Premorbid and Illness-related Social Difficulties in Eating Disorders: An Overview of the Literature and Treatment Developments

Cardi, Valentina; Tchanturia, Kate; Treasure, Janet

doi:10.2174/1570159x16666180118100028

Cited by 78 publications

(69 citation statements)

References 98 publications

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“…This familial association suggests that problems in social cognition may be an endophenotype that increases the risk of developing an ED. In addition, adverse social experiences during development such as childhood maltreatment [13], insecure attachment [14], or teasing, bullying, or social exclusion [15] can shape interpersonal relationships and disrupt normal identity development, potentially by increasing the salience of competitive patterns of interaction that can fuel striving for perfection and greater internalisation of beauty ideals as a standard to define the self [16].…”

Section: Social Risk and Maintaining Factorsmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

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135

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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Section: Social Risk and Maintaining Factorsmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

Self Cite

135

122

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“…Adolescence is the period when psychopathology commonly emerges (Paus, Keshavan, & Giedd, ), thus making childhood/adolescence ideal to study direct associations between EDs and general psychiatric symptoms. According to the AN staging model (Treasure, Stein, & Maguire, ), this appears to be particularly important in AN given that interpersonal difficulties and comorbid psychiatric symptoms gradually worsen as the illness progresses (Cardi et al, ; Cardi, Tchanturia, & Treasure, ; Hudson, Hiripi, Pope Jr, & Kessler, ). Hence, an assessment of the relationships between general psychopathology and ED symptoms in adolescence may clarify whether general psychopathological symptoms are as central in young people with a short illness duration as in adults (Solmi et al, , ).…”

Section: Introductionmentioning

confidence: 99%

Re‐conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness

Monteleone

Mereu

Cascino

et al. 2019

Intl J Eating Disorders

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Objective Research evidence suggests the need to identify treatments based on a more precise characterization of psychopathology and psychiatric comorbidity in anorexia nervosa. Network analysis provides a new method to conceptualize psychopathology. We use this approach to investigate the relationships between eating disorder and general psychiatric symptoms in adolescents with anorexia nervosa. Methods Four‐hundred and five adolescents with anorexia nervosa and illness duration less than 3 years were consecutively recruited from those admitted to inpatient treatment. They completed the following questionnaires: the Eating Disorder Inventory‐3, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Youth Self Report. A network analysis was conducted, including eating psychopathology measures, anxiety and depressive symptoms, and obsessive–compulsive and post‐traumatic stress problems. We employ a novel approach, the bridge function, to identify symptom clusters. Results Depression symptoms and personal alienation were the nodes with the highest centrality in the network, followed by asceticism, post‐traumatic stress problems, drive to thinness, low self‐esteem, and anxiety physical symptoms. Three symptom clusters (relative to eating disorder psychopathology, self‐esteem problems, and internalizing difficulties) were identified. Depression symptoms, personal alienation, low self‐esteem, and interoceptive deficits showed the highest bridge centrality. Besides eating disorder core symptoms, negative affect and internalizing symptoms seem to contribute to anorexia nervosa psychopathology independently from illness duration effects. Discussion These findings suggest that anorexia nervosa is characterized by a broad psychopathological spectrum rather than the mere eating disorder core symptoms, confirm the need to re‐conceptualize psychiatric comorbidity in this disorder, and provide intriguing diagnostic and therapeutic implications.

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“…Adverse interpersonal experiences predate the onset of the anorexia nervosa at least in a subgroup of individuals (Cardi et al 2018a). Negative social experiences include episodes of bullying, criticism from others (especially in relation to weight and shape), exposure to the sudden death of a close relative and poor care and communication in the family, amongst others (Cardi et al 2018b). These experiences are broadly salient, because of their potential to threaten the universal need of social belonging and could be specifically relevant to individuals with anorexia nervosa, who tend to demonstrate involuntary submissiveness, fear of negative evaluation from others and sensitivity to rejection (Cardi et al 2013a;Rieger et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Training Rejection Interpretation in Eating disordeRs (TRIER): Preliminary Findings of a Feasibility Study in Adolescents with Anorexia Nervosa

et al. 2019

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This study investigated expectations of social rejection in adolescents with anorexia nervosa. Female adolescents (N = 24) admitted for hospital treatment completed both a positive interpretation bias training (experimental training) and a 50% positive and 50% negative interpretation bias training (control training), in a counterbalanced order, in two different testing sessions using a within-subjects design. The primary outcome for the training was the frequency of negative interpretations produced in the sentence completion task. At baseline, participants produced more negative than benign interpretations of ambiguous social scenarios (medium/large effect size). Following experimental training, participants produced fewer negative and more benign interpretations compared to control training (medium/large effect sizes). A trend for higher levels of self-esteem following virtual ostracism was found in the experimental condition compared to the control condition (small/ medium effect size). Interpretation bias modification has the potential to improve resilience to rejection in adolescents with anorexia nervosa.

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Premorbid and Illness-related Social Difficulties in Eating Disorders: An Overview of the Literature and Treatment Developments

Abstract: More work is needed to establish whether these approaches can improve on the rather disappointing outcomes that are attained by currently used treatments for eating disorders.

Cited by 78 publications

References 98 publications

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Re‐conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness

Training Rejection Interpretation in Eating disordeRs (TRIER): Preliminary Findings of a Feasibility Study in Adolescents with Anorexia Nervosa

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