| 1. |
- Bulik, Cynthia M., et al.
(författare)
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SUBJECTIVE EXPERIENCES OF ANOREXIA NERVOSA IN PATIENTS WITH HIGH VS LOW ANOREXIA NERVOSA POLYGENIC RISK
- 2023
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Ingår i: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 75:Suppl. 1, s. S14-S14
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Recent genome-wide association studies (GWAS) suggest that genetic factors play a key role in its development and expression and that anorexia nervosa (AN) might have both psychiatric and metabolic underpinnings. One hypothesis is that those with high genetic vulnerability to AN may experience negative energy balance (NEB) (i.e., expending more energy than you consume) in a positive manner, rendering self-starvation and excessive exercise exceptionally reinforcing. This “paradoxical” response to NEB may also complicate recovery. In the Polygenic risk of Anorexia nervosa and its Clinical Expression (PACE) study, we explored differences in clinical and phenomenological/experiential phenotypes (i.e., how patients reported their experience of illness) in 10 individuals with AN who were in the top decile of AN polygenic risk (PRS) and 10 individuals with AN who were in the lowest decile in the Swedish subsample of the Anorexia Nervosa Genetics Initiative (ANGI) study. We interviewed the participants in a double-blind study design using a structured interview guide focusing on the experience of AN, including experiences of NEB (e.g., hunger, satiety, dietary restriction), the development of symptoms, as well as the reactions of others including family members and treatment providers to patients’ experiences of NEB. All interviews have been coded and the blind will be broken in May 2023 at which point group comparisons will be analyzed. This is the first study, to our knowledge, to explore experiential impact of genetic risk. Findings may aid in understanding risk, clinical course, and individual experience of AN and contribute suggestions for tailoring interventions with input from genetic risk profiles.
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| 2. |
- Forsén Mantilla, Emma, et al.
(författare)
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Exercise caution : Questions to ask adolescents who may exercise too hard
- 2018
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- When the primary goal of exercise is to compensate for food intake and to alter body shape and weight, it is considered compulsive and may be harmful. Compulsive exercise (CE) is important in the pathogenesis of eating disorders (EDs). Many healthy adolescents engage in CE too, and this may indicate a risk for EDs. Our aim was to learn more about ED risk factors tied to CE and to try to isolate questions to ask in order to probe for high ED risk in adolescents engaging in CE. Using two well-established instruments (the Structural Analysis of Social Behavior and the Eating Disorders Examination Questionnaire), we studied associations between ED variables and CE in healthy adolescent boys and girls. We examined gender-specific items to generate the best possible fit for each gender. Individuals with CE displayed significantly greater ED pathology and more self-criticism, and this pattern was stronger in girls than in boys. Risk factors for ED among individuals with CE differed slightly for boys and girls. We put forward a set of gender-specific questions that may be helpful when probing for ED risk among adolescents engaging in CE.
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| 3. |
- Forsén Mantilla, Emma, et al.
(författare)
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Impulsivity and compulsivity as parallel mediators of emotion dysregulation in eating-related addictive-like behaviors, alcohol use, and compulsive exercise
- 2022
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Ingår i: Brain and Behavior. - : John Wiley & Sons. - 2162-3279 .- 2162-3279. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Transdiagnostically relevant psychological traits associated with psychiatric disorders are increasingly being researched, notably in substance use and addictive behaviors. We investigated whether emotion dysregulation mediated by impulsivity and/or compulsivity could explain variance in binge eating, food addiction, self-starvation, and compulsive exercise, as well as alcohol use (addictive-like behaviors relevant to the obesity and eating disorder fields).METHOD: A general population sample of adults (N = 500, mean age = 32.5 years), females (n = 376) and males (n = 124), completed the Difficulties in Emotion Regulation Scale-16, the Trait Rash Impulsivity Scale, the Obsessive-Compulsive Inventory-Revised, the Eating Disorders Examination Questionnaire, the Self-Starvation Scale, the Exercise Dependence Scale, the Yale Food Addiction Scale, and the Alcohol Use Disorders Identification Test online. Besides gender comparisons and intercorrelations between measures, we used predefined multiple mediation models with emotion dysregulation as independent variable, impulsivity and compulsivity as parallel mediators, to investigate whether these factors contributed explanatory power to each addictive-like behavior as outcome, also using age and body mass index as covariates.RESULTS: Females scored higher than males on emotion dysregulation and the eating-related addictive-like behaviors food addiction, self-starvation, and binge eating. Intercorrelations between measures showed that emotion dysregulation and compulsivity were associated with all outcome variables, impulsivity with all except compulsive exercise, and the eating-related behaviors intercorrelated strongly. Mediation models showed full or partial mediation of emotion dysregulation for all behaviors, especially via compulsivity, suggesting a behavior-specific pattern. Mediation models were not affected by age or gender.DISCUSSION: Addictive-like behaviors seemed to be maintained by trait levels of emotion dysregulation, albeit channeled via trait levels of compulsivity and/or impulsivity. The role of emotion dysregulation may help us to understand why addictive-like behaviors can be difficult to change in both clinical and nonclinical groups, and may be informative for treatment-planning in patients where these behaviors are present. Our findings support adopting a more dimensional approach to psychiatric classification by focusing psychological facets such as those studied.
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| 4. |
- Levallius, Johanna, et al.
(författare)
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Binge eating and addictive-like behaviours in males and females
- 2022
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Ingår i: Psychological Reports. - : Sage Publications. - 0033-2941 .- 1558-691X. ; 125:1, s. 148-166
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Binge eating is a common behaviour that is strongly linked to both obesity and eating disorder. There is evidence that binge eating commonly co-occurs with other problematic and addictive-like behaviours; however, this has not been explored systematically. The present study aimed to examine the relationship between binge eating, body weight, disordered eating behaviours and associated addictive-like behaviours, with particular attention paid to gender differences.METHOD: A community sample (N = 500; 75% female, Mage = 32.5 years) reported disordered eating behaviours (i.e. binge eating, purging, restriction of eating, compulsive exercise), body mass index (BMI), food addiction, starvation addiction, exercise dependence, tobacco use and alcohol consumption.RESULTS: 42% of females and 21% of males reported binge eating during the past four weeks. Binge eating was significantly associated with all investigated behaviours in females, and with purging, compulsive exercise and overweight/obesity in males. Controlling for BMI, self-starvation predicted binge eating in males (OR = 1.07), while food addiction (OR = 1.73) and alcohol dependence (OR = 1.11) predicted binge eating in females.CONCLUSIONS: The multiple associations between binge eating and addictive-like behaviors supports broad screening and generalized prevention efforts. Prevention efforts should reflect gender differences.
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| 5. |
- Monell, Elin, et al.
(författare)
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Emotion dysregulation and eating disorders : Associations with diagnostic presentation and key symptoms
- 2018
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Ingår i: International Journal of Eating Disorders. - : Wiley. - 0276-3478 .- 1098-108X. ; 51:8, s. 921-930
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Emotion dysregulation seems involved in the development, maintenance, and outcome of eating disorders (EDs). The present study aimed to differentiate patients with EDs from a comparison group on emotion dysregulation, and to examine emotion dysregulation in relation to ED diagnostic presentation and ED symptoms.Method/Results: Participants, patients with EDs (N=999) and a student comparison group (N=252), completed the Difficulties in Emotion Regulation Scale and the Eating Disorder Examination Questionnaire. Patients were compared to the comparison group and compared by diagnosis regarding emotion dysregulation, and unique associations between emotion dysregulation aspects and ED symptoms were examined. Patients reported greater general emotion dysregulation than the comparison group, especially poorer emotional awareness and clarity. There were very few diagnostic differences. In both patients and the comparison group, limited access to emotion regulation strategies was associated with cognitive ED symptoms, and presence of binge eating in the comparison group. In patients, poor emotional awareness and emotional non-acceptance were additionally associated with cognitive symptoms, and difficulties in impulse control and emotional non-acceptance were associated with binge eating.Discussion: Emotion dysregulation is an important transdiagnostic characteristic of ED. Results suggest interventions that enhance emotional awareness and acceptance, as well as emotion regulation skills training, in both ED treatment and prevention.
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| 6. |
- Monell, Elin, et al.
(författare)
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Emotion dysregulation, self-image and eating disorder symptoms in University Women
- 2015
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Ingår i: Journal of Eating Disorders. - : BioMed Central (BMC). - 2050-2974. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: We studied associations between emotion dysregulation, self-image and eating disorder (ED)symptoms in university women, and contrasted two indirect effect models to examine possible interveningmechanisms to produce ED symptoms.Methods: 252 female Swedish university students completed the Difficulties in Emotion Regulation Scale(DERS), the Structural Analysis of Social Behavior (SASB) self-image measure, and the Eating DisorderExamination Questionnaire (EDE-Q). Correlations between scales were followed by five simple mediationanalysis pairs with two possible pathways using five ED symptom variables as outcome. The models positedeither self-image or emotion dysregulation as mediator or independent variable, respectively. ED symptomswere EDE-Q Global score, objective binge eating episodes (OBE), subjective binge eating episodes (SBE), andtwo variants of EDE-Q excessive exercise.Results: Emotion dysregulation and self-image were strongly correlated, and both correlated moderately withEDE-Q Global score. There were distinct indirect effects through self-image on the relationship between emotiondysregulation and ED symptoms, but not vice versa. These indirect effects were evident in relation to cognitive EDsymptoms and both OBE and SBE, but not in relation to excessive exercise.Conclusions: Results suggest that even if closely related, emotion dysregulation and self-image both contributeunique knowledge in relation to ED symptoms. Self-image as an intervening mechanism between emotiondysregulation and ED symptoms is relevant for models of the development, maintenance and treatment of ED, as wellas treatment focus.
