Junilla K. Larsen

Cognitive and emotional characteristics of alexithymia A review of neurobiological studies

OBJECTIVE To review neurobiological studies of alexithymia in order to achieve a better understanding of the relationship between alexithymia and psychosomatic diseases and psychiatric illnesses. METHODS Neurobiological studies of alexithymia were reviewed with a special focus on how emotional and cognitive elements of alexithymia are reflected in earlier research. RESULTS Studies that have correlated alexithymia to corpus callosum dysfunctioning have mainly found impairments in cognitive characteristics of alexithymia, whereas from studies of right hemisphere and frontal lobe deficits, it may be concluded that both cognitive and emotional characteristics of alexithymia are impaired. CONCLUSION The fact that there is no general agreement on how to define alexithymia seems to have hampered theoretical and empirical progress on the neurobiology of alexithymia and related psychosomatic diseases and psychiatric illnesses. Alexithymia should no longer be approached as one distinct categorical phenomenon and follow-up studies should monitor subjects according to both the cognitive and emotional characteristics of alexithymia.

Construct validation of the Restraint Scale in normal-weight and overweight females.

The Restraint Scale (RS) is a widely used measure to assess restrained eating. The purpose of this study was to examine the construct validity of the RS in a sample of normal-weight (n=349) and overweight (n=409) females using confirmatory factor analyses of the RS in relation to other measures for dieting, overeating and body dissatisfaction. Following Laessle et al. [(1989a). A comparison of the validity of three scales for the assessment of dietary restraint. Journal of Abnormal Psychology, 98, 504-507], we assumed a three-factor structure: (1) overeating and disinhibitory eating, (2) dieting and restriction of food intake, and (3) body dissatisfaction and drive for thinness. Analyses revealed that the RS loaded significantly on all three factors for both samples, confirming its multifactorial structure. However, the RS appears to capture these constructs differently in overweight and normal-weight females such that the RS may overestimate restraint in overweight individuals. This may explain the greater effectiveness of the RS in predicting counter-regulation in normal-weight than in overweight samples of dieters.

Binge Eating and its Relationship to Outcome after Laparoscopic Adjustable Gastric Banding

Background: The aim of this cross-sectional study was to examine short and long-term eating behavior after laparoscopic adjustable gastric banding (LAGB) and the relationship of binge eating with weight and quality of life outcome. Methods: 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate quality of life and eating behavior: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months after LAGB. Results: Compared with patients before surgery, patients after surgery, in both follow-up groups, reported less binge eating, fat intake, external eating, and more restrained eating and eating self-efficacy. After surgery, about one-third of the patients showed binge eating problems, which were associated with a worse postoperative outcome. Conclusion: Our results suggest that eating behavior improves both short- and long-term after surgery for severe obesity. Although LAGB could be a long-term solution to part of preoperatively eating disordered patients, the identification and treatment of postoperative binge eating appear critical to promote successful outcome after bariatric surgery.

Psychosocial Functioning Before and After Laparoscopic Adjustable Gastric Banding: a Cross-Sectional Study

Background: The aim of this cross-sectional study was to examine short and long-term physical, mental and, particularly, social quality of life (QoL) of patients with severe obesity after laparoscopic adjustable gastric banding (LAGB). Methods: 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate several aspects of QoL: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months after LAGB. Results: Compared with patients before surgery, patients after surgery, in both follow-up groups, had lower weight and co-morbidity, felt and functioned better on physical and psychological dimensions of QoL, and on most aspects of social QoL. No significant differences emerged between the two postoperative groups. On average, the postoperative QoL was still lower than the age norm group. Mutual correlations between QoL and weight outcome were very low up to 2 years after surgery, but more strongly associated >2 years after surgery. Conclusion: LAGB could be a long-term solution to morbid obesity with regard to both weight and QoL outcome. The findings of our study emphasize the importance of including social QoL variables in outcome research. They further suggest that when the follow-up duration increases, especially in patients who are single, intervention and consultation should be simultaneously directed at weight and psychosocial variables.

Modeling of palatable food intake in female young adults. Effects of perceived body size

Laboratory taste-test studies have shown that social modeling effects on food intake are powerful. The aim of the present study was to examine the degree to which people model food intake in a more naturalistic eating setting. After completing a cover task, female participants (N=102) spent a 15-min break with a female confederate who ate a large amount or a small amount of M&Ms or no M&Ms at all. Further, the confederate had a slim or (subtly manipulated) normal-weight appearance. Females who were exposed to a confederate who ate much consumed more than those who were confronted with a confederate who ate only a little or nothing at all. Although the manipulation of the confederates appearance had no significant main effect on the amount of food that participants consumed, a significant interaction effect was found, such that the modeling effect of eating was present only in the normal-weight appearance condition. Our findings suggest that normal-weight young women are more inclined to imitate the food intake of a female confederate if they are more similar to the confederate.

