Giovanni Abbate Daga

Anger and personality in eating disorders

OBJECTIVE This study was designed to examine how anger, temperament and character profiles differ across subtypes of eating disorders (EDs) in comparison to healthy controls and to analyze the relationship between anger expression, eating attitudes and personality dimensions. METHOD One hundred and thirty-five outpatients (50 of whom suffered from anorexia nervosa restrictor type [AN-R], 40 from anorexia nervosa binge/purging [AN-BP] and 45 from bulimia nervosa [BN]) and 50 control subjects were recruited and administered State-Trait Anger Expression Inventory (STAXI), Temperament and Character Inventory (TCI) and Eating Disorder Inventory II (EDI-II). RESULTS STAXI showed greater levels of anger in patients with BN than in those with AN. TCI showed different personality profiles, in accordance with previous studies. Correlations were found between the management of anger feelings and psychological and personality traits typical of patients with EDs. CONCLUSIONS Clinically, impulsivity seems to be the psychopathologic element most strongly correlated to anger. Moreover, it appears clear that anger is better managed by individuals with greater character strength.

Olanzapine therapy in anorexia nervosa: psychobiological effects.

Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing–purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss–Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament–character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss–Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss–Durkee Rating Scale direct aggressiveness, of temperament–characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, ‘depression’ (Hamilton Rating Scale) and ‘direct aggressiveness’ (Buss–Durkee Rating Scale) among anorexia nervosa bingeing–purging patients, ‘persistence’ (temprerament–characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity–compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.

Efficacy of citalopram in anorexia nervosa: a pilot study.

INTRODUCTION Anorexia nervosa (AN) still lacks a defined treatment. Since fluoxetine proved effective in weight-restored anorexics, this pilot study evaluates the efficacy of another SSRI, citalopram, in restricting-type AN. EXPERIMENTAL PROCEDURES Fifty-two female anorectic outpatients were randomized in the citalopram (n=26) and waiting list (n=26) as a control group. Efficacy was assessed using Eating Disorder Inventory-2, Eating Disorder Inventory-Symptom Checklist, State-Trait Anger Expression Inventory, Beck Depression Inventory, Symptom Checklist-90 and Structured Clinical Interview for DSM-IV Axis II Disorders. RESULTS Thirteen patients dropped-out, thus 19 patients received citalopram and 20 remained in the control group. After 3 months of treatment, the citalopram group showed a decrease on BDI and SCL-90 Depression subscale and an improvement of baseline obsessive compulsive features on SCL-90, EDI-2 impulsiveness and Trait-anger on STAXI. Weight gain was similar in the two groups. DISCUSSION These preliminary results support the efficacy of citalopram in anorectics. Citalopram seems to improve depression, obsessive-compulsive symptoms, impulsiveness and Trait-anger.

Use of Reboxetine in Bulimia Nervosa: A Pilot Study:

The pharmacological approach to bulimia nervosa is mainly based (BN) on selective serotonin reuptake inhibitors, but many elements suggest the possible involvement of the noradrenergic system in this disorder. The aim of the study was to assess the efficacy of reboxetine – aselective norepinephrine uptake inhibitor – in a sample of bulimicoutpatients, after 3 months of treatment. Twenty-eight of 77consecutively admitted patients with a DSM-IV diagnosis of BN (without Axis I comorbidity) received reboxetine. All patients were assessed at baseline (T0), and after 1 month (T1) and 3 months (T3), respectively, of treatment with reboxetine 4 mg/day. The subjects were administered the following questionnaires: Hamilton Rating Scale for Anxiety (HAM-A) and for Depression (HAM-D), Global Assessment Functioning (GAF), Eating Disorder Inventory-2 (EDI-2) and Body Shape Questionnaire (BSQ). Sixty percent of the patients were responsive to treatment(evaluated as a 50% decrease of bulimic behaviours). After 3 months of treatment, a significant reduction emerged in the scores of various EDI-2 subscales (Bulimia, Drive for Thinness, Body Dissatisfaction, Social Insecurity, Interpersonal Distrust, etc.) and in the BSQ total score. Moreover, depressive symptoms (HAM-D) and Global Functioning (GAF) scores showed a significant improvement. These data support a fast and favourable effect of reboxetine in the treatment of BN, both onsymptoms and psychopathological features. Moreover, the specific and strong action of reboxetine on improvement of social functioning is also supported in this disorder.

Clinical, Psychological, and Personality Correlates of Asceticism in Anorexia Nervosa: From Saint Anorexia to Pathologic Perfectionism

This study investigated the personality and clinical correlates of asceticism in 154 anorectic patients. Multiple linear regression models showed that asceticism was related to angry temperament, high control over anger, perfectionism, maturity fears, and number of vomiting episodes per week. These results suggest that the self-discipline and hypercontrol of anorectic patients are related to a temperament prone to angry feelings in subjects with a fear of becoming adult and with a trait of pathologic perfectionism.

