Carolina Lopez

Central coherence in eating disorders: a systematic review

BACKGROUND This review systematically appraised the research evidence for local versus global information processing to test the hypothesis that people with eating disorders (ED) had weak central coherence. METHOD Searches on Medline, EMBASE, PsycINFO and ISI Web of Science databases were conducted in November 2006 and subsequently updated in September 2007. Each search was conducted in two steps: (1) neuropsychological tasks measuring central coherence and (2) words related to cognitive functioning in eating disorders. Data were summarized in a meta-analysis if the number of studies for a given test was >5. RESULTS Data were extracted from 16 studies. Meta-analyses were conducted for four tasks obtaining moderate effect sizes. The majority of studies found global processing difficulties across the ED spectrum. The results are less clear regarding local processing. CONCLUSIONS People with ED have difficulties in global processing. It is less certain as to whether they have superior local processing. Currently, there is insufficient evidence to refute the weak central coherence hypothesis.

Weak central coherence in eating disorders : A step towards looking for an endophenotype of eating disorders

Previous work has found that women with anorexia nervosa and bulimia nervosa have weak coherence. The aim of this study was to examine whether women who had recovered from an eating disorder (ED) also had weak coherence. A total of 42 recovered ED women and 42 healthy women were assessed with a battery of five neuropsychological tests that measure aspects of global or local functioning. The recovered ED group showed superior local processing and poorer global processing than the healthy group. These results are indicative of weak coherence. The finding that weak coherence is a stable characteristic rather than a state effect suggests that it may be an endophenotype for ED.

Sensitivity to reward and punishment in eating disorders

The aim of this review was to collate and summarise the self-report data regarding anomalies in sensitivity to reward and punishment in eating disorders (ED) with use of a meta-analysis where possible. Electronic databases were searched to December 2008. Studies were required to have a non-eating disorder healthy control group and include at least one self-report measure of sensitivity to reward or punishment in an eating disorder population. Findings were very heterogeneous and inconsistencies between studies and measures were highlighted. In general, patients with anorexia nervosa (restricting type) were less sensitive to reward than healthy controls, whereas patients with bulimia nervosa and anorexia nervosa (binge/purge) type were more sensitive. All ED groups report higher sensitivity to punishment than healthy controls. Individuals with eating disorders differ from healthy controls in measures of reward and punishment sensitivity as measured using the Temperament and Character Inventory, Tridimensional Personality Questionnaire and BIS/BAS scales, but further work is required as there is some heterogeneity in the data. Generating more research using behavioural measures may increase understanding of the findings.

Central coherence in eating disorders: an updated systematic review and meta-analysis.

Abstract Objectives. A bias towards local information over the global “gist” (weak central coherence, WCC), has been identified as a possible contributing and maintaining factor in eating disorders (ED). The present study aimed to provide an updated review of the WCC literature and examine the hypothesis that individuals with ED have WCC. Methods. The new search found 12 eligible studies. Meta-analyses were performed on nine of these 12 studies, the remaining three were commented on individually. Data were combined with data from the previous 2008 review, and meta- analyses were performed on 16 studies (nine studies from the new search and seven studies from 2008 review). Results. Meta-analysis of the Group Embedded Figures Task provided evidence of superior local processing across all ED subtypes (pooled effect size of d = −0.62 (95% CI = −0.94, −0.31), P < 0.001). Evidence of poorer global processing in ED groups was found from meta-analyses of the Rey-Osterrieth Complex Figures task (d = −0.63 (95% CI = −0.77, −0.49, P < 0.001), and the Object Assembly Task (d = −0.65 (95% CI = −0.94, −0.37), P < 0.0001). Conclusions. As well as supporting the results of previous studies by providing evidence of inefficient global processing, this review has provided evidence of superior local processing, which supports the WCC hypothesis in ED.

The Assessment of the Family of People with Eating Disorders

The National Institute for Clinical Excellence (NICE) guidelines for eating disorders recommend that carers should be provided with information and support and that their needs should be considered if relevant. The aim of this paper is to describe how to structure an assessment of carers needs so that the family factors that can contribute to the maintenance of eating disorder symptoms are examined. We describe in detail the pattern of interpersonal reactions that can result when a family member has an eating disorder. Shared traits such as anxiety, compulsivity and abnormal eating behaviours contribute to some of the misperceptions, misunderstandings and confusion about the meaning of the eating disorder for family members. Unhelpful attributions can fuel a variety of emotional reactions (criticism, hostility, overprotection, guilt and shame). Gradually these forces cause family members to accommodate to the illness or be drawn in to enable some of the core symptoms.

