Sven Holmgren

Impulsivity and long-term prognosis of psychiatric patients with anorexia nervosa/bulimia nervosa.

Few if any reliable indicators of long-term outcome have been found in eating disorders. Impulsivity was the strongest predictor in the present study of 35 adults with anorexia nervosa or bulimia nervosa. This variable accounted for 25% of anorectic symptoms at 2 to 3 years follow-up and 14% at 4 to 6 years (Eating Attitudes Test). The relationship was specific insofar as impulsivity predicted neither depression nor overall mental health. Cognitive impairment may be one reason for the poor prognosis of impulsive patients.

Binge eating versus nonpurged eating in bulimics: is there a carbohydrate craving after all?

Food selection and macro nutrient content were evaluated in a group of bulimic subjects, both during the nonpurged intake and the bingeing. Dietary data was assessed by single 24‐hour recall. As expected, energy distribution and food selection differed markedly between the nonpurged diet and the binges. The main differences were related to an inverse relationship in the order of macro nutrients, fat being the dominant and protein the least important source of macro nutrients during binge eating. The nutrient content during binges admittedly had a preponderance for fat. Nevertheless, the primary choice of food items during binges was carbohydrates, which was shown both by a greater quantity and by the subjects’ own desires.

Food selection in anorectics and bulimics: food items, nutrient content and nutrient density.

OBJECTIVE The food selection and nutrient intake were investigated in women with anorexia nervosa, bulimia nervosa and controls. METHODS Dietary data was obtained by 24-hour recall, and 7-day recording among eating disordered patients, and by 3-day registration among controls. RESULTS The intake of energy and nutrients differed from controls, as expected, while there were no differences between anorectics and bulimics in this respect, except for iron. There were only minor differences among the three groups studied with respect to nutrient density. Energy percentages of protein, fat, and carbohydrates, were similar in all groups, but a subdivision of the macronutrients into respective sources showed that bulimics had a lower relative and absolute intake of carbohydrates from bread and cereals than anorectics and controls. CONCLUSION Eating disorder patients, despite their marginal food intake, still met the minimum requirement for most nutrients according to the Nordic Nutrient recommendations.

Ego functioning in eating disorders: Description and relation to diagnostic classification

A working assumption for many clinicians is that differences in personality functioning among eating-disordered patients are crucial for treatment planning and prognosis. However, the empirical documentation is scarce. The present study used analyses of 13 objectively rated ego functions in a sample of 48 eating-disordered patients to try to establish a firmer empirical basis in the area. The variation in ego functioning was great, and a cluster analysis identified four clusters. These were tentatively named “higher neurotic,” “lower neurotic,” “borderline,” and “borderline-psychotic.” The clusters were unrelated to DSM-III-R eating disorder diagnoses and to the restricter/bulimic distinction and related markedly differently from those classifications to other clinical variables. The most interesting associations occurred between ego functioning and variables of possible prognostic value. Ego functioning thus constitutes a complementary diagnostic dimension of potential importance for prognosis.

Personality Traits and Self-Injurious Behaviour in Patients with Eating Disorders

The interest in different aspects of personality and the neuropsychological basis for behaviour in eating disorder patients has increased over the last decade. The present study aims at exploring personality traits, self-injurious behaviour (SIB) and suicide attempts in a group of severely ill eating disorder patients. Patients with eating disorders (N = 38) and age-matched controls (N = 67) were examined concerning self-reported personality traits by means of the Karolinska scales of personality (KSP). Psychosocial history and SIB was collected from medical records. Depression was rated by means of the Beck Depression Inventory (BDI). Results indicated significantly higher anxiety-related and detachment traits in both anorexia nervosa (AN) and bulimia nervosa (BN) patients and higher hostility in BN patients than controls. No specific personality traits could be defined as typical for self-injurious or suicidal behaviour. The AN group was lower than the BN group on scales measuring impulsivity, guilt and anxiety. Furthermore, presence of SIB and suicide attempts was more frequent among the BN patients.