Temperament and character in couples with fertility disorders: a double-blind, controlled study

OBJECTIVE To evaluate the personality features of infertile patients. DESIGN A double-blind, controlled study. SETTING An outpatient facility for diagnosis and care of infertility. PATIENT(S) We assessed 142 infertile couples with obstetric-gynecologic clinical and instrumental examinations. The couples were divided into three groups: organic infertility, functional infertility, and infertility of uncertain origin. The third group was excluded. INTERVENTION(S) Organic infertility and functional infertility were ascertained with gynecologic and andrologic clinical examinations, seminal liquid examination, postcoital testing, progesterone assay, hysterosalpingography, biopsy of endometrium, and laparoscopy. Personality traits were assessed with the Temperament and Character Inventory (TCI). MAIN OUTCOME MEASURE(S) Results of the Temperament and Character Inventory. RESULT(S) Infertile women showed lower Cooperativeness than control women. Women with functional infertility had lower scores in Cooperativeness and Self-Directedness than women with organic infertility. Men belonging to the functional infertility group had a lower Novelty Seeking score than did those of the organic infertility group. Men and women in the functional infertility group showed higher Harm Avoidance than those in the organic infertility and control groups. CONCLUSION(S) The results emphasize that the study of personality in the diagnostic and therapeutic assessment of infertility might provide useful predictive elements for functional infertility.

Parental bonding and eating psychopathology in bulimia nervosa: personality traits as possible mediators

AIMS The relationship between eating disorders, attachment, personality traits and eating psychopathology remains unexplored. This study tested the mediating role of temperament and character between parental bonding and psychopathology in bulimic women. METHODS 154 bulimic subjects and 154 healthy controls were compared using Parental Bonding Instrument (PBI), Temperament and Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), and Beck Depression Inventory (BDI). Multiple regression analysis tested the mediation of personality traits between parenting and eating psychopathology. RESULTS Bulimic subjects displayed low maternal and paternal care and low self-directedness, and high novelty seeking and eating psychopathology. Maternal care was negatively related to social insecurity, inadequacy and impulsiveness. Paternal care predicted novelty seeking, self-directedness, interoceptive awareness, impulsiveness, and asceticism. The mediation effect of self-directedness between paternal care and psychopathology was significant, not the one of novelty seeking. CONCLUSIONS Parental care is lower in bulimic than in control women even when controlled for possible confounding variables. Some eating psychopathology traits are related to maternal and paternal care, but not the bulimia subscale. Paternal care is also related to temperament and character traits which are related to eating psychopathology. Self-directedness mediates with different degrees between parenting and eating psychopathology. Clinical implications are discussed.

Hypomania across the binge eating spectrum. A study on hypomanic symptoms in full criteria and sub-threshold binge eating subjects.

BACKGROUNDS Obese subjects affected by binge eating can be distinguished between those showing full criteria Binge Eating Disorder (BED) and those who show binge eating of insufficient frequency to satisfy DSM criteria, or sub-threshold BED (s-BED). The present paper aims to investigate whether subjects with BED full criteria show more hypomanic symptoms than those with s-BED, after controlling for personality variables as potential confounders. METHODS The Hypomania Checklist (HCL-32), the Beck Depression Inventory (BDI) and the Temperament and Character Inventory (TCI) were administered to 103 obese patients with binge eating. RESULTS Full criteria BED subjects were more likely to be female and showed higher HCL-32 scores and lower scores in character dimensions (Self-directedness and Cooperativeness) compared to s-BED subjects. A logistic regression with Eating Disorder Diagnosis as outcome measure (BED or s-BED) revealed that lower Cooperativeness, higher Hypomania scores and female sex predicted having BED full criteria. LIMITATIONS Further research is necessary to replicate these findings in a larger sample. CONCLUSIONS Patients with more severe binge eating might be more likely to have a comorbid bipolar spectrum disorder. Hypomanic symptoms should be assessed and mood stabilizing treatment should be considered in these patients.

Novelty-Seeking in Parkinson's Disease After Deep Brain Stimulation of the Subthalamic Nucleus: A Case–Control Study

BACKGROUND The prevalence of psychiatric comorbidity in Parkinsons disease (PD) is about 50%. OBJECTIVE The authors investigated differences among PD patients treated by deep brain stimulation (DBS), by drugs alone (noDBS), and healthy control subjects. METHOD Samples of 22 subjects in each group were assessed with the Temperament and Character Inventory (TCI) and Hamilton scales for anxiety and depression (Ham-A and Ham-D). RESULTS Higher scores emerged on two Novelty-Seeking subscales in PD-DBS patients. Ham-A and Ham-D scores were lower in PD-DBS patients than in PD-noDBS patients and control subjects. Rigidity and non-impulsiveness were lower in PD-DBS than in PD-noDBS patients. CONCLUSION Further studies should investigate whether or not these changes in personality are a consequence of the motor and depression improvement after DBS.

Baseline personality functioning correlates with 6 month outcome in schizophrenia

OBJECTIVE The assessment of outcome in schizophrenic patients should consider both the response to treatment and the recovery of social skills. The aim was to evaluate the outcome and related psychostructural and clinical factors in schizophrenic patients after they underwent 6 months of residential multimodal treatment. METHOD Fifty-two schizophrenic patients enrolled in a multimodal treatment program were included in the study. Symptomatology and social functioning were assessed with the Brief Psychiatric Rating Scale (BPRS) and the Social and Occupational Functioning Assessment Scale (SOFAS). The Karolinska Psychodynamic Profile (KAPP) was used for the psychostructural evaluation. RESULTS After 6 months there was a significant improvement in the global scores of BPRS, SOFAS, and some areas of KAPP. The personality (KAPP) and social-occupational functioning (SOFAS) at baseline (T0) correlated with the global score of BPRS at 6 months (T6); moreover, SOFAS at T6 correlated with BPRS and KAPP at T0 and with the illness duration. CONCLUSION The better the personality functioning in schizophrenic patients the better seems to be the response to treatment, with regard to symptoms as well as rehabilitation. Personality assessment might be useful for the individualisation of therapies, even within the context of a standardised program.