grade selflessness scores at initial screening phase predicted ED status determined in clinical interview at the 2-year interval and abnormal eating attitudes at the 4-year interval, above and beyond baseline seventh-grade eating-attitude scores. Perfectionism was not found to predict the development of neither ED nor abnormal eating attitudes. Preventional and therapeutic implications of the role of selflessness as a predisposing factor for ED are discussed.

An integrative quantitative model of factors influencing the course of anorexia nervosa over time.

OBJECTIVE: To identify factors influencing the course of anorexia nervosa (AN) over time. METHOD: Former female patients with AN (36 remitted and 24 nonremitted) and 31 healthy females responded to standardized interviews and self-rating questionnaires. Remitted patients maintained normal eating, normal weight, and regular menses for the past 12 months. Patients not fulfilling these criteria were considered nonremitted. RESULTS: Using logistic regression, we identified that number of hospitalizations, duration of ambulatory treatment, past vegetarianism, past anxiety, and childhood sexual abuse differentiated remitted from nonremitted patients, predicting nonremission. A similar analysis identified that elevated follow-up vegetarianism and eating-related concerns and lower body mass index (BMI) differentiated remitted from nonremitted patients, contributing to nonremission. Univariate analyses identified that remitted patients had elevated anxiety and eating-related obsessionality compared with the controls, suggesting these variables to potentially predispose to AN. DISCUSSION: Elevated anxiety and eating-related obsessionality may increase the risk for the development of AN and for nonremission.

The influence of a primary prevention program on eating-related attitudes of Israeli female middle-school students.

The present study aimed to assess the impact of a primary prevention program on eating-related attitudes in 231 female 7th graders at baseline and following a six-session prevention program. Fifty-nine 7th grade control females received six unstructured lectures about adolescence. One hundred and three experimental students and 37 controls were re-evaluated after one year. Among the participants in the prevention program, there was a significant post-intervention and one-year improvement in the total score of the eating-related attitudinal Treatment Efficacy Scale (TES) and in several of its domains. Whereas no change occurred in the attitudes of the controls at post-intervention, some improvement was shown in several TES domains after one year, compared to baseline. Attitudinal changes were significantly more favorable in the prevention program participants than in the controls both at post-intervention and at one-year follow-up. These findings suggest that eating-related attitudes of female middle-school students may improve following a primary prevention program, with some of these improvements persisting after one year.

The complexity of the interaction between binge-eating and attention.

OBJECTIVE: To investigate whether binge-eating in patients with eating disorders (EDs) is associated with attentional deficits. METHODS: We studied ED patients with binge-eating (n = 51), no binge-eating (n = 59) and controls (n = 58). ED patients were assessed following the stabilization of weight and ED pathology. Attention assessment included evaluation of attention deficit hyperactivity disorder (ADHD) diagnosis, the Adult ADHD Self-Report (ASRS) and ADHD Rating Scale-IV-Home Version (ADHD-RS) questionnaires, and attention functioning assessed with neuropsychological tools. The severity of eating-related pathology, depression, anxiety and obsessionality was also monitored. RESULTS: Patients with binge-eating showed more ADHD symptomatology on the ADHD-RS compared with non-binge-eating patients. No differences were found between binge-eating and non-binge-eating patients in ADHD diagnosis and neuropsychological functioning. Among the specific ED subtypes, patients with anorexia nervosa binge/purge type (AN-B/P) showed the highest rates of ADHD symptomatology on the ADHD-RS, and were characterized with sustained attention deficits. CONCLUSION: Binge-eating is not associated with attention deficits as measured by objective neuropsychological tools. Nonetheless, it is associated with attentional difficulties as measured with the self-reported ADHD-RS. AN-B/P patients are the only ED category showing objective sustained attention deficits.

Surgery and parental separation as potential risk factors for abnormal eating attitudes-longitudinal study.