Levels of Tumour Necrosis Factor-Alpha and Interleukin-6 in Severely Ill Patients with Eating Disorders

Background: The underlying pathophysiology of eating disorders (ED) is dependent on complex interactions between psychological, biological and social factors. The purpose of the present study was to examine a possible increase in cytokines indicating inflammation, as measured by tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in ED patients, and to explore possible relationships between cytokines and self-reported personality traits. Methods: Female patients with severe ED (n = 26) were recruited consecutively from an inpatient clinic and were compared to age-matched healthy females (n = 12). Commercial ELISA tests developed for the measurement of serum levels of TNF-α and IL-6 were employed. Personality traits were measured using Karolinska Scales of Personality. Results: The patient group displayed increased levels of the cytokine TNF-α and a tendency towards increased IL-6 levels. Spearman’s rank correlation coefficient was used to examine possible relationships between levels of cytokines and personality traits. The results showed that IL-6 levels were positively related to both somatic and psychic anxiety and to aggression scales, such as irritability and suspicion. Increased levels of TNF-α, in turn, were significantly correlated with high scores on the depression-related anxiety scale Inhibition of Aggression. However, increased levels of cytokines in the ED group did not seem to be mainly associated with symptoms of depression. Conclusion: We cannot rule out the possibility that comorbid conditions in the group contribute to the higher cytokine values. Further studies need to explore the possible influence of cytokines on the severity of ED and whether this might be mediated or moderated by specific personality traits.

Saliva secretion rate and saliva composition in relation to extraversion

Abstract In this study of 20 healthy volunteers, relationships were sought between degree of extraversion (as determined by means of the EPI) and saliva secretion rate and composition. A significant negative correlation was found between both unstimulated and stimulated saliva secretion rates and extraversion. The correlation was most pronounced in the morning. In the morning introverts had significantly higher unstimulated secretion rates than extraverts. The differences were less pronounced in the afternoon. Introverts had higher concentrations of proteins and glycoproteins in their saliva than had extraverts. The results seem to support theories about a higher cortical arousal and a higher sympathetic activity in introverts than in extraverts.

Guided self-help as the first step for bulimic symptoms: implementation of a stepped-care model within specialized psychiatry.

OBJECTIVE This study describes the implementation and effectiveness of the first step, guided self-help (GSH), in a clinical setting, of a stepped-care model of cognitive behavior therapy for patients with bulimic symptoms. METHOD Eighty-nine patients participated. RESULTS In the intent to-treat analyses, the effect sizes were small to moderate (0.25-0.66). However, the effect sizes were substantially larger (0.44-1.66) for the patients who completed all the GSH sessions (45%). The majority of noncompleters stayed within psychiatric services. Supplementary treatments were mostly directed towards comorbid conditions, especially depression. Those discontinuing treatment in advance where characterized by more lifetime diagnoses and higher ratings on the restraint subscale of the EDE-Q. DISCUSSION GSH within specialized psychiatry might be effective for about 30% of the patients. There is no indication of patients losing their confidence in psychiatric services by being offered GSH as the first treatment.

Phase 1 treatment for the chronic and previously treated anorexia. Bulimia nervosa patient

Treatment of anorexia nervosa/bulimia patients with a chronic course who previously were treated is given little attention in the literature. At the Uppsala University Hospital, a special program was developed for this category. It is assumed that successful therapy requires (1) a combination of therapeutic modalities, (2) a stepwise treatment, (3) a combination of anorexia nervosa and bulimia treatment principles, and (4) a treatment goal that is subjectively valid for the patient. In the present article, “Phase 1” is described. This involves teaching eating control through detailed diet and activity regimens supported by daily talk sessions, body-awareness therapy, and occupational therapy. “Phase 2” psychotherapy is thereby made possible. Results are promising in that a substantial proportion of patients were able to reach eating and weight goals not attained in previous treatments. Possible ways of improving results, the role of medical management, and implications for treatment of young patients are discussed.