Eating disorders, trauma, PTSD, and psychosocial resources.

The frequency of traumatic events and comorbid post-traumatic stress disorder (PTSD) in women with eating disorders (ED) was assessed. Also, patients with anorexia nervosa (AN) and bulimia nervosa (BN) were compared; post-traumatic symptomatology and the role of psychosocial resources were analyzed. One hundred three ED patients (29.1±10.5 years) were studied through the use of standardized questionnaires. We found that 23.1% of AN and 25.5% of BN patients fulfilled the study definition for a current diagnosis of PTSD. Cumulative traumatization led to more severe symptomatology. Psychosocial resources were found to have strong associations with symptomatology. These findings provide additional support for the association between traumatization and ED. Clinical interventions for traumatized ED patients may benefit from a focus on post-traumatic stress symptomatology and personal resources.

Anxiety, posttraumatic stress, and fear of cancer progression in patients with melanoma in cancer aftercare.

UNLABELLED: Several studies have described mental distress and anxiety in patients with melanoma. The findings of these studies varied from patients with a quality of life similar to the general population and those with increased mental distress. In the present study, we investigated anxiety, posttraumatic stress, and fear of cancer progression to gain a detailed picture of the burdens of these patients. PATIENTS AND METHODS: 70 patients with malignant melanoma who attended cancer aftercare were surveyed using the psychometric instruments Hospital Anxiety and Depression Scale (HADS), Posttraumatic Symptom Scale (PTSS-10), and Fear of Progression Questionnaire (FoP-Q). The questionnaires were evaluated and an analysis of the single items carried out. RESULTS: The scores for the three anxiety parameters were low, but 7% of the patients presented an increased HADS score, and 17% an increased PTSS-10 value. An analysis of the items showed that patients feared physical disabilities more than mental distress or lack of social support. CONCLUSION: Most of the patients perceived themselves as stable, and relied on the assistance of their families. However, a small group of patients suffered from clinically relevant anxiety; these patients should be given the support indicated for their specific distress.

[Mental health of Polish immigrants compared to that of the Polish and German populations]. / Die Psychische Gesundheit Polnisch-Stämmiger Migranten im Vergleich zur Polnischen und Deutschen Bevölkerung.

OBJECTIVES: This survey examines the mental health of immigrants of Polish origin compared to samples from the Polish and German populations. METHODS: In a sample of 513 subjects (261 persons with Polish migration background and 252 autochthone Poles) depression (BDI), anxiety (BAI), and somatic complaints (GBB-24) were measured. RESULTS: Immigrants of Polish origin showed a significantly higher level of anxiety as well as somatic complaints but only a tendency toward higher depressiveness than the German normvalue, but not than that of the native Poles. Female immigrants showed an overall higher number of symptoms in the three domains in question compared to German women and - except for depressiveness - also compared to male immigrants. CONCLUSIONS: Persons with a Polish migration background present levels of mental distress higher than the general German population, but similar to the population of their country of origin. Further research is needed to clarify the special structure of the mental morbidity in Polish immigrants.

Influence of kinship on donors' mental burden in living donor liver transplantation.

In the context of living donor liver transplantation (LDLT), German transplantation law stipulates that donor candidates should primarily be relatives of the recipients or persons with distinct and close relationships. In this study, we investigated the influence of the relationship between the donor and the recipient on the donor's emotional strain before transplantation. Donors were categorized according to the following subgroups: (1) parents donating for their children, (2) children donating for their parents, (3) siblings, (4) spouses, (5) other relatives, and (6) nonrelatives. The sample consisted of 168 donor candidates. Anxiety (F = 2.8, P = 0.02), depression (F = 2.6, P = 0.03), and emotional quality of life (F = 3.1, P = 0.01) differed significantly according to the relationship between the donor and the recipient. In comparison with healthy controls, parents donating for their children were significantly less stressed before LDLT and demonstrated fewer anxiety (P < 0.01) and depression symptoms (P < 0.05). Adult children donating for their parents demonstrated the highest mental burden and the lowest emotional quality of life. However, this was not due to the responsibility of these children for their own families because differences between donors with children and donors without children could not be ascertained. This group should be given special attention before LDLT and during follow-up visits, and psychological help should be provided when it is necessary.

