Laura Benni

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.

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.

Childhood stressful events, HPA axis and anxiety disorders

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is 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. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

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.

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.

Sexuality and eating disorders

AIM The aim of the present study is to explore the sexual functioning of an Eating Disorders (ED) sample composed by Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS) patients. METHODS 98 patients (AN: 23; BN: 14; EDNOS: 61) have been compared with 88 health subjects. All participants have filled in the following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), Eating Disorders Examination (EDE-q), Binge Eating Scale (BES), Emotional Empathy Scale (EES). For the evaluation of the sexual activity Female Sexual Function Index (FSFI) was applied. RESULTS 67 patients (68.4%) and 80 healthy controls (90.9%) reported a sexual activity with a partner or masturbation in the four latest weeks. Only one healthy control (1.1%) reported masturbation and 79 (89.8%) controls showed sexual activity with a partner, on the contrary 11 patients (11.2) reported masturbation and 56 (57.1%) patients showed sexual activity with a partner. Moreover patients showed higher scores on every FSFI subscales. No significant differences were observed between AN, BN and BED in terms of FSFI scores. DISCUSSION Women with ED show a lower sexual activity with a partner, a six-fold increase in the risk of sexual dysfunction and an higher frequency of masturbation as the only sexual activity when compared with healthy controls. The cognitive distraction produced by the discomfort to show own body during a sexual intercourse with the partner may explain our results.

Quality of life and living arrangements for people with intellectual disability

Purpose – Recent international experiences of community inclusion have produced a major change in residential care for people with intellectual disability (ID). Assignment and outcome assessment through new person‐centred measures are raising increasing interest; however, the information on quality of life and accommodation is still limited. This paper aims to provide an overview of the application of quality of life models and the size of the provision of different living arrangements.Design/methodology/approach – A systematic mapping of the literature of the last decade was followed by an expert guided review of the available evidence.Findings – QoL outcomes measures of living arrangements in people with ID show conceptual and methodological challenges. The following key topics were identified: individual level: issues related to health status, behavioural problems and other personal factors (ageing, choice and empowerment); family and peers; local level: accommodation, architecture and urbanization, an...

Generalized anxiety disorder: is there any specific symptom?

OBJECTIVE The main aim of the present research was to evaluate the coherence of generalized anxiety disorder (GAD) psychopathological pattern, the robustness of its diagnostic criteria, and the clinical utility of considering this disorder as a discrete condition rather than assigning it a dimensional value. METHOD The study was designed in a purely naturalistic setting and carried out using a community sample; data from the Sesto Fiorentino Study were reanalyzed. RESULTS Of the 105 subjects who satisfied the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for the diagnosis of GAD, only 18 (17.1%) had no other comorbid DSM-IV disorder. The most frequent comorbid condition was major depressive disorder (70.4 %). Only 2 of the GAD diagnostic symptoms (excessive worry and muscle tension) showed a specific association with the diagnosis itself, whereas the others, such as feeling wound up, tense, or restless, concentration problems, and fatigue, were found to be more prevalent in major depressive disorder than in GAD. CONCLUSION Our study demonstrates that GAD, as defined by DSM-IV criteria, shows a substantial overlap with other DSM-IV diagnoses (especially with mood disorders) in the general population. Furthermore, GAD symptoms are frequent in all other disorders included in the mood/anxiety spectrum. Finally, none of the GAD symptoms, apart from muscle tension, distinguished GAD from patients without GAD.

[Female sexual functioning: the role of psychopathology].

BACKGROUND In the study of the relationship between sexuality and psychopathology, female sexual functioning appears to be relatively poorly explored. In addition, most studies have been conducted on clinical samples, so that the question of whether non-clinically relevant psychopathological symptoms may have a negative impact on womens sexual response still remains unanswered. The aim of this study was to analyze the influence of psychopathology on specific phases of sexual functioning (desire, arousal, lubrication, orgasm, satisfaction) and pain in a sample of young women without psychiatric case history. METHODS Two questionnaires were administered to a sample of female students in Psychology of the University of Florence (n=75): the Symptom Checklist (SCL-90) to evaluate psychic distress and the Female Sexual Function Index (FSFI) for data collection on sexual functioning. RESULTS 44 questionnaires were valid. The dimensions of SCL-90 explain a relatively high percentage of variance of the global severity index of sexuality (R²=0.49); significant predictors were: somatization (Beta=-0.75), depression (Beta=-0.89), anxiety (Beta=-0.79), and hostility (Beta=-0.48). The same variables were significant predictors, though at a lesser extent, for all the single dimensions of sexuality, with the exception of pain, on which only hostility had a significant correlation (Beta=-0.55). CONCLUSIONS Although the small size and the peculiar characteristics of the sample do not allow to extrapolate the results, the findings of this study show that psychopathological dimensions can affect female sexual functioning at subclinical level in the absence of the confounding effect of drug therapy.BACKGROUND In the study of the relationship between sexuality and psychopathology, female sexual functioning appears to be relatively poorly explored. In addition, most studies have been conducted on clinical samples, so that the question of whether non-clinically relevant psychopathological symptoms may have a negative impact on womens sexual response still remains unanswered. The aim of this study was to analyze the influence of psychopathology on specific phases of sexual functioning (desire, arousal, lubrication, orgasm, satisfaction) and pain in a sample of young women without psychiatric case history. METHODS Two questionnaires were administered to a sample of female students in Psychology of the University of Florence (n=75): the Symptom Checklist (SCL-90) to evaluate psychic distress and the Female Sexual Function Index (FSFI) for data collection on sexual functioning. RESULTS 44 questionnaires were valid. The dimensions of SCL-90 explain a relatively high percentage of variance of the global severity index of sexuality (R²=0.49); significant predictors were: somatization (Beta=-0.75), depression (Beta=-0.89), anxiety (Beta=-0.79), and hostility (Beta=-0.48). The same variables were significant predictors, though at a lesser extent, for all the single dimensions of sexuality, with the exception of pain, on which only hostility had a significant correlation (Beta=-0.55). CONCLUSIONS Although the small size and the peculiar characteristics of the sample do not allow to extrapolate the results, the findings of this study show that psychopathological dimensions can affect female sexual functioning at subclinical level in the absence of the confounding effect of drug therapy.