[Orthorexia Nervosa between growing attention to food quality and eating disorders: diagnostic criteria and evaluation tools]. / L'ortoressia nervosa tra attenzione per la qualità dell'alimentazione e disturbi alimentari: criteri diagnostici e strumenti di valutazione.

The literature on Orthorexia Nervosa (ON) rapidly grew in recent years, highlighting the perverse and paradoxical aspects of healthy eating. In this review, authors examine the different meanings of ON, the proposals of diagnostic criteria and evaluation tools, and the most promising research tracks that, if developed, will allow to fully understand the nature of ON, and therefore identify strategy for secondary and primary prevention.

Integration of Clozapine-associated Harm Obsessions into Cognitive Behavioral Conceptualization and Treatment Planning for Thought Broadcasting: A Case Study.

BACKGROUND AND OBJECTIVES: As many as 30% of individuals with a schizophrenia spectrum disorder experience obsessive-compulsive symptoms (OCS). Clozapine has demonstrated superior efficacy for the treatment of medication-resistant schizophrenia but it is also associated with an increased risk for OCS. Because pharmacologic management of clozapine-related OCS can be particularly challenging, cognitive behavioral therapy (CBT) should be considered. Nevertheless, there are few detailed accounts of CBT for OCS and schizophrenia. METHODS: The authors describe the interdisciplinary outpatient care of a client who had a 25-year history of schizoaffective disorder, bipolar type, and OCS. The case formulation was used to guide interventions to target core schemas of being dangerous and defective. The case study describes the cognitive behavioral formulation, treatment targets, treatment course, and functional and symptom response. RESULTS: The client received 21 sessions of a formulation-based CBT for psychosis protocol, which included a 6-session course of exposure with response prevention, consisting of imaginal and in vivo exposure to multiple salient harm stimuli. Reduced ratings of distress and a 50% reduction in OCS suggest that habituation and inhibitory learning occurred. The treatment of OCS resulted in the complete resolution of thought broadcasting. Subsequently, the client was more successful in his efforts to adhere to an action schedule. LIMITATIONS: The use of both the treatment approach described in this clinical case report and contemporaneous medication management preclude comment on the mechanism(s) of the therapeutic change observed in this case. CONCLUSIONS: This report presents a means of conceptualizing the interplay between thought broadcasting and harm obsessions and discusses considerations in identifying and treating individuals with similar comorbid conditions, particularly in the context of clozapine treatment for medication-resistant psychosis.

Cognitive and behavioral correlates of depressive symptoms in a community sample of adolescents.

Research in adults demonstrates a positive association among obsessive-compulsive symptoms, eating pathology, cognitive distortions, and comorbid depressive symptoms. Given that adolescence is characterized by unique and rapid changes in biopsychosocial processes, it is imperative to elucidate the relationship between these variables in youth. In this cross-sectional study, we explored whether obsessive-compulsive symptoms, thought-action fusion, thought-shape fusion, and eating pathology would be positively associated with and predict depressive symptoms in a school-based community sample of adolescents (n = 86; Mage = 15.60). All study variables were positively correlated with depressive symptoms. Results indicated that obsessive-compulsive symptoms, thought-shape fusion, and eating pathology explained a significant proportion of variance in depressive symptoms, whereas thought-action fusion did not. In accordance with the cognitive behavioral model of psychopathology, these findings highlight the relationships between key interrelated correlates of depressive symptoms that may be pertinent targets for prevention and treatment efforts in adolescents.

The Effects of Risk Behaviors and Orthorexic Behavior on Glycemic Control in Adolescents with Type 1 Diabetes

Objective: Adolescents with chronic disease are as likely to exhibit risk-taking behavior as their peers. The aim was to investigate the risk behaviors of adolescents with type 1 diabetes (T1D) and the effect of orthorexic eating behaviors (OEB) on glycemic control (GC). Methods: This cross-sectional study was conducted with 107 adolescents with T1D, aged between 13-18 years and attending high school. The Risk Behavior Scale (RBS) and Orthorexic Behavior Scale (ORTO-11) were administered. A high RBS score indicates risky behavior; a low ORTO-11 score suggests a tendency to OEB. Participants hemoglobin A1c (HbA1c) status was used to assess GC: optimal GC (HbA1c ≤7%); or poor GC (HbA1c >7%). Results: Among females, those with poor GC had significantly lower (p=0.031) ORTO-11 scores than those with optimal GC, which was not the case in males. A significant correlation (r=0.358, p<0.001) was found between HbA1c and total RBS, eating habits subscale, and suicidal tendency subscale scores. Participants with poor GC had significantly higher eating habits subscale, alcohol use, and tobacco use subscale scores (p<0.05). Among females, total RBS and suicidal tendency subscale score was found to be significantly higher in those with poor GC; among males, alcohol subscale score was found to be significantly higher in those with poor GC. Conclusion: This study is the first to show the effect of the tendency for OEB on GC among female adolescents with T1D. The study showed that, along with inappropriate eating behaviors, adolescents with T1D should also be assessed for other risk behaviors to help achieve optimal GC.

