Silja Vocks

Meta‐analysis of the effectiveness of psychological and pharmacological treatments for binge eating disorder

OBJECTIVE The aim of this study was to compute and compare mean effects of various treatments for binge eating disorder. METHOD A total of 38 studies with 1973 participants fulfilled the defined inclusion criteria. Effect sizes, odds ratios, and simple rates were integrated in fixed and random (mixed) effects categorical models. RESULTS From randomized controlled trials, psychotherapy and structured self-help, both based on cognitive behavioral interventions, were found to have large effects on the reduction of binge eating. Regarding pharmacotherapy, mainly comprising antidepressants, randomized controlled trials revealed medium effects for the reduction of binge eating. Uncontrolled studies on weight-loss treatments demonstrated moderate reductions of binge eating. Combination treatments did not result in higher effects compared with single-treatment regimens. Except for weight-loss treatment, none of the interventions resulted in a considerable weight reduction. DISCUSSION Psychotherapy and structured self-help, both based on cognitive-behavioral interventions, should be recommended as the first-line treatments.

Reduction of gray matter density in the extrastriate body area in women with anorexia nervosa

Body processing has been associated functionally to the so called extrastriate body area (EBA) which is located in the lateral occipital cortex. As body image disturbance is one of the main diagnostic criteria in anorexia nervosa (AN) this study aimed at looking for alterations in gray matter density in women with (AN) especially in the EBA. High resolution T1 images from 15 women with AN and 15 age matched healthy controls women were contrasted using voxel based morphometry (VBM). Additionally functional localizer scans were used to determine functionally the EBA of each participant. In general, total gray matter volumes did differ between groups. VBM results yielded evidence for a reduction of gray matter density in the left EBA. This reduction, which resulted from whole brain analysis, was localised within the activation cluster of the EBA localizer scan. The current results provide for the first time evidence for structural alterations in the EBA in patients with AN which might suggest that body image distortion is related at least in part to structural alteration in the EBA.

Eating and Body Image Disturbances in Male-to-Female and Female-to-Male Transsexuals

The aim of the study was to discover whether persons with Gender Identity Disorder (GID) differed from controls of both sexes and from persons with eating disorders in terms of the degree of eating and body image disturbance, self-esteem, and depression. A total of 88 self-identified male-to-female transsexuals (MtF), 43 female-to-male transsexuals (FtM), 62 females with an eating disorder, 56 male controls, and 116 female controls completed the Eating Disorder Examination Questionnaire, Eating Disorder Inventory, Body Checking Questionnaire, Drive for Muscularity Scale, Rosenberg Self-Esteem Scale, and Beck Depression Inventory. MtF showed higher scores on restrained eating, eating concerns, weight concerns, shape concerns, drive for thinness, bulimia, body dissatisfaction, and body checking compared to male controls, and concerning some variables also compared to female controls. FtM displayed a higher degree of restrained eating, weight concerns, shape concerns, body dissatisfaction, and body checking compared to male controls. Furthermore, participants with GID showed higher depression scores than did controls, whereas no differences concerning drive for muscularity and self-esteem were found. Between MtF and FtM, the only significant difference emerged for body checking, with MtF displaying higher scores. Although it was shown that on these variables the values for persons with GID were lower than for those with eating disorders, these data lead us to speculate that persons with GID might be at a higher risk of eating disturbances. Therefore, the implementation of prevention programs might help persons with GID to avoid developing a clinically relevant eating disorder.

The ups and downs of psychotherapy: Sudden gains and sudden losses identified with session reports

Abstract Psychotherapy does not always follow a linear path. The present study explores the frequency of sudden gains and losses during the course of outpatient psychotherapy. The sample includes 1500 patients treated at three different outpatient centers. The patients were 57.4% female, and suffered primarily from anxiety and depressive disorders. Progress was measured by session reports. Significant sudden shifts in both directions were prevalent for 28.9% of the patients. Patients with early sudden gains showed the highest effect sizes and patients with sudden losses showed the smallest at the end of treatment. The therapeutic relationship was significantly better after the sudden gain sessions. Results suggest further investigation of the occurrence of sudden gains in relation to early response as well as further exploration of sudden losses during the course of treatment with respect to differential patterns of change and outcome.

Parental catastrophizing about their child’s chronic pain: Are mothers and fathers different?

Preliminary evidence suggests that parental catastrophizing about their childs pain may be important in understanding both parental responses to their childs pain and the childs pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three‐factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS‐P) ( Goubert et al., 2006 ) in mothers and fathers of children with chronic pain, (ii) to explore differences between mothers and fathers in parental catastrophizing, (iii) to investigate the contribution of parental catastrophizing on the childs chronic pain problem and pain‐related parent behavior.

