Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study

Todisco, Patrizia; Meneguzzo, Paolo; Garolla, Alice; Αντωνιάδης, Άθως; Vogazianos, Paris; Tozzi, Federica

doi:10.1007/s40519-020-00916-5

Cited by 15 publications

(17 citation statements)

References 60 publications

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“…Fewer studies have examined the relationship between EDs and traumatic events during adulthood, showing a specific association between EDs and sexual abuse, and more recently, between EDs and lockdown experience (Dubosc et al, 2012;Trottier and MacDonald, 2017;Monteleone et al, 2021a,b). Therefore, some authors have suggested that some cases need two treatment levels: one to control harmful and compromising behaviors and a second one to change the specific psychopathology (Corstorphine et al, 2007;Castellini et al, 2018;Todisco et al, 2020). If the extended psychopathological core of ED seems to remain stable and is characterized by an overestimation of weight and shapes, depression (D), anxiety, and interpersonal ineffectiveness, patients with and without a history of trauma history seem to show different psychological phenotypes that require a different specific focus (Solmi et al, 2018b;Rodgers et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Cognitive distortion such as a lack of autonomy, emotional regulation difficulties, and interpersonal problems are pervasive elements of chronic mental illness, and early detection could positively impact recovery (Pauwels et al, 2016;Pilkington et al, 2020). For these reasons, a growing body of literature has started to report the results of the integration of elements from third-wave therapies with cognitive-behavioral treatment protocols, with encouraging results (Öst, 2008;Ben-Porath et al, 2020;Pisetsky et al, 2020;Todisco et al, 2020). However, a recent meta-analysis found that there is still a lack of understanding of the effect of trauma on the psychological features and outcomes of ED patients, showing that more longitudinal studies are needed (Molendijk et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

Meneguzzo

Cazzola²,

Castegnaro³

et al. 2021

Front. Psychol.

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Background: The literature has shown a significant association between traumatic experiences and eating psychopathology, showing a greater symptomatology in patients with trauma history. Less is known about the associations between trauma and cognitive schemas, and personality traits and the differences between childhood and adulthood trauma experiences. Thus, this paper aims to assess the clinical and psychological characteristics of eating disorder (ED) patients, looking for differences between patients without a history of trauma and patients with trauma experiences, as well as at possible differences between exposure in childhood, adulthood, or repeated events. Another aim of the paper is to evaluate the possible mediation role of cognitive schemas and personality traits in the relationship between early trauma and eating psychopathology.Methods: From January to November 2020, 115 consecutive inpatients admitted for a specific multidisciplinary ED treatment in a dedicated Unit were evaluated for trauma, differentiating between trauma occurring in childhood and adulthood. The subjects were evaluated for early maladaptive schemas (EMS), personality traits, trauma symptomatology, quality of life, and specific psychopathologies linked to EDs. Mediation analyses between childhood and adulthood trauma and eating psychopathology were performed, with EMS and personality traits as mediators.Results: Patients with a history of trauma showed higher physical and psychological symptomatology scores, with a more impaired clinical profile in patients with both childhood and adulthood trauma exposure. The mediation analysis showed a specific mediator role for the “disconnection and rejection (DR)” EMS factor in the relationship between childhood trauma (cT) and eating psychopathology.Conclusion: Trauma experiences are associated with more severe clinical symptomatology in EDs and may need a specific assessment in patients with failed outpatient standard treatments. Specific cognitive schemas linked to DR domain should be evaluated in treatments for ED patients with history of trauma due to the mediation role between trauma and eating psychopathology. The need for outcome studies about treatment approaches for ED patients with history of trauma is discussed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

Meneguzzo

Cazzola²,

Castegnaro³

et al. 2021

Front. Psychol.

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“…ED patients typically endorse significantly more maladaptive schemas than healthy controls [ 25 , 26 ]. Previous ED studies [ 11 ] have found significant associations between (1) cluster B personality disorders (narcissistic, antisocial, histrionic and borderline [ 27 ], and bulimic symptoms and the schemas of insufficient control, emotional deprivation and mistrust/abuse schemas; and between (2) cluster C personality disorders [avoidance, dependent and obsessive–compulsive, [ 27 ]], and restrictive ED symptoms and the schemas of failure to achieve, social undesirability, subjugation and unrelenting standards [ 28 , 29 ]. These maladaptive schemas have also been associated with NSSI in both clinical ED patients [ 11 ] and non-clinical ED samples [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