Prospective associations between disgust proneness and OCD symptoms: Specificity to excessive washing compulsions.

Although considerable evidence has linked disgust proneness (DP) to obsessive-compulsive disorder (OCD), few studies have examined the extent to which DP predicts OCD symptoms over time. Further, it remains unclear if DP is a risk factor for the contamination subtype of OCD specifically or if it is prospectively associated with other OCD symptom subtypes. The present study sought to address these gaps in the literature with a large sample of unselected community participants (n = 497) that completed measures of DP and OCD symptoms monthly over a 6-month period. Latent growth analysis revealed that initial levels of DP were associated with higher initial level of total OCD symptoms when controlling for depression, but not the slope of change in total OCD symptoms over time. Initial levels of total OCD symptoms were also associated with higher initial levels of DP when controlling depression, but not the slope of change in DP over time. Examination of symptom specificity revealed that initial levels of DP were associated with initial levels of washing, neutralizing, obsessing, ordering, and hoarding symptoms. However, initial levels of DP were associated only with the slope of change in the washing subtype when controlling for depression such that high initial levels of DP were associated with steeper increases in washing symptoms of OCD over the 6-month period. These findings suggest that although DP may have concurrent associations with symptoms of OCD more broadly, prospective associations are specific to the contamination/washing subtype of OCD. The implications of these findings for the etiology and treatment of contamination-based OCD are discussed.

Validation of the Polish version of the Penn Alcohol Craving Scale (PACS). / Walidacja polskiej wersji Skali Glodu Alkoholu Penn (Penn Alcohol Craving Scale ­ PACS).

OBJECTIVES: The conducted studies were aimed at making a Polish adaptation of the Penn Alcohol Craving Scale (PACS) by B. Flannery and co-workers. The Scale is a self-assessment method, it comprises 5 statements, and is designed to assess alcohol craving experienced by a patient in a week prior to the examination. METHODS: 550 patients with diagnosed alcohol dependence syndrome were examined, and the final analysis included results of 510 persons. The examined group consisted of 396 men and 114 women. The study was made in the 3rd week of their alcohol treatment. There were used: the PENN Craving Scale, the Alcohol Dependence Development Scale (SRUA) (the part in which craving is dealt with), a clinical interview with specially prepared questions about alcohol craving experienced last month and last week, and the Yale-Brown Obsessive Compulsive Intense Drinking Scale. RESULTS: The Polish version of the Penn Scale is characterised by very good psychometric properties - it is a reliable and valid tool. The exploratory and confirmatory factor analyses have proved the existence of one factor. The internal consistency, assessed on the basis of Cronbach's alpha, equalled 0.89. The method displays statistically significant (majority p < 0.0010) relationships with levels of craving experienced last year, last month, and last week before the examination, and also with total score on the Yale-Brown Scale. CONCLUSIONS: The effects of the conducted adaptation works on the Penn Scale speak for recommending the method for scientific research and use in therapeutic practice.

The relationship between trauma and weight status among adolescents in eating disorder treatment.

A relationship between trauma and eating disorders in adolescence is well established, though less is known about how different types of trauma, apart from childhood sexual abuse, associate with eating disorders. The purpose of this study is to describe the prevalence of various trauma types in a clinical sample of adolescents presenting at an outpatient eating disorder treatment facility (N = 182). Thirty-five percent of the sample reported experiencing one or more traumatic events during their lifetime. Bullying was the most prevalent type of trauma (10%), followed by significant death/loss (9%), and sexual abuse (8%). Adolescents with any trauma exposure had higher body mass index (BMI), BMI percentile, and percent expected body weight (%EBW) compared to those without any trauma exposure. Specifically, patients who were exposed to bullying and domestic violence reported a significantly higher %EBW than those who were not exposed. On average, adolescents exposed to bullying had a %EBW that was 7 percentage points higher than their non-exposed peers. Patients with bulimia nervosa were more likely to report trauma exposure than those with other eating disorder diagnosis. Providers working with adolescents diagnosed with eating disorders of all weight statuses should consider assessing for past and current trauma, including bullying and exposure to domestic violence. Trauma informed approaches to eating disorder treatment are needed to avoid potentially activating or exacerbating trauma related distress for adolescents in eating disorder treatment.