Sense of coherence and depression in the framework of immigration: Turkish patients in Germany and in Turkey.

The present study explores sense of coherence (SOC) levels in two clinical samples (outpatients with neurotic disorders) with the same Turkish cultural background in comparison to the German reference values as well as the association between SOC and depression and the protective role of SOC. A total of 96 Turkish patients in Germany (36.67 ± 9.52 years) as well as 60 local Turkish patients (38.57 ± 10.15 years) have been examined for SOC measured with the Sense of Coherence scale (SOC-29) and depression with the Beck Depression Inventory (BDI). Both samples scored significantly lower for SOC compared to the normal Turkish and German population and to German subjects with psychiatric symptoms (p < 0.001) but did not differ significantly from each other. Negative significant correlations were found between SOC and the degree of depressiveness in both groups (immigrants: r = -0.59, p < 0.001; Turks: r = -0.51, p < 0.001). Multiple regression analyses including SOC, age, gender, education, marital and employment status have demonstrated SOC to be the strongest predictor for depressiveness. SOC can be regarded as a protective factor for depression in patients with Turkish migration background in Germany and in local Turkish patients. However, further studies are needed to clarify if the concept SOC can be used adequately in collectivistic cultures as, for example, the Turkish one.

[Validation of the German translation of the Eating Disorders Quality of Life (EDQOL)]. / Validierung der deutschen Übersetzung des Eating Disorders Quality of Life (EDQOL).

The aim of the study was the translation and validation of a disease-specific questionnaire (Eating Disorders Quality of Life, EDQOL) to measure the health-related quality of life of eating-disordered patients. 195 patients with eating disorders and 109 healthy controls were examined by EDQOL and other instruments (SF-12, EDI, FKB-20, SEED, BSI, IIP-D and SOC-13). The EDQOL total score proved to have a high internal consistency. The four factorial structure of the original version was confirmed. There were indications of very good construct validity and a good sensitivity for change. For the first time, in the German-speaking part there is an economic, reliable and valid instrument that assesses the specific health-related quality of life for patients with eating disorders which is recommended for use in research as well as in clinical settings.

[Prevalence, comorbidity and severity of psychosomatic disorders in outpatients with Turkish migration background]. / Prävalenz, Komorbidität und Ausprägungsgrad psychosomatischer Erkrankungen bei ambulanten Patienten mit türkischem Migrationshintergrund.

In this study the prevalence and comorbidity of mental disorders were examined for the first time with the Structured Clinical Interview for DSM-IV (SCID-I) in a consecutive sample of Turkish speaking patients (n=51). The symptom severity of the depressiveness was measured with the Beck Depression Inventory (BDI), of the somatoform complaints with the Screening for Somatoform Symptoms (SOMS) and of the posttraumatic stress disorder (PTSD) with the Essen Trauma Inventory (ETI). The most common current diagnoses were the somatization disorder (41.2%; n=21), a single episode of major depression (37.3%; n=19) and the PTSD (31.4%; n=16). In 80.4% (n=41) of the patients at least one comorbid mental disorder was documented. In comparison with German reference values the Turkish patients showed a significant higher severity of the depressive and posttraumatic, however not of the somatoform symptomatology.

[Effects of inpatient treatment on eating disorder symptoms, health-related quality of life and personal resources in anorexia and bulimia nervosa]. / Effekte stationärer Psychotherapie auf Essstörungssymptomatik, gesundheitsbezogene Lebensqualität und personale Ressourcen bei Anorexia und Bulimia nervosa.

