Paolo Cotrufo

Full-syndrome, partial-syndrome and subclinical eating disorders: an epidemiological study of female students in Southern Italy

We screened a sample of 919 female students, aged 13–19 years, by means of the EDI 2 and GHQ‐28 questionnaires. Those students identified as being at risk for an eating disorder (281 subjects) underwent a psychiatric interview. We found 2 cases of full‐syndrome anorexia nervosa (0.2%), 21 cases of full‐syndrome bulimia nervosa (2.3%) and 2 cases of full‐syndrome binge‐eating disorder (0.2%). Moreover, 35 girls (3.8%) met the criteria for partial‐syndrome and 98 girls (10.7%) fulfilled the criteria for subclinical eating disorders. Subjects with partial‐syndrome and subclinical eating disorders had higher scores than those with no diagnosis, but lower scores than students with full‐syndrome eating disorders, on both the EDI 2 and GHQ‐28 questionnaires. A follow‐up of subjects with partial‐syndrome and subclinical eating disorders is now in progress.

Aggressive Behavioral Characteristics and Endogenous Hormones in Women with Bulimia nervosa

Increased aggressiveness frequently occurs in patients with bulimia nervosa (BN), but its neurobiological correlates have been poorly investigated. In this study, we investigated possible relationships between such clinical measure and blood levels of endogenous hormones in patients with BN. Morning plasma levels of testosterone, 17β-estradiol, prolactin (PRL) and cortisol were measured in 33 bulimic women and 22 healthy female controls. The eating-related psychopathology, depression and aggressiveness were rated by specific psychometric scales. Bulimic patients showed decreased plasma levels of PRL and 17β-estradiol, and increased concentrations of cortisol and testosterone. Moreover, patients scored higher than healthy controls on rating scales assessing eating-related psychopathology, depressive symptoms and aggressiveness. A significant positive correlation was found between testosterone plasma levels and aggressiveness in patients but not in controls. These findings suggest that in BN, increased plasma levels of testosterone may play a role in the modulation of aggressiveness.

Eating disorder attitude and abnormal eating behaviours in a sample of 11–13-year-old school children: The role of pubertal body transformation

OBJECTIVE: A cross sectional study was performed to evaluate the presence, in a sample of subjects in the age of pubertal transition, of those psychological characteristics and abnormal eating behaviours, which are generally considered the predictors of eating disorders (EDs) in adolescence. The primary aim of our study was to evaluate the presence of EDs-related psychological traits and of abnormal eating behaviours, in a wide sample of natural 11–13-year-old population, and to determine if, in this period of transition, there are the same differences between males and females, which are related to the ED psychological characteristics that are often observed and assessed in samples of adolescents or young adults; our secondary aim was to evaluate, in the female sample, if and how the episode of menarche, and the related pubertal body transformation, play a role in the development of ED symptomatology. METHOD: We screened 2925 school children by means of an ad-hoc socio-demographic schedule, the EDI 2 and the EDI-Symptom Checklist questionnaires. We compared each EDI 2 scales score (Mann-Whitney U) and the abnormal eating behaviours (χ2 analyses) between pre- and post-menarche female subjects, for each age subgroup. RESULTS: Fourteen percent of the entire sample scored higher than the cut-off value at the EDI 2 drive for thinness scale and have to be considered at risk for an ED onset. The EDI 2 scores and the adoption of abnormal eating behaviour increase, in the female population, depending on whether they have had menarche. In the male sample the mean values at EDI 2 scales decrease with increasing age. DISCUSSION: The abnormal eating behaviours and the psychological ED attitude are widespread even among a “cross-pubertal” population. Our data confirm the differences between male and female subjects at the EDs attitude, suggesting a strong relation in the female children between the pubertal body transformation and the risk of ED onset.