Due to the susceptibility of eating disorders (ED) to stressful life events, we wanted to examine longitudinally whether two childhood adversities: (1) surgery and (2) parental separation, will affect abnormal eating attitudes in adolescents. Consecutively for 4 years, the eating attitude test (EAT-26) and the eating disorder inventory-2 (EDI-2) questionnaires were administered to students from grades 7th through 10th and 8th through 11th. Multilevel analysis revealed that parental separation and oral or cosmetic dermatologic surgeries were significantly correlated with EAT-26 and EDI-2 scores throughout the 4 years of the study. Post-hoc interpretation suggests a connection between (A) chirurgic intervention in the oral cavity and problematic eating attitudes, and (B) cosmetic dermatologic surgery and greater awareness to body appearance-a feature which might characterize adolescents who are prone to develop ED.

Depressive tendencies and lower levels of self-sacrifice in mothers, and selflessness in their anorexic daughters.

(1) To compare levels of selflessness (the tendency to ignore one's own needs and serve others') and asceticism of parents and daughters, in anorexic and control families. (2) To investigate the relationship between parents' depression and daughters' selflessness. Twenty-eight anorexic daughters and their 28 mothers and 23 fathers were compared to 29 control daughters and their 29 mothers and 28 fathers, participants were administered the Beck Depression Inventory, the Selflessness Scale, the asceticism scale of the Eating Disorder Inventory and the Structured Clinical Interview for DSM-IV. Anorexics' mothers showed significantly lower levels of selflessness and asceticism compared to control mothers; anorexic daughters showed significantly higher levels of selflessness and asceticism compared to control daughters. Depressive tendencies in anorexics' mothers were associated positively and significantly with their daughters' selflessness. The results support the clinical literature that depicts the anorexic daughters' readiness to sacrifice themselves for the family's needs. Clinical implications are drawn.

Evidence Basis for Psychodynamic Self-Psychology in Eating Disorders - A Review Paper.

The purpose of the present study is to present the empirical basis for the capability of the theory of psychodynamic self-psychology to predict in crosssectional and prospective longitudinal studies, both the development of and the remission from eating disorders. In addition, we present the effectiveness of psychodynamic self-psychological treatment in a randomized control study over two other techniques. Theoretical constructs of the theory and technique suggestions will be weaved into the empirical data.

Anorexia Nervosa, Selflessness, and Gender-role Identity: A Study of Daughters and Parents.

BACKGROUND: This study examines the relationship between anorexia nervosa (AN), selflessness, and genderrole identity in young Israeli women and explores their parents' gender-role identity. METHOD: Forty-seven AN women and 50 non-clinical controls completed the Eating Attitudes Test (EAT26), Eating Disorder Inventory (EDI-2), Bem Sex-Role Inventory (BSRI), and Selflessness Scale. Twenty-four parents from the AN group, and 41 mothers and 38 fathers from the control group also completed the BSRI. RESULTS: As predicted, masculine traits protected against the detrimental effects of selflessness on eating disorder symptoms. The AN participants obtained lower masculinity scores, their mothers also scoring lower on both the masculinity and femininity measures than the control-group. Conclusions drawn from the BSRI must be adopted with caution since gender-role characteristics may vary over time. CONCLUSIONS: The findings suggest the need to integrate the self-psychological approach, which emphasizes the anorexic's tendency to ignore her own interests in favor of others' needs, with feminist views that stress the role society plays in putting pressure on women to become alienated from themselves.

The relationship between selflessness levels and the severity of anorexia nervosa symptomatology.

This study examined the relationship of selflessness, the tendency to ignore one's own needs and interests and serve others, to the severity of anorexia nervosa (AN) symptomatology. Measures of selflessness, perfectionism, obsessiveness, self-esteem, disordered eating, body dissatisfaction, drive for thinness and general symptomatology were completed by 205 women with a history of AN (ANh) in various stages of illness and recovery (42 ill, 90 partially recovered and 78 recovered) and 238 female controls. The ANh women's scores on the Selflessness Scale declined significantly as the severity of current pathology decreased. Recovered anorexics scored similarly to female controls. Assertion of one's own needs and interests may be an integral component of recovery from AN, and should be emphasized in therapy.