Giovanni Maria Ruggiero

Perfectionism in depression, obsessive-compulsive disorder and eating disorders

High levels of perfectionism have been observed in major depression, anxiety disorders and eating disorders. Though few studies have compared levels of perfectionism across these disorders, there is reason to believe that different dimensions of perfectionism may be involved in eating disorders than in depression or anxiety [Bardone-Cone, A. M. et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 84-405]. The present study compared patients with major depression, obsessive-compulsive disorder, and eating disorders on dimensions of perfectionism. Concern over Mistakes was elevated in each of the patient groups while Pure Personal Standards was only elevated in the eating disorder sample. Doubts about Actions was elevated in both patients with obsessive-compulsive disorder and eating disorders, but not in depressed patients. Analyses of covariance indicated that Concern over Mistakes accounted for most of the variance in the relationship of perfectionism to these forms of psychopathology.

Body Dissatisfaction and Its Interrelations with Other Risk Factors for Bulimia nervosa in 12 Countries

Background: It is widely accepted that risk factors for bulimia nervosa, mainly body dissatisfaction, are dependent on cultural factors. However, to date few studies have compared data from different cultures with an appropriate methodology. Therefore we aimed to gather reliable information on body dissatisfaction and other risk factors for bulimia from different nations and to reveal their functional interrelations. Methods: A series of 10 silhouettes, designed to be as far as possible free from cultural and other detailed aspects, was shown to 1,751 medical and nursing students in 12 nations. A functional model was applied to each sample and tested by structural equation methodology. Results: The most extreme body dissatisfaction was found in northern Mediterranean countries, followed by northern European countries. Countries currently undergoing a process of westernization show an intermediate amount of body dissatisfaction, and non-western countries demonstrate rather low values. Body dissatisfaction is the most important influence on dieting behaviour in most countries. Conclusions: Despite ongoing adoption of western values worldwide, we observe remarkable differences in body dissatisfaction between different cultures. That body dissatisfaction seems disturbingly partly detached from the actual BMI, i.e. possible overweight, as well as from feelings of low self-esteem in some western countries, raises new questions about the possible origin of the pressure to be thin.

A single blind comparison of amisulpride, fluoxetine and clomipramine in the treatment of restricting anorectics.

1. The study evaluated the efficacy of amisulpride, fluoxetine and clomipramine at the beginning of the re-feeding phase of the treatment of restricting anorexia nervosa according to DSM-IV criteria. 2. 13 patients, mean weight 37.61 kg +/- 9.80 SD, were treated with clomipramine at a mean dosage of 57.69 mg +/- 25.79 SD; 10 patients, mean weight 40.90 kg +/- 6.98 SD, were treated with fluoxetine at a mean dosage of 28.00 mg +/- 10.32 SD; 12 patients, mean weight 38.41 kg +/- 8.33 SD, were treated with amisulpride at a mean dosage of 50.00 mg +/- 0.00 SD. 3. Clinical evaluation was carried out under single-blind condition at basal time and after three months by a structured clinical interview, the Eating Disorder Interview based on Long Interval Follow-up Evaluation (LIFE II BEI). 4. Patients treated with amisulpride showed a more significant increase (p=0.016) of mean weight. Concerning weight phobia, body image disturbance and amenorrhoea, no significant difference resulted.

Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem

OBJECTIVE There is a large body of research about perfectionism and low self-esteem in eating disorders (ED). However, little is known about the influence in ED of a distorted cognition in the domain of control: the perception of low control. The present study examined the main and interactive effects of concern over mistakes (an important dimension of perfectionism), self-esteem, and perception of control on drive for thinness, bulimia, and body dissatisfaction. METHOD Forty individuals with ED and 55 controls completed the Multidimensional Perfectionism Scale, the Anxiety Control Questionnaire, the Rosenberg self-esteem scale, and the three symptomatic scales of the Eating Disorder Inventory, which are drive for thinness, bulimia and body dissatisfaction. Multiple linear regression was used to test the hypothesis that perception of low control has a significant effect on the symptomatic scales of the EDI. RESULTS The ED group had significantly lower perception of control and self-esteem and higher concern over mistakes, drive for thinness, bulimia, and body dissatisfaction than the control group. Analysis of interactive effects suggested that a combination of a low perception of control and a low self-esteem seems to moderate the effects of concern over mistakes on drive for thinness, bulimia, and body dissatisfaction. DISCUSSION ED are associated with a tendency to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal feelings and external events. Perception of control and self-esteem seems to moderate the predictive power of concern mistakes on symptoms of ED. The results suggest that a low perception of control is an important cognitive factor in ED.

Daily and Nightly Anxiety Among Patients Affected by Night Eating Syndrome and Binge Eating Disorder

We tested if there were any differences about nocturnal and diurnal anxiety between patients either affected by Binge Eating Disorder (BED) or Night eating Syndrome (NES). Fifty four patients affected by BED, 13 by NES and 16 by both BED and NES were tested using the Self Rating Anxiety Scale (SAS) and the Sleep Disturbance Questionnaire (SDQ). Their nocturnal eating behavior was ascertained through the Night Eating Questionnaire (NEQ). Patients affected by both BED and NES scored significantly higher on SAS than other patients. Among NES patients we found a correlation between a SDQ subscale and two subscales of the NEQ. Among BED patients we found a correlation between SAS scores and the nocturnal ingestion subscale of the NEQ. Nocturnal eating is related to nocturnal anxiety among NES patients while it is related to diurnal anxiety among patients affected by BED. These findings support the hypothesis that BED and NES are distinct syndromes sharing overeating but with different pathways to excessive food intake.