Influence of gender role orientation (masculinity versus femininity) on body satisfaction and eating attitudes in homosexuals, heterosexuals and transsexuals

ObjectiveThe primary aim of this study was to investigate the relationship between gender role orientation and eating disorder attitudes and behaviors and body dissatisfaction in a sample of homosexuals, heterosexuals, and transsexuals.MethodWe screened 132 homosexuals, 178 heterosexuals (both male and female), and 15 MtF transsexuals by means of an ad hoc socio-demographic schedule; the Eating Disorders Inventory-2 and Symptom Checklist; the Body Uneasiness Test and the Bem Sex Role Inventory.ResultsDifferences between homosexual, heterosexual, and transsexual participants emerged, but those data seem to be best explained by the constructs of femininity and masculinity than by the biological gender.DiscussionThe empirical evidence of a positive correlation between femininity and eating problems, and the negative correlation between masculinity and eating problems, is full of implications. Eating disorders appear to be diseases of femininity; masculinity seems to be a protective factor, independently by the biological gender.

An epidemiological study on eating disorders in two high schools in Naples

In this study, we investigated the prevalence of full syndrome (FS), partial syndrome (PS) and subclinical syndrome (SCS) eating disorders in a sample of 356 high school girls. We identified two cases of anorexia nervosa (0.56%), 14 of bulimia nervosa (3.94%) and one of binge eating disorder (0.28%) according to Diagnostic and Statistical Manual (DSM)-IV. Moreover, 17 girls (4.77%) were recognized as PS cases and 49 (13.7%) as SCS cases. A follow-up is now ongoing to explore the clinical evolution of partial and subclinical syndromes.

Muscle Dysmorphia: A Comparison Between Competitive Bodybuilders and Fitness Practitioners

Abstract: Objective: The primary aim of this study was to investigate the features of Muscle Dysmorphia and other body image-related concerns in a sample of competitive male bodybuilders. Method: We screened 217 male athletes, 119 bodybuilders and 98 fitness practitioners, recruited in 12 gymnasiums in Southern Italy, by means of an ad hoc sociodemographic schedule, the Muscle Dysmorphia Inventory (MDI) and the Muscle Appearance Satisfaction Scale (MASS). Results: Twenty one of the bodybuilders (17.6%) show high levels of preoccupation and dissatisfaction with their muscularity, 45.4% (N=54) a marked dependence on bodybuilding; 35.3% (N=42) follow a high-protein diet and 35.3% (N=42) used vitamin supplements to improve their weightlifting performances and favor post-training physical recovery. In addition, forty-three (36.1%) also report use of substance while nine subjects (7.6%) declare to avoid situations in which their body might be seen or manifest high levels of distress when this happens. The ANCOVA (Exercise Frequency per Week as a covariate) results indicate that bodybuilders, compared to fitness practitioners, report significant elevations in all measures. Moreover, considering only the bodybuilders sample, who report a regular use of substance scored higher in Dietary Behavior, Body size-symmetry, Physique Protection, Supplement Use MDI scales and on Body building Dependence, Muscle Checking and Injury MASS subscales. Discussion: Our findings seem to suggest that the practice of the bodybuilding is associated to the proposed criteria of muscle dysmorphia if compared with regular fitness practice. In particular, we found that a regular use of substance was associated with greater dissatisfaction with muscularity.

Self-esteem, body shame and eating disorder risk in obese and normal weight adolescents: A mediation model.

OBJECTIVE To investigate dysfunctional eating behaviors and psychological variables typically associated to eating disturbances such as low self-esteem, perfectionism, shame, perceived parental care and protectiveness in obese and normal weight adolescents and to examine how the main powerful eating disorder risk factors interact with each other which explains eating psychopathology vulnerability. METHOD 111 high school students (68 males; age range 13-19years) classified as obese and 111 age-, sex- and social status-homogeneous normal weight controls were included in the current study. All participants were asked to fill out self-report measures of parental behavior as perceived by the offspring, eating disturbance attitudes and behaviors, self-esteem, perfectionism and shame. RESULTS Significant differences between the two groups in relation to dysfunctional eating behaviors emerged. Body shame had the strongest relationship to eating problems vulnerability and acted as a mediator in the relationship between low self-esteem and eating disorder risk among both obese and non-obese youngsters. CONCLUSIONS These findings further our understanding of a potential underlying mechanism for eating pathology development in youngsters in general and in obese adolescents in particular, which is of great importance in terms of prevention and treatment.