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| 7. |
- Monell, Elin
(författare)
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Emotion dysregulation, self-image, and eating disorders
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Eating disorders (EDs) are complex psychiatric disorders that entail great suffering, high prevalence of comorbid psychiatric and somatic conditions, and increased mortality. The understanding of how EDs develop and are maintained is unclear, although emotion- and self-related themes are highlighted in several theoretical models of EDs. This thesis focuses on two psychological traits in relation to EDs: emotion dysregulation (difficulties in understanding and managing one’s emotions) and self-image (habitual self-directed evaluations and behaviors). Higher emotion dysregulation and more negative self-image may differentiate those suffering from EDs from controls, and independently, both concepts are associated with ED symptom severity and outcome. However, previous studies have generally been conducted in smaller samples and/or with only some ED diagnoses represented, and the impact of specific aspects of emotion dysregulation on symptoms remains unclear. Also, no prior research has concurrently examined both emotion dysregulation and self-image in relation to ED psychopathology and outcome in order to clarify potential pathways whereby these traits affect each other in relation to symptoms. Doing so could present an opportunity to integrate models, disentangle association pathways, and increase specificity. Aims: This thesis aimed to examine aspects of emotion dysregulation in relation to diagnostic presentation, specific ED symptoms, and ED outcome. It also aimed to examine direct and indirect associations between emotion dysregulation, self-image, and ED psychopathology, in ways that may inform both risk and potentially pathology-specific maintenance models. Lastly, it aimed to clarify if, and in that case how, these concepts may impact on ED outcome. Methods: Participants were patients with a range of EDs presenting to specialized ED treatment units (Studies I and III: N=999; Study IV: N=307) and comparison participants (female university students; Studies I and II: N=252). Emotion dysregulation was measured by the Difficulties in Emotion Regulation Scale (DERS), self-image by the Structural Analysis of Social Behavior (SASB), and ED symptoms by the Eating Disorder Examination Questionnaire (EDE-Q). Study I examined differences in DERS between patients and the comparison group, and between patients with different EDs. It also examined unique associations between DERS subscales and ED psychopathology and behavioral symptoms. Study II examined direct and indirect associations between emotion dysregulation, self-image, and ED symptoms in the comparison group using mediation analysis. Study III aimed to replicate the main Study II findings, and additional analyses extended previous work by exploring direct and indirect associations using particular emotion dysregulation dimensions and distinct self-image aspects. Study IV examined if initial DERS, or one-year change in DERS, could predict ED outcome in a subset of patients with complete follow-up data using multiple regression. It also examined pathways whereby change in emotion dysregulation and self-image might influence change in ED psychopathology over one year using mediation analysis. Results: Patients generally reported higher emotion dysregulation than the comparison group, but emotion dysregulation generally did not differ between diagnoses. Higher perceived lack of emotion regulation strategies was uniquely associated with ED psychopathology in both patients and comparison participants. In patients, higher difficulties in impulse control and emotional non-acceptance showed unique associations with binge-eating, while lower difficulties in goal-directed behavior was associated with compulsive exercise. Emotion dysregulation was strongly associated with negative self-image in both comparison participants and patients. When examined concurrently in relation to ED psychopathology, emotion dysregulation was only indirectly associated with symptoms through self-image. More finegrained analyses in patients with and without binge-eating characterized by loss of control, respectively, showed differentiating indirect effects through specific self-image aspects. Initial emotion dysregulation only weakly predicted ED outcome, while less improvement (or worsening) in emotion dysregulation was strongly associated with both higher follow-up ED psychopathology and an increased risk of still having an ED, even when initial severity was taken into consideration. Lastly, less emotion dysregulation improvement only was indirectly associated with less ED psychopathology improvement, through less self-image improvement. Conclusions: Emotion dysregulation seems to differentiate individuals suffering from EDs from comparison groups but generally not diagnoses from each other, indicating emotion dysregulation as a potential transdiagnostic risk factor. Although both emotion dysregulation and self-image independently may function as maintenance factors for ED psychopathology and mechanisms of change in relation to better ED outcomes, results from mediation analyses particularly suggest self-image as the influential factor whereby emotion dysregulation influences ED psychopathology. Thus, although results confirm considerable associations between emotion dysregulation and symptoms that would benefit from clinical attention, they particularly highlight the importance of addressing self-image when doing so. That is, helping patients to respond to themselves with acceptance and protection rather than harsh blame and neglect, even in the presence of unwanted, undifferentiated, and ‘unmanageable’ emotions, may provide patients with necessary tools for reducing ED symptoms.