Similarity in depressive symptoms in adolescents' friendship dyads: selection or socialization?

This study examined friendship selection and socialization as mechanisms explaining similarity in depressive symptoms in adolescent same-gender best friend dyads. The sample consisted of 1,752 adolescents (51% male) ages 12-16 years (M = 13.77, SD = 0.73) forming 487 friend dyads and 389 nonfriend dyads (the nonfriend dyads served as a comparison group). To test our hypothesis, we applied a multigroup actor-partner interdependence model to 3 friendship types that started and ended at different time points during the 2 waves of data collection. Results showed that adolescents reported levels of depressive symptoms at follow-up that were similar to those of their best friends. Socialization processes explained the increase in similarity exclusively in female dyads, whereas no evidence for friendship selection emerged for either male or female dyads. Additional analyses revealed that similarity between friends was particularly evident in the actual best friend dyads (i.e., true best friends), in which evidence for socialization processes emerged for both female and male friend dyads. Findings highlight the importance of examining friendship relations as a potential context for the development of depressive symptoms.

Modeling of palatable food intake. The influence of quality of social interaction.

This study investigates the effects of the quality of social interaction on modeling of food intake among young women. A two (confederates food intake: high versus low) by two (confederates sociability: sociable versus unsociable) between-participant factorial design was employed. A total of 100 young women (18-27 years) participated. Findings indicated that young women generally ate more when exposed to a high-intake peer than women exposed to a low-intake peer. However, this modeling effect was only found in the unsociable context. This study underscores the influence of social atmosphere on modeling effects of palatable food intake and suggests that contextual uncertainty or ingratiation strategies may be important in explaining the magnitude of modeling effects.

Emotion Regulation in Adolescence: A Prospective Study of Expressive Suppression and Depressive Symptoms

Cross-sectional studies have shown a positive association between expressive suppression and depressive symptoms. These results have been interpreted as reflecting the impact of emotion regulation efforts on depression. However, it is also possible that depression may alter emotion regulation tendencies. The goal of the present study was to prospectively examine the bidirectional association between habitual use of suppression and depressive symptoms in young adolescents. Participants were 1,753 adolescents (mean age = 13.8 years) who reported their use of suppression and depressive symptoms at two time points with a 1-year interval. Suppression and depressive symptoms were correlated within each time point. Depressive symptoms preceded increased use of suppression 1 year later, but suppression did not precede future depressive symptoms. Overall, the findings suggest depressive symptoms may be a potential precursor of habitual use of suppression during adolescence.

Dietary restraint: Intention versus behavior to restrict food intake

The Dutch Eating Behavior Questionnaire Restraint Scale (DEBQ-R) assesses both intentions to restrict food intake (3 items) and actual behavioral restraint (7 items). Studies in general populations samples have shown that the DEBQ-R is a reliable instrument with all items loading highly on a single factor. The purpose of the present study was to examine the psychometric properties of a two-factor intention-versus-behavior structure of the DEBQ-R in 3 different weight-concerned samples with people from different (over)weight categories (total N=790) using confirmatory factor analysis. A robust two-factor structure emerged in the various samples, generally supporting a distinction between DEBQ-R questions relating to intentions to restrict food intake and actual restrictive behavior. Results obtained in this study are important, because they suggest that a distinction between restrained intention and behavior could help to explain the relation between dietary restraint and external overeating tendencies. Future longitudinal research should examine whether the newly developed dietary restraint scales predict changes in overeating and Body Mass Index (BMI).

The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut-off Point to Differentiate Clinical Patients from Healthy Controls

The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the psychometric features of the EDDS in a clinical population of eating disordered patients. We identified a cut-off point that differentiates clinical patients from healthy controls. A clinical group of 59 Dutch female eating disordered patients and a control group of 45 Dutch students completed the EDDS, the Eating Disorder Examination Interview, the Body Attitude Test and the Beck Depression Inventory--II. The EDDS showed good test-retest reliability, internal consistency, criterion validity and convergent validity with other scales assessing eating and general pathology. An overall symptom composite cut-off score of 16.5 accurately distinguished clinical patients from healthy controls. The EDDS may be a useful instrument in clinical settings and in aetiologic, prevention and treatment research.