Andreas Joos

Emotion and eating in binge eating disorder and obesity.

This study compares 20 binge eaters (BED), 23 obese patients (OB) and 20 normal weight controls (CO) with regard to everyday emotions and the relationship between emotions, the desire to eat and binge eating. Modified versions of the Differential Affect Scale and Emotional Eating Scale were used and the TAS-20 and Symptom-Check-List-27 administered to assess overall psychopathology and alexithymia. BED-subjects show a more negative pattern of everyday emotions, higher alexithymia scores and the strongest desire to eat, especially if emotions are linked to interpersonal aspects. The emotion most often reported preceding a binge was anger. Feelings of loneliness, disgust, exhaustion or shame lead to binge eating behaviour with the highest probability.

Amygdala hyperreactivity in restrictive anorexia nervosa

Functional imaging studies had often investigated heterogeneous samples of anorexia nervosa (AN) patients with varying paradigms and methodologies that had resulted in divergent results. The present study aimed to examine these issues by studying a well-defined sample of restrictive AN patients with a disorder-specific paradigm which had been used previously. Subjects showed increased blood oxygen level dependent responses of the cingulate, frontal, insular and parietal cortices. Group comparisons demonstrated increased activity of the right amygdala in the sample of restrictive AN patients. Our results are in support of other recently published functional imaging studies and point to a pivotal role of the right amygdala in AN. Signals of the midcingulum were reduced in comparison to healthy controls. The constellation of increased activity of the amygdala and decreased activity of the cingulate cortex likely represents parts of a negative feedback loop of emotional processing. Disgust ratings correlated with the amygdala signal negatively, which points to the complex role of this structure within eating disorders.

Emotional perception in eating disorders.

OBJECTIVE It remains an open question whether there are basic emotional perception and emotional processing deficits in eating disorders (ED). The aim of this study was to explore deficits in emotional perception in restrictive anorexia nervosa (AN-R) and bulimia nervosa (BN), using visual emotional stimuli. METHOD Thirty-four patients with ED (19 with BN and 15 with AN-R) were compared with 25 controls. Visual stimuli from the international affective picture system were used. RESULTS Patients with AN-R showed increased fear when confronted with stimuli containing anger, whereas patients with BN showed a tendency towards decreased fear. There were no other fundamental differences in the emotional perception of fear, happiness, sadness, and anger. DISCUSSION The finding of increased fear when exposed to the emotion of anger might be attributed to introversion and conflict avoidance of anorectic patients. No other basic deficiency of emotional perception was found.

Grey matter deficit in long-term recovered anorexia nervosa patients.

OBJECTIVE Cerebral grey matter (GM) reduction has repeatedly been shown in anorexia nervosa (AN). Evidence concerning completeness of GM restitution in recovered patients is contradictory. METHODS Five long-term recovered patients with AN were compared to symptomatic subjects and healthy controls using voxel-based morphometry. Whole brain GM, white matter and cerebrospinal fluid fractions were studied. Additionally, voxels that had shown significant GM reductions in symptomatic patients were investigated. RESULTS Recovered subjects had been severely affected when symptomatic (mean body mass index: 12.1 kg/m²) and were in remission for a very long time period (>5 years). Whole brain tissue fractions did not differ from controls. Regional analysis showed persistent GM volume reduction, in particular of the precuneus. CONCLUSIONS This study further supports the assumption that GM volume restitution is incomplete in subjects, who had previously been severely affected by anorexia nervosa. The meaning of GM reduction in long-term recovered AN patients, that is, its pathophysiological relevance, however, remains unclear. Furthermore, the precise aetiology of GM reduction remains an open question.

Electrocortical Processing of Food and Emotional Pictures in Anorexia Nervosa and Bulimia Nervosa

Objective: To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods: We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results: Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions: Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.ANOVA = analysis of variance; AN = anorexia nervosa; BN = bulimia nervosa; EDs = eating disorders; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; EPN = early posterior negativity; EEG = electroencephalography; ERPs = event-related potentials; fMRI = functional magnetic resonance imaging; high-cal = high-calorie; IAPS = international affective picture system; LPP = late positive potential; low-cal = low-calorie; RSVP = rapid serial visual presentation.

Frontocingular Dysfunction in Bulimia Nervosa when Confronted with Disease‐specific Stimuli

OBJECTIVE Bulimia nervosa (BN) is characterized by dysregulation of impulse control, in other words, uncontrolled eating. Functional neuroimaging studies have been sparse and have used variable methodologies. METHOD Thirteen medication-free female BN patients and 13 female healthy controls were investigated by functional magnetic resonance imaging using a disease-specific food paradigm. Stimuli were rated after the scanning procedure. RESULTS Bulimia nervosa patients showed increased fear ratings and a trend for increased disgust. Magnetic resonance imaging data of 10 BN patients could be analysed. Three BN patients had to be excluded from the analysis because of minimal blood oxygen level dependent signals. Compared with healthy controls, BN patients showed less activation of the anterior cingulate cortex, which extended into the lateral prefrontal cortex. Furthermore, the right temporal pole showed decreased reactivity. DISCUSSION This study substantiates a key role of lateral prefrontal dysfunction in BN, a brain region involved in impulse control. Furthermore, the anterior cingulate cortex, which plays a key role in emotion processing, is dysfunctional. A major limitation of this study is the small sample size.

Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial

OBJECTIVE There are no studies investigating the efficacy of short-term psychodynamic psychotherapy in primary fibromyalgia syndrome (FMS). We conducted a randomized controlled trial evaluating an adapted form of individual short-term psychodynamic psychotherapy (ASTPP) versus primary care management (TAU). The study focused on FMS patients with psychiatric comorbidity. METHODS Forty-six female patients with FMS and an International Classification of Diseases, 10th Revision diagnosis of a comorbid depression or anxiety disorder were recruited in a hospital setting. Participants were randomized to receive either ASTPP (25 sessions, 1 session/week) or TAU (4 consultations/6 months). Outcome measures included the Fibromyalgia Impact Questionnaire (FIQ), the Hospital Anxiety and Depression Scale (HADS), the Pain Disability Index, the Symptom Checklist 27 and the health-related quality of life. Primary endpoints of the outcome assessment were the FIQ total score and the HADS depression scale at 12-month follow-up. RESULTS Both treatments were effective in reducing the FIQ total score (ES=0.56 and ES=0.75, respectively). Intent-to-treat analyses failed to provide evidence suggesting a marked superiority of individual psychodynamic psychotherapy as compared to TAU. CONCLUSIONS A high-standard routine treatment focusing on the improvement of health behavior and including antidepressant and analgesic medication is equally effective as a short-term individual psychodynamic psychotherapy in improving fibromyalgia-related symptoms.

Stability of Long-Term Outcome in Bulimia Nervosa: A 3-Year Follow-Up

We report on the 3-year course and outcome of patients with bulimia nervosa (BN), initially treated in an inpatient or day clinic setting. Patients were assessed by structured interviews (Structured Clinical Interview for DSM Disorders I and II and Structured Interview for Anorexia and Bulimia Nervosa) and questionnaires (Eating Disorder Inventory-2, Symptom Checklist-90-R, and Social Adjustment Scale) at time points of admission, discharge, and 3-month, 12-month and 36-month follow-ups. Data of 83.7% of the 43 patients were available. After 3 years, about one third of patients showed complete remission, one third showed partial remission, and one third still fulfilled all the criteria of BN. Most changes occurred during hospitalization. Remission status showed substantial fluctuation over time, with little correlation between time points of assessment (discharge and 3-month, 12-month, and 36-month follow-ups). A cluster analysis revealed four patterns of longitudinal symptom change. Day clinic and inpatient treatment are overall effective. Longitudinal and repeated assessments are necessary to validly measure outcome in BN.

A manual-based group program to improve mental health: what kind of teachers are interested and who stands to benefit from this program?

PurposeIn order to evaluate a manual-based group program for teachers aiming at strengthening mental health, we examined (1) whether the teachers interested in participating differ from their colleagues without interest and (2) whether there is evidence of subgroups benefiting more than others among those who participated.MethodsOut of a basic sample of 949 schoolteachers, 337 teachers declared interest in a group program. All teachers were surveyed with the “General Health Questionnaire”, the “Maslach Burnout Inventory” and the “Effort Reward Imbalance Questionnaire”. In addition, participating teachers were screened with the “Symptom Checklist 27” T and χ2-tests were calculated to detect differences between those interested in the program and the remaining 612 teachers. Six factors were established and used for a regression analysis that identified specific parameters more or less correlating with health benefits of those who participated in the program.ResultsFindings showed that those declaring interest in the intervention displayed a higher degree of occupational stress according to all health parameters examined. Teachers interested in the program were significantly younger, more frequently female and single. The regression analysis showed that the baseline scores of the six health parameters were the strongest predictors for improvement. Worse scores before the beginning of the intervention correlated with a more positive effect.ConclusionsIntervention programs aiming at alleviating the mental stress of teachers find the interest of those who need it most. More importantly, the latter are the ones who—at least if our program is applied—benefit best.

Distinct functional and structural cerebral abnormalities in eating disorders in the light of diagnostic classification systems.

prised the cingulate cortex as well as the parietal, temporal, insular, supplementary motor and subcortical (caudate nucleus) regions [7] . A photon emission computed tomography study reported almost reverse perfusion patterns of AN and BN when subjects were compared in the resting condition and after food intake [8] . Furthermore, using magnetic resonance spectroscopy of the anterior cingulate cortex, BN patients showed a positive correlation of glutamate with ‘drive for thinness’, whereas restrictive AN subjects did not [9] . With respect to ventromedial dysfunction (including the anterior cingulate cortex), it should however be kept With DSM-5 advancing there is a debate with respect to the classification of eating disorders (EDs). In principle, the categorical approach of DSM-IV will be kept, with anorexia nervosa (AN) and bulimia nervosa (BN) representing the main ED entities. However, there are also rationales to conceptualize ED as a continuum: Most ED patients – independent of diagnostic category – are characterized by an overevaluation of shape and weight, a strong dissatisfaction with their body and an engagement in some form of weight control behavior. They often switch diagnostic categories over time, and there is genetic cross-transmission. Furthermore, about half of ED cases do not fulfill all criteria of AN or BN. Here we raise the question whether the increasing number of neurobiological studies, in particular imaging data, might contribute to this debate. One of the first functional magnetic resonance imaging (fMRI) studies was suggestive of functional cerebral substrates common to various EDs, demonstrating increased reactivity of the medial prefrontal cortex [1] . Recent fMRI studies have shown different results. One study that used words concerning body image demonstrated an increased response of the right amygdala in AN, while ventromedial abnormalities characterized BN [2] . Investigations using visual body images yielded amygdalar activation in AN, but not in BN [3, 4] . Our group used a food paradigm, which demonstrated an increased response of the right amygdala and decreased signals of the midcingulate cortex in restrictive AN [5] , while BN patients had decreased frontocingular and temporal signals [6] . Contrasting these samples directly, BN was characterized by decreased frontocingular activation, as shown in figure 1 . A further recently published fMRI investigation used the active instruction to imagine eating the food shown in the images and compared AN with BN patients [7] . Again, differences in blood oxygen level-dependent signals were demonstrated, which comReceived: November 10, 2011 Accepted after revision: March 2, 2012 Published online: September 9, 2012