Effects of gustatory stimulation on brain activity during hunger and satiety in females with restricting-type anorexia nervosa: An fMRI study

BACKGROUND Previous research has demonstrated altered neuronal responses to visual stimulation with food in anorexia nervosa, varying with the motivational state of hunger or satiety. The aim of the present fMRI study was to assess hunger- and satiety-dependent alterations in the gustatory processing of stimulation with food in anorexia nervosa. METHODS After food abstention (hunger condition) and after eating bread rolls with cheese (satiety condition), 12 females with restricting-type anorexia nervosa and 12 healthy females drank chocolate milk and water via a tube in a blocked design during image acquisition. Additionally, heart rate was registered during the measurements, and subjective ratings of hunger/satiety and of the valence of chocolate milk were assessed using a Likert scale. RESULTS In participants with anorexia nervosa, drinking chocolate milk in the hunger condition induced significant activations in the right amygdala and in the left medial temporal gyrus relative to healthy controls. When contrasting neuronal responses to drinking chocolate milk during satiety with those evoked during hunger, a significant activation was found in the left insula in healthy controls, whereas in participants with anorexia nervosa, neuronal activity in the inferior temporal gyrus, covering the extrastriate body area, was observed. CONCLUSIONS Neuronal responses evoked by gustatory stimulation differ depending on hunger and satiety. Activations located in the amygdala and in the extrastriate body area might reflect fear of weight gain, representing one of the core symptoms of anorexia nervosa.

The Diagnosis and Treatment of Eating Disorders

BACKGROUND Eating disorders are of major significance both in clinical medicine and in society at large. Anorexia and bulimia nervosa almost exclusively afflict young persons, severely impairing their physical and mental health. The peak ages for these diseases are in late adolescence and young adulthood; patients therefore suffer setbacks both in school and/or in their occupational careers. This scientifically based S3 guideline was developed with the intention of improving the treatment of eating disorders and motivating future research in this area. METHODS The existing national and international guidelines on the three types of eating disorders were synoptically compared, the literature on the subject was systematically searched, and meta-analyses on bulimia nervosa and binge-eating disorder were carried out. 15 consensus conferences were held, as a result of which 44 evidence-based recommendations were issued. RESULTS Anorexia and bulimia nervosa are diagnosed according to the ICD-10 criteria (International Classification of Diseases), binge-eating disorder according to those of the DSM (Diagnostic and Statistical Manual of Mental Disorders). Psychotherapy is the mainstay of treatment for all three disorders, and cognitive behavioral therapy is the form of psychotherapy best supported by the available evidence. The administration of selective serotonin reuptake inhibitors (SSRI) can be recommended as a flanking measure in the treatment of bulimia nervosa only. The evidence does not support any type of pharmacotherapy for anorexia nervosa or binge-eating disorder. Bulimia nervosa and binge-eating disorder can usually be treated on an outpatient basis, as long as they are no more than moderately severe; full-fledged anorexia nervosa is generally an indication for in-hospital treatment. CONCLUSION This guideline contains evidence- and consensus-based recommendations for the diagnosis and treatment of eating disorders. If strictly implemented, it should result in improved care for the affected patients.

Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: a randomized controlled fMRI study

BACKGROUND Previous neuroimaging studies have demonstrated abnormalities in visual body image processing in anorexia and bulimia nervosa, possibly underlying body image disturbance in these disorders. Although cognitive behavioural interventions have been shown to be successful in improving body image disturbance in eating disorders, no randomized controlled study has yet analysed treatment-induced changes in neuronal correlates of visual body image processing. METHOD Altogether, 32 females with eating disorders were randomly assigned either to a manualized cognitive behavioural body image therapy consisting of 10 group sessions, or to a waiting list control condition. Using functional magnetic resonance imaging, brain responses to viewing photographs of ones own and another females body taken from 16 standardized perspectives while participants were wearing a uniform bikini were acquired before and after the intervention and the waiting time, respectively. RESULTS Data indicate a general blood oxygen level dependent signal enhancement in response to looking at photographs of ones own body from pre- to post-treatment, whereas exclusively in the control group activation decreases from pre- to post-waiting time were observed. Focused activation increases from pre- to post-treatment were found in the left middle temporal gyrus covering the coordinates of the extrastriate body area and in bilateral frontal structures including the middle frontal gyrus. CONCLUSIONS Results point to a more intense neuronal processing of ones own body after the cognitive behavioural body image therapy in cortical regions that are responsible for the visual processing of the human body and for self-awareness.

Emotion recognition, emotional awareness and cognitive bias in individuals with bulimia nervosa.

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for BN was found. Problems with emotional self-awareness suggest a cognitive-affective disturbance in emotion recognition. Implications for therapy are discussed.

Reduced connectivity between the left fusiform body area and the extrastriate body area in anorexia nervosa is associated with body image distortion

The aim of the present study was to investigate the network and its effective connectivity subserving body processing in women suffering from anorexia nervosa (AN) and also in healthy controls. Ten women diagnosed with AN and 15 healthy, age matched controls were investigated using fMRI during viewing images of bodies and chairs. Effective connectivity between cortical areas which are involved in human visual body processing was accessed. Effective connectivity analysis yielded evidence for a different network in AN and healthy controls during visual processing of human bodies. Left sided effective connectivity in the occipital cortex of women with AN showed a highly negative correlation with body size misjudgment. Present results yield evidence for altered networks for body processing in women with AN. Results explain body size misjudgment, a key feature in AN, which seems to be based on reduced effective connectivity in the body processing network.