Estimated intelligence quotient in anorexia nervosa: a systematic review and meta-analysis of the literature

BackgroundIt has been hypothesised that people with anorexia nervosa have a higher intelligence quotient (IQ) level than the general population. The purpose of this review was to systematically appraise the research into reported IQ levels in people with anorexia nervosa.MethodsA search using the terms intelligence quotient, IQ, intelligence, cognition, eating disorders and anorexia was conducted in electronic databases only.ResultsIn all, 30 peer-reviewed studies written in English that used well established measures of intelligence quotient (the National Adult Reading Test and Wechsler Intelligence Scales) were identified. This review established that people with anorexia nervosa score 10.8 units and 5.9 units above the average intelligence quotient of the normative population on the National Adult Reading Test and Wechsler Intelligence Scales, respectively. An association was found between Body Mass Index and intelligence quotient, as measured by the National Adult Reading Test.ConclusionsMore studies including other eating disorder categories and recovered people are needed to explore important questions regarding the role of the intelligence quotient in treatment response.

Feasibility and acceptability of DVD and telephone coaching‐based skills training for carers of people with an eating disorder

OBJECTIVE The aims of this study were (1) to describe the feasibility and acceptability of this skills-based training for carers of people with eating disorders and (2) to examine whether the anxiety, depression, and expressed emotion involved in the caregiving experience were reduced. METHOD Sixteen carers participated in the study. Assessment measures including the General Health Questionnaire, the Hospital Anxiety and Depression Scale, the Experience of Caregiving Inventory, and the Family Questionnaire were taken before and after the intervention. Feedback and a measure of acceptability measure were also collected. RESULTS Participants expressed high levels of satisfaction with most aspects of the training. Also most of the carers reported that the digital video devices (DVDs) provided sufficient training and were helpful for their stress levels. However, due to the small sample size, the lessening of psychological distress and depression after the intervention, did not reach formal levels of significance according the self-report measures. CONCLUSION The DVDs appear to be an acceptable method of delivering information and skills-based training for carers.

Meta-analysis on drugs in people with eating disorders.

OBJECTIVE The aim of this study was to examine whether drug use (DU) is higher in people with eating disorders (EDs) compared to a healthy control group and to perform a meta-analysis on the literature related to DU in people with EDs. METHOD We searched electronic databases (Medline, PsycINFO, Web of Science and CINAHL) and reviewed studies published from 1994 to August, 2007, in English, German or Spanish. A total of 16 papers fulfilled the inclusion criteria and were included. RESULTS The general meta-analysis revealed a negligible albeit significant effect size (0.119, p < .05). Risk was found to be higher in bulimia nervosa (BN, delta = 0.462, p = < .001), smaller in binge eating disorder (delta = 0.14, p < .05) and non-significant in anorexia nervosa (AN, delta = -.167, p = .070). CONCLUSIONS The differential risk observed in patients with BN might be related to differences in temperament or might be the result of reward sensitization.

Central coherence in women with bulimia nervosa

OBJECTIVE To examine the concept of central coherence in women with bulimia nervosa (BN) and address similarities and difference with those with anorexia nervosa (AN) METHOD: Forty two women with BN and 42 matched healthy women, completed neuropsychological testing measuring aspects of central coherence: Rey-Osterrieth Complex Figure (RCFT), Embedded Figures Test (EFT), Block Design Test (BD), Homograph Reading Test (HRT), and Sentence Completion Task (SCT). RESULTS The BN group showed superiority in local processing as measured by EFT and lesser relative advantage from segmentation in BD, and difficulties in global processing in both visual and verbal domains as examined by RCFT, HRT, and SCT. Anxiety levels were associated with low central coherence indices in RCFT. CONCLUSION People with BN displayed a profile consistent with the weak central coherence hypothesis. Their pattern of cognitive performance resembles that seen in AN although some differences are apparent.

Using neuropsychological feedback therapeutically in treatment for anorexia nervosa: two illustrative case reports.

Information processing in anorexia nervosa (AN) has been characterised as having a tendency to get trapped in detail, and having difficulties with set-shifting. These characteristics can be addressed in treatment through personalised interventions targeting thinking styles and their role in the development and maintenance of an eating disorder (ED). This paper outlines a three-session assessment and feedback module designed to identify and address these information processing biases. Two case reports are presented to illustrate the structure, content and outcome of the intervention. Both patients described the intervention as helpful in providing a structure and rationale for the steps required in recovery. The short nature and promising results of this intervention make it an attractive addition to current treatment programmes.