Carla E. Ramacciotti

Orthorexia nervosa in the general population: A preliminary screening using a self-administered questionnaire (ORTO-15)

OBJECTIVE: Orthorexia, from the Greek words orthos (straight, proper) and orexis (appetite), is a newly conceptualized disorder characterized by distorted eating habits and cognitions concerning supposedly healthy nutrition. In this article we present preliminary results of a wider research aimed to investigate the diffusion of Orthorexia in the general population and to highlight its characteristics and particularly the relationship with Eating Disorder and Obsessive-Compulsive Disorder. METHOD: One-hundred and seventy seven adult subjects from the general population, were administered the ORTO-15 test, a selfadministered questionnaire specifically designed to assess orthorexic symptomatology; note that statistical analyses were repeated twice, referring to different diagnostic thresholds (40/35). RESULTS: Orthorexia had a 57.6% prevalence in our sample, using the 40-point threshold, with a female/male ratio 2:1; the figure was sensibly lower with the 35-point threshold (21%). CONCLUSION: The results of this study highlight the diffusion of Orthorexia which may constitute an important risk factor for mental and physical health, but also the opportunity of more specific diagnostic instruments, so to facilitate a thorough understanding of this disorder.

Social anxiety spectrum

The aim of this paper is to provide the prevalence rates of mild, moderate and severe symptoms of social anxiety in a sample of high school students and to analyze gender differences and associated impairment levels within these three levels of severity. Five hundred and twenty students were assessed with the Social Anxiety Spectrum Self-Report (SHY-SR), a questionnaire that explores social anxiety spectrum. By applying two cut-off scores determined on a separate sample by using ROC analysis, the large majority (73.3 %) of subjects were classified as low scorers, 9% as medium scorers and 17.7% as high scorers. Fears related to social situations were reported both by high and medium scorers. Functional impairment defined by avoidance and school difficulties was more common among high scorers, but it was also reported to a significant extent by medium scorers. Compared to low and medium scorers, high scorers showed a higher F/M ratio (about 4:1) and a more homogeneous symptomatological profile in the two genders. In conclusion, our report confirms, in line with the literature, that even moderate levels of social anxiety are associated with significant functional impairment and distress for the individuals.

Binge eating disorder: prevalence and psychopathological features in a clinical sample of obese people in Italy.

Binge eating disorder (BED) is a recently conceptualized eating disturbance, and its clinical features and prevalence are still a matter of debate. This study uses interview methodology to estimate the prevalence of BED in Italy in a sample of 66 obese people presenting for treatment, and examines potential related features typical of patients with anorexia and bulimia nervosa. The lifetime and the 6-month prevalences of BED were 18.1 and 12.1%, respectively. Breaking the group down on the basis of the current as well as lifetime presence of BED, we found that the weight and shape primary to self-esteem, and the interpersonal distress related to body image, were associated with lifetime BED (P<0.05). All-or-none thinking about food and dieting was typical of BED patients as a whole, either current (P<0.01) or remitted (P<0.05). We discuss two important findings from our study: (a) the key role of self-esteem depending upon weight and shape in discriminating the eating-disordered obese from non-eating-disordered individuals; and (b) the need to explore the whole lifespan when screening for BED, so pointing to the state-trait issue.

Relationship between bipolar illness and binge-eating disorders

In this study we describe the frequency of eating disorders (EDs) in a group of bipolar (BP) patients. We evaluated a sample of 51 outpatients, diagnosed as having BP I disorder on the basis of the Structured Clinical Interview for DSM-IV (SCID). Each of these subjects was administered the Binge Eating Disorder Clinical Interview (BEDCI) to determine the presence of binge eating disorder (BED) or bulimia nervosa (BN). Of the 51 BP patients, 14 (9 BED, 5 BN) met criteria for an ED. Most patients developed binge eating coincident with the first episode of BP disorder or after the onset of it. This was true for those who developed BED as well as BN, and involved both manic and depressive phases. All BN patients were women (5/5), and family history of binge eating was present in 80% of BN subjects, but only in 22.2% of BED and 29.7% of non-ED BP patients. We found a high frequency of concordance between BP illness and binge eating problems in our sample of BP patients. Given the temporal sequence of the mood disorder, which generally preceded the ED, we suggest a model in which the ED evolves due to modulation of emotions with food, as well as use of medications to treat BP disorder that disrupt hunger and satiety mechanisms. Given differences in gender distribution and family history, cultural and familial influences may also be significant in the minority of BP binge-eating patients who develop BN.

Shared psychopathology in obese subjects with and without binge-eating disorder.