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| 8. |
- Monell, Elin, et al.
(författare)
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Factor structure and clinical correlates of the original and 16-item version of the Difficulties In Emotion Regulation Scale in adolescent girls with eating disorders
- 2022
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Ingår i: Journal of Clinical Psychology. - : John Wiley & Sons. - 0021-9762 .- 1097-4679. ; 78:6, s. 1201-1219
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The Difficulties in Emotion Regulation Scale (DERS) is increasingly used in adolescents. This study is the first to examine the factor structure, measurement, and structural invariance across age, reliability, and validity of the original 36-item and 16-item version of the DERS in adolescents with eating disorders.METHODS: Several models were examined using confirmatory factor analysis. Measurement and structural invariance were studied across age groups, and Omega, Omega Hierarchical, and criterion validity were examined.RESULTS: A bifactor model, with five subscales, showed acceptable fit in both DERS versions. Measurement and structural invariance held across age. The general factor had high reliability and accounted for a large proportion of variance in eating pathology and emotional symptoms.CONCLUSION: The Awareness subscale had a negative effect on fit in DERS, but both DERS versions were reliable and valid measures in both younger and older adolescents with eating disorders when using only five subscales.
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| 9. |
- Monell, Elin, et al.
(författare)
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Running on empty : a nationwide large-scale examination of compulsive exercise in eating disorders
- 2018
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Ingår i: Journal of eating disorders. - : BioMed Central (BMC). - 2050-2974. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Compulsive exercise (CE) has been the neglected "Cinderella" among eating disorder (ED) symptoms, even though it seems to impact severity, treatment and outcome. This prompted a large-scale and systematic examination of the impact of CE in a representative ED sample.METHODS: CE was examined in over 9000 female and male patients from a clinical ED database (covering out-patient, day and/or residential treatment) with respect to prevalence, ED diagnosis, ED symptoms, clinical features, patient characteristics, and outcome at 1-year follow-up. Relationships between changes in CE behavior and remission were also examined.RESULTS: CE was a transdiagnostic symptom, present in nearly half of all patients (48%). It was associated with greater overall ED pathology, particularly dietary restraint, and negative perfectionism. Initial CE did not impact remission rate, but patients continuing or starting CE during treatment had considerably lower remission rates compared to patients who never engaged in, or ceased with, CE. Results were comparable for females and males.CONCLUSIONS: At baseline, there were few differences between patients with and without CE, except a somewhat higher symptom load for patients with CE, and CE did not predict ED outcome. However, how CE developed during treatment to 1-year follow-up considerably impacted remission rates. We strongly recommend CE to be systematically assessed, addressed, and continuously evaluated in all ED patients seeking treatment.
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| 10. |
- Monell, Elin, et al.
(författare)
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Taking the LEAP : study protocol for a randomized, multicentre, naturalistic, efficacy trial of the compuLsive Exercise Activity theraPy (LEAP) - a cognitive behavioral program specifically targeting compulsive exercise in patients with eating disorders
- 2021
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Ingår i: BMC Psychiatry. - : BMC. - 1471-244X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background About half of Swedish eating disorder patients report exercising compulsively and compulsive exercise (CE) is prevalent in all diagnoses and both genders. Yet there are no systematic treatments targeting CE in specialist care. This study aims to evaluate the effects of The CompuLsive Exercise Activity TheraPy (LEAP) - a promising group treatment targeting compulsive exercise, in Swedish eating disorder patients. Method One hundred twenty-eight adult females and males suffering from anorexia nervosa, bulimia nervosa or other specified feeding and eating disorders (type 1, 2, or 4) with CE will be recruited via four specialist eating disorder treatment units. Participants will be randomized to receive treatment as usual (control group) or treatment as usual plus LEAP (intervention group). The groups will be assessed on key variables (e.g., BMI, eating disorder symptoms, exercise cognitions and behaviors) at three occasions: initially, after 3 months and after 6 months. Discussion The project takes place in a clinical setting, including both male and female patients with different eating disorder diagnoses with CE, enabling a good indication of the efficacy of LEAP. If our results are positive, LEAP has the potential of benefiting about half of the eating disorder population, with remission and recovery hopefully improving as a result.
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