The aim of the present prospective-naturalistic study was the evaluation of psychosomatic inpatient treatment for anorexia nervosa (AN) and bulimia nervosa (BN). 128 patients with eating disorders (n=59 AN and n=69 BN) were investigated on admission and discharge using the following standardized questionnaires: eating disorder symptoms (EDI), general psychopathology (BSI), quality of life (SF-12), and personal resources (SOC-13, SWE). Moderate to large effect sizes were achieved for the eating disorder symptoms; in addition, general psychopathology was substantially reduced at the end of treatment, and quality of life as well as personal resources were enhanced. Personal resources were found to be the strongest predictors for therapy outcome. Based on our data, important insights and recommendations may be gained for the inpatient treatment of eating disorders, especially with regard to the potential influence of personal resources.

[The Essen Trauma-Inventory for children and adolescents (ETI-CA)]. / Das Essener Trauma-Inventar für Kinder und Jugendliche (ETI-KJ).

OBJECTIVE: In light of the clinical and scientific relevance of traumatic events and posttraumatic disorders our study aimed to develop and validate the Essen Trauma-Inventory for Children and Adolescents (ETI-CA). The new instrument should assess various aspects of traumatic events and both posttraumatic disorders, namely Posttraumatic Stress Disorder and Acute Stress Disorder according to the criteria provided in DSM-IV. METHOD: ETI-CA was administered to a sample consisting of 276 children and adolescents aged between 12 and 17 years with regard to psychometric properties on clinical and non-clinical groups. RESULTS: The ETI-CA subscales as well as the total score proved to have high internal consistency. The 4-factorial structure (intrusion, avoidance, hyperarousal, dissociation) was in line with the theoretical assumptions. Associations between ETI-CA and other trauma instruments as well as instruments for psychological distress and protective factors provided empirical evidence for the construct validity of ETI-CA. CONCLUSIONS: In German-speaking regions, the ETI-CA represents the first economic, reliable and valid screening instrument that assesses exposure to a broad range of potential traumatic events as well as posttraumatic disorders. The ETI-CA can be recommended for use in research as well as in clinical settings.

Influence of satiety and subjective valence rating on cerebral activation patterns in response to visual stimulation with high-calorie stimuli among restrictive anorectic and control women.

BACKGROUND: There is evidence that patients with anorexia nervosa (AN) demonstrate specific cerebral activation patterns in response to visual food stimulation. We postulated that cerebral activation patterns could represent different perceptions of high-calorie images during hunger and satiety and could be determined by patients' subjective ratings. METHODS: After 6 h of starvation and also in a state of satiety, 12 female patients with AN and 12 normal-weight women were assessed by use of fMRI with high-calorie food images. All patients suffered from a restrictive type of AN. Heart rates, subjective ratings of satiety and valences of the visual stimuli were assessed. RESULTS: Food stimuli presented during a state of hunger were associated with significant activation of the anterior cingulate cortex and insula in the control group and of the prefrontal and central cortices and insula in the AN group. During the hunger state activation in AN of the dorsal posterior cingulate cortex was revealed compared to the controls. In the state of satiety, activation of the left insula was observed in the AN group. Use of the food valence judgment as a covariate confirmed the insula activation and revealed additional activation of the orbitofrontal, cingulate and medial temporal cortices. CONCLUSION: Our results indicate differences in cerebral activation patterns due to different perceptions of high-calorie food images, modulated by feelings of hunger or satiety, among AN patients with modulation by subjective ratings of food valence.

Traumatic events, posttraumatic stress symptomatology and somatoform symptoms in eating disorder patients.

OBJECTIVE: The central aim of the study was to assess the frequency of traumatic events and comorbid posttraumatic stress disorder (PTSD) in women with eating disorders (EDs). In addition, the frequency of somatoform complaints was investigated in patients with PTSD compared to those without PTSD. METHOD: 101 ED patients (26.4 years, SD = 7.4) from an outpatient department were investigated by means of standardized questionnaires. RESULTS: 63.3% of the anorexic and 57.7% of the bulimic patients had experienced at least one trauma in their life. 10% of the anorexic and 14.1% of the bulimic patients fulfilled the study definition for a current diagnosis of PTSD. Patients with a comorbid PTSD reported somatoform symptoms more frequently than patients without PTSD (p < 0.001). DISCUSSION: These findings provide additional support for the association between somatization and PTSD in ED patients. In addition, clinical interventions for traumatized ED patients may benefit from a focus on posttraumatic stress symptomatology.

[What can weight losses in anorexia nervosa predict about the premature termination of treatment?]. / Was können Gewichtsverläufe bei Anorexia Nervosa über den Ausgang eines vorzeitigen Therapieabbruches vorhersagen?

It was analysed if the weight course in the first half of a four-step psychosomatic treatment program for inpatients with Anorexia nervosa (AN) was useful to predict premature termination of treatment. The weight courses, sociodemographic and disorder-related data of 121 female adult inpatients were investigated. 39% of the studied patients did not reach their target weight (not completers). 61% of the patients completed all four steps of treatment (completers). The not completers showed significant more time with weight losses in the first step and had more and bigger weight losses in the second step of treatment than the completers. Furthermore, they had fewer comorbid depression. In contrast to the sociodemografic and disorder-related data, the weight courses in the first treatment half were very useful to predict premature termination of treatment for inpatients with AN.

Mental and physical quality of life in actual living liver donors versus potential living liver donors: a prospective, controlled, multicenter study.

In a quasi-experimental design, we investigated the quality of life (QOL) in actual liver donors (n = 43) and potential liver donors (n = 33) before and 3 months after liver transplantation. This is the first study in this field combining a prospective design with an adequate control group. Potential donors served as a control group because they also had a relative in need of a liver transplant and were as emotionally involved with the recipient as actual donors, but they were not subjected to the donor operation. Groups did not differ in age, gender, marital status, donor-recipient relationship, urgency of transplantation, or recipient group (adult versus child). Actual donors showed decreased physical QOL, whereas potential donors were not affected. However, for both groups, a decrease in anxiety was found. Furthermore, actual donors showed a better mental QOL postoperatively than potential donors. The recipients of these 2 groups did not differ with respect to postoperative complications. Furthermore, the groups did not report a different caregiver burden, but actual donors showed higher self-esteem. Because of the surgery, the worsening of physical symptoms in actual donors was expected. It is remarkable, however, that although actual donors still showed a limited physical QOL 3 months after the operation, in both groups, a similar reduction in anxiety could be observed, and actual donors even demonstrated a better mental QOL postoperatively than potential donors. The latter might be due to a psychological benefit that actual donors derived from the fact that they were able to help the recipients.

Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: an fMRI study.

INTRODUCTION: Transsexuals harbor the strong feeling of having been born to the wrong sex. There is a continuing controversial discussion of whether or not transsexualism has a biological representation. Differences between males and females in terms of functional imaging during erotic stimuli have been previously described, revealing gender-specific results. AIM: Therefore, we postulated that male-to-female (MTF) transsexuals may show specific cerebral activation differing from their biological gender. MAIN OUTCOME MEASURE: Cerebral activation patterns during viewing of erotic film excerpts in functional magnetic resonance imaging (fMRI). METHODS: Twelve male and 12 female heterosexual volunteers and 12 MTF transsexuals before any treatment viewed erotic film excerpts during fMRI. Additionally, subjective rating of sexual arousal was assessed. Statistics were performed using the Statistical Parametric Mapping software. RESULTS: Significantly enhanced activation for men compared with women was revealed in brain areas involved in erotic processing, i.e., the thalamus, the amygdala, and the orbitofrontal and insular cortex, whereas no specific activation for women was found. When comparing MTF transsexuals with male volunteers, activation patterns similar to female volunteers being compared with male volunteers were revealed. Sexual arousal was assessed using standard rating scales and did not differ significantly for the three groups. CONCLUSIONS: We revealed a cerebral activation pattern in MTF transsexuals compared with male controls similar to female controls compared with male controls during viewing of erotic stimuli, indicating a tendency of female-like cerebral processing in transsexualism.