OBJECTIVE To investigate obese people with/without binge-eating Disorder (BED) in terms of shared psychopathological features pertaining to spectrum of eating disorders. METHOD One-hundred obese adult patients with a BMI > 30 kg/m(2) referred to an Eating Disorder Unit and/or hospital weight-loss programs were administered the BED Clinical Interview, the Eating Disorder Inventory, and the Structured Clinical Interview for Anorexic-Bulimic Spectrum, Self-Report. RESULTS Twenty-seven subjects satisfied DSM-IV research criteria for current BED; compared to nonbingeing obese subjects, BED ones were characterized by greater weight-shape concerns influencing self-esteem (p = .05), overall impairment due to the overweight condition (p < .005), psychological distress leading to professional help (p < .001), dichotomous reasoning (p = .01) and secondary social phobia due to the overweight condition (p < .005). Compared to the other group, BED obese subjects scored higher at the following EDI subscales: bulimia (p < .0001), ineffectiveness (p < .01), interoceptive awareness and social insecurity (p < .05). CONCLUSION The results of this study highlight the role of cognitive mechanisms such as dichotomous reasoning and weight-shape concerns unduly influencing self-esteem as a hallmark of BED in obese patients, and the importance of investigating eating disorder psychopathology by adopting a dimensional perspective, rather than strictly focusing on categories when dealing with obese patients.

Serotonergic activity measured by platelet [3H]paroxetine binding in patients with eating disorders

Most of the evidence from pharmacological studies supports the hypothesis of a serotonergic (5-HT) dysregulation in eating disorders (ED), though a specific alteration related to the major ED subtypes, anorexia (AN) and bulimia nervosa (BN), has not been identified yet, possibly because of changes over time in ED nosology. The aim of the present study was to verify whether differences in serotonergic activity, measured by platelet [3H]paroxetine binding, would validate current ED classification. Platelet [3H]paroxetine binding was investigated in 26 patients with eating disorders diagnosed in accord with DSM-IV criteria (AN, n=11; BN, n=15) and 26 normal weight controls of comparable age; ED symptomatology was assessed by the Diagnostic Schedule for Eating Disorders. ED patients had significantly lower B(max) values than controls (288.5+/-109.2 vs. 1396.8+/-251.3 fmol/mg), whereas the K(d) was not significantly altered (0.12+/-0.13 and 0.12+/-0.05 nM, respectively). Among patients, differences in B(max) were related neither to DSM-IV subtypes nor to clinical variables such as presence of binge-eating, purging, impulsive behaviors, or symptoms of depression. Although ED patients share a dysregulation in serotonergic activity, DSM-IV subtype classification was not validated by [3H]paroxetine binding, and hence does not correspond to a specific 5-HT profile.

Silent pericardial effusion in a sample of anorexic patients

Mortality in anorexic patients is mainly due to suicide or cardiac failure. The aim of this study was to investigate structural and functional cardiovascular alterations further by means of echocardiography in a sample of 15 medication-free patients with DSM-IV anorexia nervosa (AN) (BMI<17.5 kg/m2) and without any known cardiovascular disease and/or a family history of deafness or sudden death, and correlate the findings with clinical variables. The controls consisted of a sample of 10 constitutionally thin women (BMI<19 kg/m2), of comparable age, height and degree of physical activity. All of the subjects underwent Doppler echocardiography (ECHO), and the patients were also administered the Diagnostic Schedule for Eating Disorders (DSED) in order to assess the features and course of the eating disorder. ECHO revealed silent pericardial effusion in 71.4% of the patients vs. 10% of the controls (p<0.05); among the patients, the separation of pericardial leaflets was more frequent in those with a shorter duration of illness (p<0.05). Mitral valve motion abnormalities were more frequent among the patients than the controls (69.2% vs. 10%, p<0.005), and the left ventricular mass/body surface area was lower (54.8% vs. 59%, p<0.001). Isovolumetric relaxation time was longer in the patients (98.4 vs. 65 msec, p<0.01), but there were no significant differences in left ventricular ejection fraction (53.8% vs. 59%) or early diastolic deceleration time (146 vs. 155 msec). The results of this study support the association between AN and demonstrable anatomic and functional cardiac abnormalities, such as a reduced ventricular mass and mitral valve abnormalities. The ECHO findings provide evidence for clinically silent pericardial effusion in AN, which may be an early sign of cardiovascular involvement.

The relationship between binge eating disorder and non-purging bulimia nervosa

Aims.To further investigate the differentiation between non-purging bulimia nervosa (BN-NP) and binge eating disorder (BED), particularly as concerns weight-shape overconcern affecting self-esteem, a core belief to both anorexia and bulimia nervosa. Methods.Twenty-five female subjects with BN-NP and 25 female subjects with BED, consecutively referred to the Eating Disorder Unit of the DPPhNB, were administered the BEDCI, the EDI-2 and the BUT. Results.BED patients had a higher BMI (35.5 vs. 23.8 kg/m2, p<0.0001 and were slightly older than BN-NP ones. Weight-shape concerns as one of the main/the most important things influencing self-esteem were reported by 68% of BN-NP patients and 62.5% of BED ones. Age at onset of binge-eating, weight-cycling, overall impairment due to the eating behavior, sexual harassment, depressive and substance abuse comorbidity were equally represented in the two groups of patients. BN-NP patients scored higher than BED ones as regards EDI drive for thinness (p<0.05) and BUT weight phobia (p<0.05), with these scores significantly related to differences in BMI (p<0.0005 and p=0.012). Weight-shape overconcern influencing self-esteem was predictive of an earlier onset of binge-eating (p<0.05) and higher scores at the BUT weight phobia, and body image concerns (p<0.05). Conclusions.Differences between BED and BN-NP seem to be more of degree than type and there seems little value in the separation between BED and BN-NP based on weight-shape concerns that substantially impair self-esteem. This construct seems core to both disorders and plays a substantial role in triggering and maintaining the binge-eating cycle.

Lifetime Subthreshold Mania is Related to Suicidality in Posttraumatic Stress Disorder

INTRODUCTION Although the association between mood disorders, and particularly bipolar disorders, comorbidity and suicidality in posttraumatic (PTSD) patients is well established, less information is available on the impact of subsyndromal mood symptoms. The aim of the present study was, thus, to explore the frequency and relationship between subthreshold mood symptoms, assessed by a specific and validated questionnaire, and suicidality in PTSD patients. METHOD Sixty-five PTSD outpatients without bipolar disorders and 65 healthy control subjects were asked to complete the Mood Spectrum-SR-Lifetime Version (MOODS-SR), a questionnaire exploring the presence of subthreshold affective symptoms. Logistic regression models were used to analyze the relationships between suicidality, explored by six items of the MOODS-SR combined and dichotomized to denote the presence or absence of suicidal ideations/plans and/or attempts, and the number of manic/hypomanic or depressive symptoms. RESULTS Statistically significant and positive associations were found between the presence of manic/hypomanic and depressive symptoms and the likelihood of suicidal ideation or attempts. CONCLUSION Besides depressive, even subthreshold manic/hypomanic features seem to be associated with higher suicidality in PTSD patients.

Caffeine consumption among eating disorder patients: Epidemiology, motivations, and potential of abuse

Objective: Aim of the study was to investigate caffeine use in different types of eating disorders (ED) patients either using a categorical approach [Diagnostic and Statistical Manual of Mental Disorders — Fourth Edition — Text Revision (DSM-IV-TR) diagnostic criteria] or a dimensional perspective. Method: Fifty-eight ED female patients [anorexia nervosa (AN), restricting and binge-eating/purging type, N=15; bulimia nervosa (BN) purging type/nonpurging type, N=26; binge eating disorder (BED), N=17] referred to an Eating Disorder Unit and 15 non-clinical controls were administered the Eating Disorder Inventory-2 (EDI-2), the Clinical Global Impression (CGI) and the Caffeine Use Test, an interview specifically developed to investigate caffeine intake. Statistical analyses were then repeated clustering patients according to the presence/absence of purging behaviors (purgers, N=22; non-purgers, N=19; BED, N=17). Results: Current and lifetime caffeine use, measured as mg/day, were similar comparing controls and ED patients as a whole. BN patients showed a significantly higher maximum lifetime caffeine intake (817.4±528,9 vs 325.0±294.6 mg/die, F=3.246, p<0.05); the same for purgers vs controls (p<0.05). Caffeine abuse was significantly more represented among patients vs controls (p<0.01), but similar among different patients’ groups. As for diagnoses according to DSM-IV-TR Substance Use modified for caffeine, no significant difference was found among the different groups, for either Dependence, Intoxication or Withdrawal. Most of patients and controls reported pleasure as the main motivation for caffeine use, followed by increased vigilance and attention and appetite suppression in AN and BN patients. Note that a shift in diagnosis in the course of the ED from non-purging to purging type was associated with an increase in caffeine current, lifetime and maximum lifetime intake (F=1.667 p<0.05), except for BED patients. Severity of the ED measured as CGI score or comorbidity did not affect caffeine intake in patients as a whole, but in the purging subgroup current caffeine use was increased in presence of an anxiety disorder (p<0.05), and decreased in presence of a mood disorder (p<0.01). Conclusions: Data from the present study are in agreement with previous evidence in literature that a high percentage of ED patients ordinarily use caffeine with an average intake similar to that of the general population, however with a kind of binge attitude. Among heavy drinkers, daily caffeine intake and alcohol/cigarettes use are associated supporting the link with the dimension of impulse disregulation. The substantial number of subjects from our sample satisfying research criteria for Dependence, together with increasing reports of caffeine intoxication, suggests the growing relevance of these issues that deserve further investigation.