Giovanni Giacomo Rovera

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.

Mood, eating attitudes, and anger in obese women with and without Binge Eating Disorder

OBJECTIVE The aim of this study was to evaluate the anger levels and their management in obese patients. METHODS A total of 103 obese women [51 with Binge Eating Disorder (BED) and 52 without BED] were included in the study and compared to 93 healthy controls. They were assessed with the State-Trait Anger Expression Inventory (STAXI), Beck Depression Inventory (BDI), and Eating Disorder Inventory-2 (EDI-2). RESULTS The BDI score is higher in obese subjects than in controls and obese binge eaters have higher levels of depression than obese patients without BED. Differences among the three groups can be found in almost all subscales of the EDI-2, even after controlling for the variable depression (BDI). For STAXI, the only difference among the three groups, which remains significant after controlling for depression, is the tendency to express anger outside (AX-OUT), which is higher in obese binge eaters. The correlation study highlights the importance of impulsivity in the group of obese binge eaters, whereas in obese patients without BED, the tendency toward anger suppression (AX-IN) is seen. DISCUSSION Obese patients with BED might be considered a subgroup deserving greater psychiatric interest, both for the greater severity of the eating disorder and for the comorbidity with subthreshold depressive symptoms and with borderline personality traits. In obese patients without BED, eating behavior seems more correlated to the psychological functioning typical of psychosomatic disorders. Implications for treatment are discussed.

Dropout from Brief Psychotherapy within a Combination Treatment in Bulimia nervosa: Role of Personality and Anger

Background: To explore the personality, psychopathology, and clinical features of bulimic patients who do not complete psychotherapy, within a combined treatment. Methods: 86 patients with bulimia nervosa (BN; DSM-IV) were evaluated before beginning treatment. The Eating Disorder Inventory II (EDI-II), State-Trait Anger Expression Inventory (STAXI), and the Temperament and Character Inventory (TCI) were administered to all patients. Results: 3 subjects failed to engage in psychotherapy. Comparing patients who dropped out (n = 28) with those who did not drop out from psychotherapy (n = 55), significant differences were found in some psychopathologic (EDI-II, STAXI) and personality (TCI) variables. In particular, patients who dropped out from the treatment were more impulsive and more likely to feel anger; they were also less cooperative and less self-directive. No significant differences in sociodemographic, clinical variables and in response to fluoxetine were found between the two groups (dropout and completers). Conclusions: We found a characteristic profile in the bulimic patients who dropped out from brief psychotherapy, i.e., they are less cooperative and more predisposed to anger. These data suggest that dropping out in a subgroup of BN patients could be related to borderline personality traits and to difficulties in making and maintaining a therapeutic relationship. Implications for treatment are discussed.

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.

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 Italian men with anorexia nervosa: A controlled study with the temperament and character inventory

This study compares personality traits of men and women with anorexia nervosa and matched controls. The Temperament and Character Inventory was used to assess personality traits of 15 male and 50 female anorectics and 28 male and 58 female controls matched for age and education. Male anorectic patients displayed overall lower reward dependence and cooperativeness. Male and female anorectics displayed higher persistence and lower self-directedness than controls. Anorectic men had lower harm avoidance than anorectic women. Discriminating analysis revealed the anorectic male group as the most clearly defined. Anorectic men shared more traits with anorectic women than with male controls. Temperament and character of anorectic men reflect features partly similar to those of women with anorexia. Personal history and discriminating analysis led to interesting inferences about the gender identity of anorectic men. These results should be helpful in directing pharmacologic and psychotherapeutic approaches that consider the specific personality traits of these patients.

Late DNA replication pattern in human haemopoietic cells: A comparative investigation using a high resolution quantitative autoradiography

Abstract A quantitative autoradiographic technique was used to compare DNA duplication during the final phase of the synthesis period (about 30 min) in chromosomes of lymphocytes, erythroblasts and human bone marow cells. The duration of the G2 period in the three tissues was determined and a calculation was made in order to establish at which point before the beginning of this period each pair of chromosomes had completed synthesis. It was observed that the length of the single G2 period is very much the same in all three tissues. It was therefore possible to conclude that, in 19 chromosome pairs, synthesis will terminate in the last 10 min of the S period and in the other 5 pairs in the last 5 min. The synthetic activity rate of each pair of chromosomes, in the three types of haemopoietic cells, did not present significant differences either in the overall period or in the time intervals into which this period was subdivided (using time analysis based on a cumulative distribution method). Detection of late-labelling zones at the subchromosomic level, using a new technique, made it possible to obtain characteristic patterns for many chromosomes; but we were unable to detect qualitative or quantitative differences between the cells of different tissues.

Eating psychopathology and personality in eating disorders

OBJECTIVE The question of how many psychopathologic factors are involved in Anorexia Nervosa (AN) and Bulimia Nervosa (BN) has no definite answer. The combination of psychopathology and personality research may shed a light upon the determinants of eating pathology. METHODS The study consists in the administration of the Temperament and Character Inventory (TCI) and the Eating Disorder Inventory 2 (EDI-2) to 95 outpatient anorectic women (50 restrictive and 45 binge-purging) and to 92 bulimic outpatient women (78 with and 14 without purging behaviours). The respective scores of each DCA subgroup are compared. RESULTS Restricter anorectics are characterised by lower novelty seeking on respect to all the other groups and by a higher self-directedness on respect to bingeing-purging anorectics and purging bulimics. Also psychopathologic differences between restricter anorectics and the other groups are extensive. Bingeing-purging anorexia shares many traits with bulimia. CONCLUSIONS In their complex, data suggest and in-deep study aimed to a possible re-classification of EDs which would take impulsiveness in greater consideration. The differences in temperament and character traits may partially be responsible of the repression or discontrol of impulsive eating behaviours in different ED subtypes.

Trisomy of the Philadelphia chromosome (Ph) in blastic crises of a case of chronic myeloid leukemia

Three Philadelphia chromosomes in addition to other extra-chromosomes in most of the bone marrow cells (70%) were observed in the terminal course of a case of chronic myeloid leukemia with blastic crisis. The percentage distribution of extra-chromosomes in the single groups of the Denver system was evaluated and compared with the theoretical expectation. This analysis showed a distribution of extra-chromosomes widely different from the random expectation, several chromosome groups being highly underrepresented (namely A, B, D and E) and others (C, F and G) overrepresented. From the karyotype analysis the commonest feature (27,4%) appeared to be the presence of three extra-chromosomes in group C, one extra in group F, and two extra Ph1 in group G. The leukocyte alkaline phosphatase performed on smears of peripheral blood gave a total value higher than normal. Various workers have connected the low values usually observed in chronic myeloid leukemia with the loss in chromosome 21 genetic material. In the present case, the increase in leukocyte alkaline phosphatase alongside an increase in chromatin 21 material might suggest a correlation between these two parameters.