Giovanni Castellini

Diagnostic crossover and outcome predictors in eating disorders according to DSM-IV and DSM-V proposed criteria: a 6-year follow-up study.

Objective: To evaluate in a 6-year follow-up study the course of a large clinical sample of patients with eating disorders (EDs) who were treated with individual cognitive behavior therapy. The diagnostic crossover, recovery, and relapses were assessed, applying both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and the DSM-V proposed criteria. Patients with EDs move in and out of illness states over time, display frequent relapses, show a relevant lifetime psychiatric comorbidity, and migrate between different diagnoses. Method: A total of 793 patients (including anorexia nervosa, bulimia nervosa, binge eating disorder, and EDs not otherwise specified) were evaluated on the first day of admission, at the end of treatment, 3 years after the end of treatment, and 3 years after the first follow-up. Clinical data were collected through a face-to-face interview; diagnosis was performed by means of the Structured Clinical Interview for DSM-IV and the Eating Disorder Examination Questionnaire was applied. Results: A consistent rate of relapse and crossover between the different diagnoses over time was observed. Mood disorders comorbidity has been found to be an important determinant of diagnostic instability, whereas the severity of shape concern represented a relevant outcome modifier. Using the DSM-V proposed criteria, most patients of EDs not otherwise specified were reclassified, so that the large majority of ED patients seeking treatment would be included in full-blown diagnoses. Conclusions: Among EDs, there are different subgroups of patients displaying various courses and outcomes. The diagnostic instability involves the large majority of patients. An integration of categorical and dimensional approaches could improve the psychopathological investigation and the treatment choices. AN = anorexia nervosa; BED = binge eating disorder; BMI = body mass index; BN = bulimia nervosa; CBT = cognitive behavior therapy; DSM = Diagnostic and Statistical Manual of Mental Disorders; EDs = eating disorders; EDE 12.0D = Eating Disorder Examination Interview; EDNOS = eating disorders not otherwise specified; EDNOS-A = eating disorders not otherwise specified Anorectic type; EDNOS-B = eating disorders not otherwise specified Bulimic type; OBEs = objective binge episodes; SBEs = subjective binge episodes; s-BED = subthreshold BED.

Correlations between binge eating and emotional eating in a sample of overweight subjects

The present study compared threshold, subthreshold BED (Binge Eating Disorder), and subjects without BED in a population of overweight/obese individuals seeking weight loss treatment, considering the sociodemografic features, the eating specific and general psychopathology, the organic and psychiatric comorbidity, the quality of life, and the emotional eating as a trigger factor for binge eating. Four hundred thirty eight overweight subjects seeking weight loss treatment have been evaluated by means of a clinical interview (SCID I), and different self-reported questionnaires, assessing the eating specific and general psychopathology. One hundred five subjects (24% of the sample) fulfilled the DSM-IV criteria of BED, 146 (33.3%) fulfilled the criteria of subthreshold BED, and 187 (42.7%) subjects were diagnosed overweight non-BED. The groups did not differ in terms of psychiatric comorbidity, diet attempts, quality of life, and psychopathology, while the presence of binge eating was associated to higher eating, weight, and shape concerns. Emotional eating was positively correlated to the presence/severity of binge eating.

The Role of Life Events and HPA Axis in Anxiety Disorders: A Review

Stressful life events and dysfunctional Hypothalamic Pituitary Adrenal (HPA) axis have been implicated in the pathogenesis of psychiatric disorders, including anxiety disorders. This paper attempts to review the existing literature on childhood traumata, recent life events, HPA axis functioning and their relationship in Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Phobia. Preclinical and clinical models will be analyzed. Stressful life events seem to have a role in the onset and in the course of these disorders and HPA axis abnormalities have been reported in almost all anxiety disorders. The hypothesis that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology, will be evaluated.

Functional neuroimaging in anorexia nervosa: A clinical approach

AIMS To provide a review of the available literature about the functional neuroimaging of anorexia nervosa, and to summarize the possible role of neurobiological factors in its pathogenesis. METHODS A systematic review of the literature was performed using PubMed and Medline electronic database (1950-September 2009). Eligible studies were restricted to those involving the main parameters of cerebral activity and functional neuroimaging techniques. Findings of the reviewed studies have been grouped on a diagnostic subtype basis, and their comparison has been interpreted in terms of concordance. RESULTS We found a high level of concordance among available studies with regard to the presence of frontal, parietal and cingulate functional disturbances in both anorexia nervosa restricting and binge/purging subtypes. Concordance among studies conducted regardless of the anorexia nervosa subtypes suggests an alteration in temporal and parietal functions and striatal metabolism. CONCLUSIONS The most consistent alterations in anorexia nervosa cerebral activity seem to involve the dorsolateral prefrontal cortex, the inferior parietal lobule, the anterior cingulate cortex and the caudate nucleus. They may affect different neural systems such as the frontal visual system, the attention network, the arousal and emotional processing systems, the reward processing network, and the network for the body schema.