et al. 2021

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Objective The high co-occurrence of non-suicidal self-injury (NSSI) behaviours and eating disorder (ED) symptoms suggests these conditions share common aetiological processes. We assessed a new integrative model of shared factors for NSSI and ED symptoms, where affect dysregulation, impulsivity, self-esteem, and body dissatisfaction mediated the relationship between insecure attachment and maladaptive schemas and NSSI and ED symptoms. A further aim of the study was to assess whether the model behaved similarly across a clinical eating disorder (ED) and a community sample. Method 123 females with a lifetime ED diagnosis and 531 female individuals from the community completed an online survey, which included measures assessing the variables of interest. A cross-sectional single time point analysis was used. Results Invariance testing indicated that the model was structurally non-invariant (different across groups). The proposed integrative model was a good fit for the ED group, but for the community sample only a revised model reached an acceptable fit. Both attachment and maladaptive schemas, included early in the model, were implicated in the pathways leading to ED and NSSI symptoms in the ED and community groups. In the community group, impulsivity, a mediator, was a shared predictor for NSSI and bulimic symptoms. No other mediating variables were shared by NSSI and ED symptoms in the two groups. Overall, the proposed model explained slightly more variance for the ED group relative to the community group in drive for thinness (R2 = .57 vs .51) and NSSI (R2 = .29 vs .24) but less variance in bulimic symptoms (R2 = .33 vs .39). Conclusion We conclude that the current model provides only limited support for explaining the comorbidity between NSSI and ED symptoms. It is vital to consider both common (e.g., attachment and maladaptive schemas) and specific factors (e.g., impulsivity) to better understand the pathways that lead to the co-occurrence of NSSI and ED symptoms. A new integrative model assessed whether emotion dysregulation, impulsivity, self-esteem, and body dissatisfaction were mediators in the relationship between insecure attachment and maladaptive beliefs about the world and the self and subsequent eating disorder and self-harm symptoms. A further aim was to assess whether the proposed model differed between a clinical eating disorder and a community sample. All participants were female and included 123 patients with a lifetime eating disorder and 531 individuals from the community. Participating individuals completed an online survey at one timepoint, which included measures assessing the variables of interest. The findings of the current study indicated that the proposed model was a good match for the clinical eating disorder sample, but for the community sample only a revised model yielded acceptable statistical fit. Both insecure attachment and maladaptive beliefs about the world and the self, included early in the model, were indirectly related to eating disorder and self-harm symptoms for both the eating disorder and the community groups. Impulsivity, a mediator, was the only shared predictor for self-harm, and bulimic symptoms in the community group. We conclude that the current model provides only limited support for explaining the comorbidity between self-harming behaviours and disordered eating symptoms.

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“…The treatment protocol of the ‘Casa di Cura Villa Margherita’ ward (e.g., treatment as usual, TAU) is based on a cognitive‐behavioural multidisciplinary approach, with individual weekly psychotherapy sessions, a weekly psychotherapy group session, nutritional counselling, nursing care, meal planning, family treatment, psychoeducational group therapy, and psychopharmacologic treatment as needed. Specific third‐wave approaches are already implemented (e.g., mindfulness and sensorimotor therapy) with specific individualised targets on the patients' psychopathology (see also Todisco et al., 2020 ). The rehabilitation protocol is set on 8 weeks, due to the limitations of the inpatient treatment of the Italian health system laws.…”

Section: Methodsmentioning

confidence: 99%

Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit

Meneguzzo

Tenconi

Todisco

et al. 2021

Euro Eating Disorders Rev

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Objective: Cognitive remediation therapy (CRT) has been proposed as an addon treatment approach that could increase the engagement in treatment of anorexia nervosa (AN) patients and reduce maintaining factors, but prior studies have evaluated CRT in individual and group settings, difficult protocols for rehabilitation settings. Our aim is to evaluate the CRT rolling protocol implementation in an inpatient specialised unit. Methods:A historical longitudinal controlled study was designed to include 31 AN patients for the CRT program, and 28 AN patients treated as usual. The CRT rolling group was implemented in a multidisciplinary inpatient rehabilitation ward with both adolescent and adult patients and an 8-weeks protocol. To evaluate the treatment implementation effect, different self-administered questionnaires were used. Results:The study found greater improvements of the CRT group in clinical symptomatology (p = 0.039), flexibility (p = 0.003), self-confidence about the ability to change (p < 0.001), and less short-term focus (p < 0.001), with no differences between restrictive and binge-purging patients. Conclusion:This study demonstrates that CRT rolling group protocol is feasible in an inpatient treatment setting and may improve a rehabilitation program's outcome. Our results have shown how CRT can influence cognitive styles considered AN maintenance factors, positively affecting both restrictive and binge-purge type.

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Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study

Cited by 15 publications

References 60 publications

Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

Associations Between Trauma, Early Maladaptive Schemas, Personality Traits, and Clinical Severity in Eating Disorder Patients: A Clinical Presentation and Mediation Analysis

A new integrative model for the co-occurrence of non-suicidal self-injury behaviours and eating disorder symptoms

Cognitive remediation therapy for anorexia nervosa as a rolling group intervention: Data from a longitudinal study in an eating disorders specialized inpatient unit

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