My Body and Me: Self-Injurious Behaviors and Body Modifications in Eating Disorders—Preliminary Results

We investigated self-injurious behaviors and body modification practices in eating disorder patients, considering different ED diagnoses and illness severities. Of the total sample, 50.9% showed at least one form of self-injury and 50.9% reported at least one tattoo, piercing, or both. Patients reporting only body modifications showed more positive feelings toward their bodies, higher levels of self-esteem, less impulsivity, depression, and anxiety, and lower levels of social dysfunction than those reporting only self-injury or both self-injury and body modifications. Self-injury was influenced by both diagnosis and severity of disorders.

Nonsuicidal Self-injury: A Systematic Review

Objective: Nonsuicidal self-injury (NSSI) refers to the intentional self-inflicted destruction of body tissue without suicidal intention and for purposes not socially sanctioned. Our paper presents an up-to-date overview on nonsuicidal, self-injurious behaviors. Method: In accordance with PRISMA guidelines, a systematic literature search was conducted across two databases, PubMed and PsycARTICLES, regarding the main features of NSSI with a focus on epidemiological and etiologic data, diagnostic criteria, and functions. All English articles, published between 1998 and 2016, were considered, and screened against a priori inclusion/exclusion criteria. The search terms include: self-harm, self-injury, NSSI, epidemiology, comorbidity, gender, functions and DSM. We also examined the references of the retrieved articles. Results: NSSI is most common among adolescents and young adults, and the age of onset is reported to occur between 12 and 14 years. Comorbidity with borderline personality disorder (BPD) and eating disorders is often reported. DSM-5 includes NSSI as a condition requiring further study. This review gives an overview of the prevalence rates (7.5–46.5% adolescents, 38.9% university students, 4–23% adults) and main causes that appear to stem from childhood trauma, comorbidity with many other disorders and several functions of NSSI, and the potential independence of a NSSI disorder. Conclusion: Over the years, interest in NSSI grew to such an extent that an ongoing debate was instigated on whether NSSI should be considered as a diagnosis in its own right and given its own category. This paper provides an up-to-date overview on self-injury, what is known about it and what remains to be done. Clearly, our understanding of the main issues of NSSI has increased in last two decades. However, future researches is needed to examine the developmental trajectories, cultural backgrounds and shed light on the risk factors and functions as well as clarify its role as an independent diagnostic entity.

Body dissatisfaction, abnormal eating behaviours and eating disorder attitude in homo- and heterosexuals

OBJECTIVE: The primary aim of this study was to investigate the relationship between sexual orientation and disordered eating attitudes and behaviours in a sample of homosexuals and heterosexuals subject. METHODS: We screened 110 homosexuals (85 males and 25 females) and 121 heterosexuals (85 males and 36 females) by means of: a) an ad hoc socio-demographic schedule; b) the Eating Disorders Inventory 2 (EDI 2); the Eating Disorders Inventory 2 — Symptom Checklist (EDI-SC); the Body Uneasiness Test (BUT). RESULTS: Male homosexuals obtained much higher scores than male heterosexuals on the EDI 2 Drive for thinness, Bulimia, Ineffectiveness, Interoceptive awareness, Impulse regulation scales and on all the BUT subscales. Similarly, with regard to eating behaviours, a significantly higher frequency in the use of strategies to compensate weight increase was observed. On all these scales the sample of homosexual males did not show any significant differences from the group of hetero- and homosexual women. The male homosexuals who claimed they were not in a stable relationship scored higher in all the variables considered. DISCUSSION: Our findings seem to suggest that homosexual orientation is associated with greater body dissatisfaction and abnormal eating behaviours in males, in particular among those who claimed they were not in a sentimental relationship.