Psychopathology and treatment of Night Eating Syndrome: A review

The article reviews the international literature about psychopathological aspects and treatments of Night Eating Syndrome (NES). Studies were found using Medline; data from recent international books and conferences about ED are included, but single case descriptions are not included in the study. NES seems to be consistently related to mood disorders and anxiety. There is a low overlap between other eating disorders, including binge eating disorder (BED), and NES. The relationship between the syndrome and substance abuse is unclear and needs further study. Sleep architecture seems not to be severely altered among those with NES. A limited number of treatment studies for NES have been published or presented. Most of the literature focuses on pharmacological treatment, with fewer psychotherapeutic approaches reported at this time. Larger, multi-site treatment studies would serve to confirm the findings of this first wave of clinical trials.

The effect of rumination on craving across the continuum of drinking behaviour.

BACKGROUND Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems. AIMS The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour. METHODS Participants of three groups of alcohol-dependent drinkers (N=26), problem drinkers (N=26) and social drinkers (N=29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase. RESULTS Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. CONCLUSIONS Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.

Parental overprotection and metacognitions as predictors of worry and anxiety

BACKGROUND Parental overprotection may have a direct effect on worry through hindering childrens exploration experiences and preventing the learning of action-oriented coping strategies (Cheron, Ehrenreich and Pincus, 2009; Nolen-Hoeksema, Wolfson, Mumme and Guskin, 1995) and an indirect effect through fostering the development of maladaptive metacognitions that are associated with the activation of worry and the escalation of anxiety (Wells, 2000). AIM The aim was to investigate the relative contribution of recalled parental overprotection in childhood and metacognitions in predicting current levels of worry. METHOD A community sample (n = 301) was administered four self-report instruments to assess parental overprotection, metacognitions, anxiety and worry. RESULTS Metacognitions were found to predict levels of worry independently of gender, anxiety and parental overprotection. They were also found to predict anxiety independently of gender, worry and parental overprotection. CONCLUSIONS The combination of a family environment perceived to be characterized by overprotection and high levels of maladaptive metacognitions are a risk factor for the development of worry.

Worry as an adaptive avoidance strategy in healthy controls but not in pathological worriers

The cognitive avoidance model of worry assumes that worry has the adaptive function to keep under control the physiological arousal associated with anxiety. This study aimed to test this model by the use of a fear induction paradigm in both pathological and healthy individuals. Thirty-one pathological worriers and 36 healthy controls accepted to be exposed to a fear induction paradigm (white noise) during three experimental conditions: worry, distraction, and reappraisal. Skin conductance (SCR) and heart rate variability (HRV) were measured as indices of sympathetic and parasympathetic nervous system functioning. Worriers showed increased sympathetic and decreased parasympathetic activation during the worry condition compared to non-worriers. There were no differences between groups for the distraction and reappraisal conditions. SCRs to the white noises during worry were higher in worriers versus controls throughout the entire worry period. Intolerance of uncertainty - but not metacognitive beliefs about worry - was a significant moderator of the relationship between worry and LF/HF-HRV in pathological worriers. Results support the cognitive avoidance model in healthy controls, suggesting that worry is no longer a functional attitude when it becomes the default/automatic and pathological response.

The influence of stress on the relationship between cognitive variables and measures of eating disorders (in healthy female university students): A quasi-experimental study

OBJECTIVE: Perfectionism, poor self-esteem and stress have all been described as important risk factors for eating disorders. The purpose of this study was to assess whether a stressful situation is significantly correlated to and associated with significantly higher levels of perfectionism, stress, quantifiable measures of eating disorders, and with significantly lower levels of self-esteem in a non-clinical sample. METHOD: Thirty-five female university students completed the Multidimensional Perfectionism Scale, the Rosenberg Self-Esteem Scale, the Perceived Stress Scale, and the Eating Disorder Inventory two times; once on an average university day and once on the day of an exam. Descriptive statistics and t-tests were calculated to verify whether a stressful situation was associated with a significant difference in levels of perfectionism, self-esteem, stress, and measures of eating disorders. Bivariate correlations were calculated for both the stress and non-stress situation, to observe how the dimensions of perfectionism, self-esteem, and stress were associated with measures of eating disorders. RESULTS: During the stress situation, the study participants had, on average, significantly higher levels of concern over mistakes, body dissatisfaction, drive for thinness, and perceived stress. Bivariate correlations revealed that during the stress situation perceived stress, cognitive variables and measures of eating disorders showed significant correlations with each other that were absent in the non stress situation. DISCUSSION: The results of the present study suggest that the dimensions of pathological perfectionism, low self-esteem, and perceived stress are related to an increase in dieting thoughts and dissatisfaction with body aspect in non-clinical women during a performance that could potentially challenge the perception of their self-esteem. The stressful situation can be interpreted as an experience of invalidation, which could explain the connection between cognitive constructs and behaviours related to eating disorders.