Rumination and eating disorder psychopathology: A meta-analysis.

Rumination is a cognitive process involving repetitive thoughts about negative experiences and emotions and is associated with psychopathology. Rumination has been implicated in mood and anxiety disorders, and there is a growing body of research on rumination in relation to eating disorder (ED) psychopathology. The current meta-analytic review focused on the literature addressing rumination and ED psychopathology. A comprehensive search process identified 38 studies, which primarily used cross-sectional designs with non-clinical samples. Results demonstrated that rumination was concurrently (r = 0.33) and prospectively (r = 0.22-0.23) associated with ED psychopathology, and that groups with ED psychopathology evidenced higher levels of rumination compared to non-ED control groups (g = 0.95), though no significant differences in rumination were observed when comparing anorexia nervosa to bulimia nervosa groups (g = 0.09). In addition, a narrative review of five experimental studies suggested that rumination in response to ED-related stimuli was related to increased negative affect and negative body-related cognitions across clinical and non-clinical samples. The type of rumination and sample population emerged as moderators of effect sizes, such that larger effects were observed among samples using ED-specific measures of rumination and heterogeneous samples compared to only non-clinical samples. Taken together, this literature demonstrates that rumination is a salient process in ED psychopathology, though the literature is characterized by methodological limitations and the need for more fully elaborated theories on the role of rumination in EDs. Findings are discussed in the context of existing models of rumination and ED psychopathology, with suggestions for future research in this area.

Seasonal mood changes in patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is frequently associated with mood disorders. However, to date, the co-occurrence of OCD with seasonal affective disorder (SAD) has not been investigated. We have aimed to estimate the prevalence of seasonal mood changes in patients with OCD and explore the contribution of seasonality in mood to the severity of OCD. The Seasonal Pattern Assessment Questionnaire (SPAQ), the Yale-Brown Obsession and Compulsion Scale (Y-BOCS), the Hamilton Depression Rating Scale-17 Items (HDRS-17), and the Beck Anxiety Inventory (BAI) were administered to patients with OCD (n=104) and controls (n=125). The degree of seasonality was measured by the Global Seasonality Score (GSS) calculated from the SPAQ. SAD and subsyndromal seasonal affective disorder (S-SAD) were significantly more prevalent in patients with OCD (53%, n=55) than controls (25%, n=31). When patients were assessed in the season in which SAD occurs, depression and compulsions (but not obsessions, OCD or anxiety) were more severe than those assessed in a season during which SAD does not occur. SAD frequently co-occurs with OCD and, given this co-occurrence, depression symptoms in some patients with OCD might be expected to vary on a seasonal basis.

The Association of Anger with Symptom Subtypes in Severe Obsessive-Compulsive Disorder Outpatients.

BACKGROUND: Despite the theoretical and clinical relevance of psychopathological dimensions in obsessive-compulsive disorder (OCD), no studies to date have investigated their possible association with obsession subtypes. Thus, we aimed to examine whether, in OCD patients, anger and other psychopathological dimensions are associated with specific obsession subtypes. METHODS: We consecutively recruited 57 first-visit OCD patients (66.7% female, mean age 34 years) at our Psychiatric Outpatient Clinic. We used the point biserial coefficient (rpbi) to measure the correlation between psychopathological dimensions and obsession subtypes. RESULTS: We found significant correlations (p < 0.05) between the following: (1) anger/aggressiveness dimension and aggressive, contamination, and sexual obsessions; (2) apprehension/fear dimension and contamination, religious, and somatic obsessions; (3) sadness/demoralization dimension and contamination and somatic obsessions; (4) impulsivity dimension and aggressive and sexual obsessions, and (5) somatic concern/somatization dimension and contamination and somatic obsessions. We also found that OCD patients with comorbid obsessive-compulsive personality disorder--but not schizotypal or histrionic disorders--showed higher levels (p < 0.05) of obsessiveness/iterativity and anger/aggressiveness than OCD patients without the personality disorder. CONCLUSIONS: Anger and other psychopathological dimensions seem to be linked with specific obsession subtypes in OCD patients, suggesting an association between these dimensions and OCD.

Executive dysfunction, obsessive-compulsive symptoms, and attention deficit and hyperactivity disorder in Systemic Lupus Erythematosus: Evidence for basal ganglia dysfunction?

INTRODUCTION: Chorea is well described in a group of patients with Systemic Lupus Erythematosus (SLE). There is less information, however, on other movement disorders as well as non-motor neuropsychiatric features such as obsessive-compulsive symptoms (OCS), executive dysfunction and attention deficit and hyperactivity disorder (ADHD) in subjects with SLE. METHODS: Fifty-four subjects with SLE underwent a battery of neuropsychiatric tests that included the Mini Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery (FAB), the FAS verbal and the categorical (animals) semantic fluency tests, the Obsessive and Compulsive Inventory - Revised, the Yale-Brown Obsessive and Compulsive Scale and Beck's Anxiety and Depression Scales. ADHD was diagnosed according to DSM-IV criteria. SLE disease activity and cumulative damage were evaluated according to the modified SLE Disease Activity Index 2000 (mSLEDAI-2K) and the SLICC/ACR, respectively. RESULTS: Six (11.1%) and 33 (61.1%) patients had cognitive impairment according to the MMSE and MoCA, respectively. Eleven (20.4%) had abnormal FAB scores, and 5 (9.3%) had lower semantic fluency scores than expected. The overall frequency of cognitive dysfunction was 72.2% (39 patients) and of neuropsychiatric SLE was 77.8% (42 patients). Two patients (3.7%) had movement disorders. Fifteen (27.8%) had OCS and 17 (31.5%) met diagnostic criteria for ADHD. ADHD and OCS correlated with higher disease activity, p=0.003 and 0.006, respectively. Higher cumulative damage correlated with lower FAB scores (p 0.026). CONCLUSIONS: Executive dysfunction, ADHD, OCS, and movement disorders are common in SLE. Our finding suggests that there is frequent basal ganglia dysfunction in SLE.

Focus on perfectionism in female adolescent anorexia nervosa.

OBJECTIVE: Maudsley Family-Based Treatment (FBT) for anorexia is successful for between 50 and 80% of adolescents. To improve this success rate, various approaches to augmenting the treatment have been proposed. METHOD: In this study, we describe the treatment of three girls with FBTaugmented with a module focusing on perfectionism, defined as personally prescribed or socially derived irrational and rigid expectations and exceedingly high standards of self performance. Multiple times across the 1 year of treatment, girls completed the measures of perfectionism and other outcomes. RESULTS: The results were optimistic for remission, and showed reductions in girls? perfectionism and obsessional and rigid thinking.

Disorders as undifferentiated selfobject formations: treatment of a multidisordered patient.

This paper offers a new understanding of disorders as undifferentiated selfobject formations. A treatment example of a multipledisordered patient is presented to illustrate how disorders diminished as a result of this understanding. This paper highlights the developmental importance of the undifferentiated selfobject and suggests that early interruptions of this discovery experience that take place during the infant's positive moments of freedom and enthusiasm are traumatic. If they go beyond the tolerance of the infant, they can be imprinted as unconscious core traumatic experiences. They remain as implicit memories that can act as warnings of repetitions of the trauma that occurred at the time of freedom and enthusiasm in the act of discovering. It can be suggested that the threat of repetitions of the traumatic loss is associated with these positive moments of discovery. This threat directs the needed self-sustaining undifferentiated selfobject discovery experience away from the positive, thereby leaving the posttraumatic effects of the loss as the focus of discovery. This focus leads to destructive preoccupations and obsessions that are considered disorders such as depression, suicidal thinking, self-mutilation, and eating disorders. Once patients understand the importance of the undifferentiated selfobject discovery need, the delinking of the undifferentiated selfobject from the negative preoccupations takes place. As a result, disorders diminish, and patients begin to consider positive possibilities for their lives. This paper suggests that early interferences in the development of the undifferentiated selfobject lead to the formation of disorders. A treatment of a multidisordered patient is presented to illustrate how this understanding was central to the diminishing of the disorders.

Body checking and obsessive-compulsive symptoms in Brazilian outpatients with eating disorders.

OBJECTIVE: Compare obsessive-compulsive symptoms in patients with anorexia nervosa (AN) and bulimia nervosa (BN), and assess the association of these symptoms and body checking in each of these groups of patients. METHODS: Eighty-five female outpatients with eating disorders (ED) completed body checking and obsessive-compulsive questionnaires. RESULTS: Body checking was more prevalent in the BN group. Among patients with AN, the highest mean body-checking scores were found in patients with somatic obsessions related to body areas and eating rituals (p = 0.003 and 0.018, respectively). DISCUSSION: Patients with eating disorders are believed to be included in the obsessive-compulsive spectrum, and may experience intrusive thoughts about behavior. The results of our work suggest that obsessive symptoms and body checking should be further investigated and properly managed in patients with ED.

Obsessive compulsive symptoms in patients with Schizophrenia on Clozapine and with Obsessive Compulsive disorder: a comparison study.

Obsessive compulsive symptoms are commonly reported in those with schizophrenia. Clozapine has previously been reported to induce, aggravate and alleviate these symptoms. It is unclear if these are similar to the symptoms experienced by those with obsessive compulsive disorder. This study describes the obsessive compulsive symptom profile of a population of patients with schizophrenia treated with clozapine (n = 62) and compares this with patients with Obsessive Compulsive Disorder (n = 35). All participants were attending an outpatient community mental health service. The Obsessive Compulsive Inventory (which measures the frequency and associated distress of a range of "behavioural" and "cognitive" symptoms), the Hospital Anxiety and Depression Scale and a demographic questionnaire were completed. In addition the schizophrenia group treated with clozapine completed the Brief Psychiatric Rating Scale. The OCD group reported significantly more symptoms for all OCI subscales compared to the clozapine group. Overall fourteen (22%) of the schizophrenia treated with clozapine group had clinically significant total OCI scores. Two (3%) had documented OCS pre clozapine. De novo OCS was reported in twelve (19%) cases. Nine (11%) had documented OC symptoms pre-clozapine while only two (3%) had symptoms after clozapine was initiated. In terms of OC symptom profile, the clozapine group scored highest on the Doubting scale, a cognitive symptom whereas the OCD group scored highest on Washing, a behavioural symptom. Both groups reported greater distress with cognitive rather than behavioural symptoms. Medication including clozapine dose was not correlated with symptom severity. Anxiety correlated highly with obsessive compulsive symptoms in the Clozapine group but not the OCD group. Within the Clozapine group, Obsessing correlated highly with Unusual Thought Content. Findings suggest that obsessive compulsive symptoms in the Clozapine group may reflect a subtype of 'schizo-obsessive' disorder.

Psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale in youth with autism spectrum disorders and obsessive-compulsive symptoms.

The psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) were investigated in 46 treatment-seeking youth, 7-15 years of age, who were diagnosed with an autism spectrum disorder (ASD) and exhibited obsessive-compulsive symptoms. The CY-BOCS Total score exhibited good internal consistency, with differing internal consistencies observed on the Obsession Severity scale (α = 0.86) and Compulsion Severity scale (α = 0.59). Good to excellent inter-rater reliability was observed for the CY-BOCS Total score and both Severity scales. Convergent and divergent validity of the CY-BOCS Total score and both Severity scales were satisfactory. Insight into obsessive-compulsive symptoms was moderately associated with the CY-BOCS Total score. The CY-BOCS demonstrated treatment sensitivity, demonstrating significant changes in obsessive-compulsive symptoms within a subsample of youth receiving cognitive-behavioral treatment. Overall, the CY-BOCS demonstrated adequate psychometric properties and utility in assessing obsessive-compulsive symptoms in youth with ASD and clinically significant obsessive-compulsive symptoms.

Color obsessions and phobias in autism spectrum disorders: the case of J.G.

The current study is the first investigation of color 'obsessions' and 'phobias' in ASD. We investigate the color perception and cognition of J.G., a boy with ASD who has a strong obsession with blue, and a strong phobia of other colors. J.G.'s performance on a series of color tasks (color-entity association; chromatic discrimination; color classification) is compared to 13 children with and without autism who do not have color obsessions or phobias. The findings lead to the formalization of two hypotheses: (i) color obsessions and phobias in individuals with ASD are related to an unusually strong ability to associate colors with entities; (ii) color obsessions are related to hyposensitivity, and color phobias to hypersensitivity, in the affected regions of color space.

The role of obsessive beliefs in patients with major depressive disorder.

AIM: The aim of this study is to evaluate the differences in obsessional beliefs between patients with major depressive disorder (MDD) and matched healthy controls using the obsessive-beliefs questionnaire (OBQ). METHODS: The study sample included 74 outpatients with MDD and 74 healthy subjects. The two groups were matched for age, gender, and education level. The diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). The severity of depression was measured with the Hamilton Depression Rating Scale (HAM-D). All participants filled out the 44-item OBQ. RESULTS: The total and subscale OBQ scores [Responsibility/Threat Estimation (RT), Perfectionism/Certainly (PC), and Importance/Control of Thoughts (ICT)], were significantly higher in patients with MDD than those of the control group. There was a positive correlation between HAM-D scores and the OBQ subscale scores (RT, PC, and ICT) in the patients. CONCLUSION: Obsessional beliefs appear to be related to MDD.