[Screening for distress in women with breast cancer diagnosed for the first time: employment of HADS-D and PO-Bado]. / Screening von psychischen Belastungen bei erst erkrankten Brustkrebspatientinnen: Einsatz von HADS-D und PO-Bado.

OBJECTIVES: In the context of an intensification of efforts to ensure sufficient psychooncological care for breast-cancer patients, the discussion concerning valid psychometric screening instruments gains a special relevance. METHODS: The discriminant and diagnostic validity of HADS-D and PO-Bado were investigated in a sample of 123 women with breast cancer diagnosed for the first time. RESULTS: An ROC analysis revealed a cut-off score of greater than 9 for the subscale anxiety (sensitivity: 50%; specificity: 90%) for the use of HADS-D among breast cancer patients, whereas the recommended cut-off value was greater than 7 (sensitivity: 56%; specificity: 80%) for the subscale depression. Based on the anxiety and depression scores measured by HADS-D, 74% of the clinical cases could be classified correctly. Scores for physical and mental distress measured with PO-Bado were significantly lower in the investigated sample than in the control sample. CONCLUSIONS: HADS-D has only a moderate sensitivity for the group at hand. PO-Bado is a comprehensive basic documentation for specific psychooncological distress, though without cut-off values it is not useful as a screening instrument.

Sense of coherence and social support predict living liver donors' emotional stress prior to living-donor liver transplantation.

The protection of the donors from physical or emotional harm has been a fundamental principle in living-donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors' eligibility. Being the central construct of Antonovsky's theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals' stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors' emotional strain prior to transplantation. Seventy-one donor candidates were included in the study during the donor evaluation prior to living-donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R(2) = 0.22). Sense of coherence and social support can be implemented as self-rating instruments in the psychosomatic selection of donors and would help to further objectify donors' eligibility.

Weight curves as predictors of short-term outcome in anorexia nervosa inpatients.

OBJECTIVE: The aim of the present study was to find factors that predict the short-term outcome of inpatients with anorexia nervosa (AN). METHOD: Female inpatients with AN (N = 100) were divided into treatment completers (N = 50) and drop-outs (N = 50). Using stepwise linear regression the relationship of demographic data, illness history and patterns of weight gain to BMI gain up to discharge were analysed. RESULTS: Among drop-outs, 69% of the variance in BMI gain up to discharge was explained by length of the first half of treatment (FHT), average weekly BMI gain and average weight loss during FHT. Among completers, 52% of the variance in BMI gain up to discharge was explained by BMI at admission and average weekly BMI gain during the second half of treatment (SHT). DISCUSSION: Weight curves offer important information about short-term outcome for patients with AN.

[Distortion of hunger and satiation in patients with restrictive anorexia nervosa]. / Störung des Hunger- und Sättigungsempfindens bei restriktiver Anorexia nervosa.

The controlled study examined the distortion of hunger und satiation in 12 patients with restrictive AN (BMI = 14.0; SD: 1.78; age 27.4 years; SD = 10.5) and 13 healthy and not eating-disordered normalweight controls (BMI = 21.3; age 25.3 years; SD = 3.4) by visual confrontation with food stimuli in different states of nutrition. During fasting patients with AN describe less hunger-feelings. In contrast to healthy women pictures of food and the anticipation of the consumption of hot chocolate are not experienced enjoyable, but aversive. Visual confrontation of food has a satiable effect on anorexic patients. Healthy women, however, indicate a moderate decrease in hunger feelings. After eating ad libitum satiety of healthy women reach a plateau instead of further eating. Anorexic patients initially feel hungry, a stable level of satiety, however, cannot be obtained. The visual confrontation with food is experienced aversively and satiably. These results leads us to assume a cognitive allocation of satiation ratings. The dysfunctional cognitive allocation of satiation ratings may represent a mean to maintain a food-avoidance.