Cross‐Sex Hormonal Treatment and Body Uneasiness in Individuals with Gender Dysphoria

INTRODUCTION Cross-sex hormonal treatment (CHT) used for gender dysphoria (GD) could by itself affect well-being without the use of genital surgery; however, to date, there is a paucity of studies investigating the effects of CHT alone. AIMS This study aimed to assess differences in body uneasiness and psychiatric symptoms between GD clients taking CHT and those not taking hormones (no CHT). A second aim was to assess whether length of CHT treatment and daily dose provided an explanation for levels of body uneasiness and psychiatric symptoms. METHODS A consecutive series of 125 subjects meeting the criteria for GD who not had genital reassignment surgery were considered. MAIN OUTCOME MEASURES Subjects were asked to complete the Body Uneasiness Test (BUT) to explore different areas of body-related psychopathology and the Symptom Checklist-90 Revised (SCL-90-R) to measure psychological state. In addition, data on daily hormone dose and length of hormonal treatment (androgens, estrogens, and/or antiandrogens) were collected through an analysis of medical records. RESULTS Among the male-to-female (MtF) individuals, those using CHT reported less body uneasiness compared with individuals in the no-CHT group. No significant differences were observed between CHT and no-CHT groups in the female-to-male (FtM) sample. Also, no significant differences in SCL score were observed with regard to gender (MtF vs. FtM), hormone treatment (CHT vs. no-CHT), or the interaction of these two variables. Moreover, a two-step hierarchical regression showed that cumulative dose of estradiol (daily dose of estradiol times days of treatment) and cumulative dose of androgen blockers (daily dose of androgen blockers times days of treatment) predicted BUT score even after controlling for age, gender role, cosmetic surgery, and BMI. CONCLUSIONS The differences observed between MtF and FtM individuals suggest that body-related uneasiness associated with GD may be effectively diminished with the administration of CHT even without the use of genital surgery for MtF clients. A discussion is provided on the importance of controlling both length and daily dose of treatment for the most effective impact on body uneasiness.

Comparison of individual and group cognitive behavioral therapy for binge eating disorder. A randomized, three-year follow-up study

Few long-term follow-up studies evaluated the response to psychotherapeutic interventions in binge eating disorder (BED). The effectiveness of individual and group cognitive-behavioral therapy, and the possible predictors of outcome were evaluated in a randomized controlled trial. At the beginning, at the end of treatments, and three years after the end of treatments, 144 patients affected by threshold or subthreshold BED were assessed using a clinical interview and self-reported questionnaires evaluating the eating attitudes and behavior, emotional eating, and general psychopathology. The following outcome measures were considered: recovery at 3-year follow-up, weight loss, treatment resistance, relapse, and diagnostic change. Both treatments showed similar response in terms of all outcome measures in the long-term, and determined a significant reduction of binge eating frequency, and a mild reduction of weight. The absence of a history of amphetamine derivatives consumption, lower emotional eating and binge eating severity at baseline were predictors of full recovery in the long-term. A low Emotional eating was found to be the only predictor of weight reduction. Overweight during childhood, full blown BED diagnosis, and high emotional eating were predictors of treatment resistance. Treatments considering the relationships between binge eating and emotional eating could improve the outcome of BED patients.

Gender Identity Disorder and Eating Disorders: Similarities and Differences in Terms of Body Uneasiness

INTRODUCTION Subjects with gender identity disorder (GID) have been reported to be highly dissatisfied with their body, and it has been suggested that the body is their primary source of suffering. AIMS.: To evaluate quality and intensity of body uneasiness in GID subjects, comparing them with a sample of eating disorder patients and a control group. To detect similarities and differences between subgroups of GID subjects, on the basis of genotypic sex and transitional stage. METHODS Fifty male-to-female (MtF) GID (25 without and 25 with genital reassignment surgery performed), 50 female-to-male (FtM) GID (28 without and 22 with genital reassignment surgery performed), 88 eating disorder subjects (26 anorexia nervosa, 26 bulimia nervosa, and 36 binge eating disorder), and 107 healthy subjects were evaluated. MAIN OUTCOME MEASURES Subjects were studied by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, the Symptom Checklist (SCL-90), and the Body Uneasiness Test (BUT). RESULTS GID and controls reported lower psychiatric comorbidity and lower SCL-90 General Severity Index (GSI) scores than eating disorder subjects. GID MtF without genital reassignment surgery showed the highest BUT values, whereas GID FtM without genital reassignment surgery and eating disorder subjects showed higher values compared with both GID MtF and FtM who underwent genital reassignment surgery and controls. Considering BUT subscales, a different pattern of body uneasiness was observed in GID and eating disorder subjects. GID MtF and FtM without genital reassignment surgery showed the highest BUT GSI/SCL-90 GSI ratio compared with all the eating disorder groups. CONCLUSIONS GID and eating disorders are characterized by a severe body uneasiness, which represents the core of distress in both conditions. Different dimensions of body uneasiness seem to be involved in GID subsamples, depending on reassignment stage and genotypic sex. In eating disorder subjects body uneasiness is primarily linked to general psychopathology, whereas in GID such a relationship is lacking.

Gender differences in depression and anxiety: The role of age

Although females run greater risk for affective disorders, the greater vulnerability of women for these disorders varies with the age. The present study evaluates the lifetime incidence of depressive and anxiety disorders by age and gender in a community sample (2363 subjects; 54.6% females), representative of the general population (Sesto Fiorentino Study). Lifetime prevalence of affective disorders resulted higher in females. The age-sex pattern for affective disorders was observed only before menopause.

Different Moderators of Cognitive-Behavioral Therapy on Subjective and Objective Binge Eating in Bulimia Nervosa and Binge Eating Disorder: A Three-Year Follow-Up Study

Background: Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes. Methods: 85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2). Results: At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients. Conclusions: Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.

Emotional eating in anorexia nervosa and bulimia nervosa

OBJECTIVES The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. METHODS The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). RESULTS No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. CONCLUSION Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients.