Attachment, motivational systems and anorexia nervosa: A systematic review and proposed framework for eating disorders.

INTRODUCTION: There is a direct association between patients with insecure attachment style (IAS), behavioural inhibition (BIS) and behavioural activation (BAS) motivational systems, and anorexia nervosa (AN). However, the possible direct relationships between these three variables have not been studied. OBJECTIVE: The main objective of this study is to analyse the relationship between these variables and propose a framework for analysing and understanding these relationships. METHODOLOGY: A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching the following terms: 'anorexia', 'attachment' and those related to motivational systems. The final search was limited to publications in English dated between 2014-2022 for 'anorexia and attachment' and 2010-2022 for 'anorexia and BIS/BAS'. RESULTS: Of the 587 articles retrieved, 30 were included in this study for the textual data analysis of the relationship between anorexia and attachment (17), anorexia and motivational systems (10) and anorexia, attachment and motivational systems (3). An association between avoidant IAS, AN and hypersensitivity to punishment of the BIS was observed in the analysis. A relationship was also observed with hyperreinforcement sensitivity of the BAS. After reviewing the articles, a possible relationship between the three factors, along with other mediating factors, was found. DISCUSSION: AN is directly related to the avoidant IAS and to BIS. Similarly, bulimia nervosa (BN) was directly related with anxious IAS and BAS. However, contradictions were found in the BN-BAS relationship. This study proposes a framework for analysing and understanding these relationships.

Psychosocial Factors in Adolescence and Risk of Development of Eating Disorders.

Background: current findings in the etiopathogenesis of eating disorders (ED) do not allow the formulation of a unique causal model. Currently, the main hypotheses about the etiopathogenesis are based on a multifactorial approach, considering both genetic and environmental factors. The aim of this study is to analyze the relationship between sociodemographic and behavioral factors, as well as self-esteem, in students of the first cycle of middle school and the probability of belonging to the risk group of eating disorders (ED) measured through the EAT-26 scale. Methods: The study target population consists of students of the first cycle of middle school. The instruments applied to the population consisted in: (1) a survey of sociodemographic data and behavioral variables; (2) Rosenberg's self-esteem test; and (3) EAT Test (Eating Attitudes Test 26). Results: Of a total of 656 students belonging to eight educational centers in Madrid who were offered to participate in the study, 88.6% (n = 579) answered the whole questionnaire. The mean age of the participants was 13.7 years old. Of the participating adolescents, 57.3% were male and the remaining 42.7% (n = 260) were female. A significant relationship was observed between self-esteem and belonging to an ED risk group, with an OR = 0.910 (CI 95% 0.878−0.943). Hence, each one-point increase on the self-esteem dimension decreased the risk of belonging to an ED risk group by 9.5%. In the variables considered in the area of dysfunctional feeding patterns, the variables 'number of meals' (p < 0.01), 'dieting' (p < 0.01), and 'drug consumption to lose weight' (p < 0.01) were found to be related to the risk of belonging to the ED group. Conclusions: The results obtained in our research can help to establish explanatory models that include the understanding of the interaction of the different factors that influence the appearance and development of EDs. Therefore, these should be taken into consideration when developing ED preventive programs.

Psicopatología en el paciente con obesidad / Psycopathology in obese patients

Resumen: INTRODUCCIÓN: En las dos últimas décadas se han multiplicado las publicaciones científicas que cuestionan la definición médica tradicional de la obesidad por haberse centrado en el tejido adiposo (menos inerte y más interconectado con los demás tejidos de lo que se pensaba), y en un modelo patogénico heredado del siglo XIX que reducía el problema a un mero desequilibrio entre la incorporación y el gasto de energía, todo ello vagamente modulado por factores que se analizaban como variables secundarias: psicosociales y neuroendocrinas. OBJETIVO: Relacionar la psicopatología y la obesidad, dando prioridad a los puntos de vista emocional y de comportamiento como focos para descomponer al grupo de obesos en perfiles emocional-conductuales que requerirían tratamientos diferenciales. MÉTODO: Se presentan datos descriptivos de los 180 primeros pacientes incluidos del programa de Estudio de los Aspectos Emocionales del Sobrepeso y la Obesidad del Hospital Universitario Infanta Leonor en Madrid; se realizó una entrevista semi-estructurada y una batería de test psicométricos; se presentan datos descriptivos y un análisis de asociación entre Índice de Masa Corporal (IMC) y ansiedad o depresión. RESULTADOS: La mayoría de los pacientes tienen alta puntuación en psicopatología; el 80.9% tenía sintomatología depresiva importante, el 56.39% tenía elevada ansiedad-rasgo, el 48.26% tenía elevada ansiedad-estado, el 24.4% cumplía criterios de trastorno por atracones y el 11.9% de bulimia nerviosa (BN); un 17.3% tenía criterios de trastorno por estrés postraumático. DISCUSIÓN Y CONCLUSIÓN: Nuestros resultados apoyan la asociación esencial entre obesidad y psicopatología.

Abstract: INTRODUCTION: In the past two decades the traditional definition of obesity has been challenged because it emphasizes the centrality of adipose tissue (a less inert and more interconnected tissue than previously thought), and it preserves the 19th century model that reduces the problem into simple imbalance between energetic incomes and expenditures vaguely modulated by psychosocial and neuroendocrine factors considered as mere adjuvants. OBJECTIVE: To relate psychopathology and obesity prioritizing the emotional-behavioral origin of adiposity, and start the breakdown of the general obesity group into emotional and behavioral profiles that warrant differential treatments. METHOD: Descriptive data of 180 patients treated in the Overweight and Obesity Program of Infanta Leonor University Hospital (Madrid, Spain); a semi-structured interview and psychometric tests were performed. Association tests between affective (anxiety and depression) and Body Mass Index (BMI) variables are shown. RESULTS: Most patients showed high scores in psychopathology; 80.9% had major depressive symptomatology, 56.39% had high anxiety-trait, 48.26% had high anxiety-state, 24.4% met criteria for binge eating disorder and 11.9% of bulimia nervosa; 17.3% had criteria for posttraumatic stress disorder. DISCUSSION AND CONCLUSION: Our results support the association between obesity and psychopathology.