Walter Vandereycken

Gray's Reinforcement Sensitivity Theory as a framework for research on personality–psychopathology associations

Grays Reinforcement Sensitivity Theory (RST) presupposes individual differences in the sensitivity of basic brain systems that respond to punishing and reinforcing stimuli. These differences are thought to underlie the personality dimensions of anxiety and impulsivity, and to have relevance for psychopathology. The present article aims at reviewing RST-based research on personality-psychopathology associations. First, RST and its revisions are described and the link between RST systems and personality dimensions is discussed. Second, studies investigating associations between RST systems and specific types of psychopathology are summarized. Although the available research yields a rather consistent picture with respect to constellations of BIS/BAS sensitivity that are associated with specific types of psychopathology, it also provides a clear indication that much work remains to be done. The discussion section highlights several topics that deserve future research attention.

The Body Attitude Test for Patients with an Eating Disorder: Psychometric Characteristics of a New Questionnaire

Abstract The Body Attitude Test (BAT) is a new self-report questionnaire developed for female patients suffering from eating disorders. Its psychometric characteristics have been tested in a large number of patients and control subjects (eating disorders, Weight Watchers, and normal subjects). Repeated analyses yielded a stable four factor structure: negative appreciation of body size, lack of familiarity with ones own body, general body dissatisfaction, and a rest factor. Repeated tests in different subgroups have shown the BAT to be reliable and valid, as well as easy and practical (only 20 items).

Dissociative experiences and trauma in eating disorders

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Pimozide combined with behavior therapy in the short-term treatment of anorexia nervosa. A double-blind placebo-controlled cross-over study.

Eighteen female inpatients were included in a double‐blind placebo‐controlled cross‐over study aimed at testing the hypothesis that dopamine blockade may enhance the effectiveness of behavior therapy in the short‐term weight restoration of anorexia nervosa patients. The patients were given a uniform contingency management program and, after a baseline period, they alternatingly (3‐ week periods) received pirnozide (4 or 6 mg) or a placebo. During the first two periods pimozide almost significantly enhanced the weight gain induced by the behavior therapy program and beneficially influenced the patients attitude towards treatment.

Family interaction in eating disorder patients and normal controls

The families of 30 eating-disorder patients were matched with 30 normal control families on social class, family size, and age and sex of the patient. We tested if the age (adolescent or young adult) and the symptomatology of the patient (restricting anorexic, bulimic anorexic, and normal-weight bulimic) had a significant effect on a behavioral and a self-report measure of cohesion, adaptability, and conflict. The age of the patient proved to be nonsignificant. The eating-disorder families showed more stability and discussed less openly disagreements between parents and children. On the remaining family measures, the anorexic (restricting and bulimic) and bulimic families revealed a completely opposite interaction pattern. The anorexic family had interpersonal boundary problems and a stable and conflictavoidant way of interacting, which was experienced as nonconflictual and cohesive by the patient too. The bulimic family showed strong interpersonal boundaries, a less stable organization, and less avoidance of disagreements. The patient herself also described her family as conflictual, uncohesive, and badly organized.

The affect-regulation function of nonsuicidal self-injury in eating-disordered patients: which affect states are regulated?

This study examines the affect regulation function of different types of nonsuicidal self-injury (NSSI) in 177 female eating-disordered inpatients. Almost 45% of the eating-disordered patients displayed at least 1 type of NSSI. Cutting and scratching were the most common forms of NSSI followed by bruising and burning oneself. For all types of NSSI except bruising, the affect regulation function was most strongly endorsed. Affect states reported to precede and follow NSSI were also examined to determine the particular affect states regulated by NSSI. In general, positively valenced low-arousal affect states increased and negatively valenced high-arousal affect states decreased from before to after NSSI. Finally, affective changes associated with NSSI were related to different NSSI characteristics, indicating that the increase in positive affect after NSSI is significantly related to the frequency of NSSI and the numbers of functions reported for NSSI. Theoretical and treatment implications are discussed.

Brief report: The association between non-suicidal self-injury, self-concept and acquaintance with self-injurious peers in a sample of adolescents

The current study investigated the association between non-suicidal self-injury (NSSI), self-concept and acquaintance with NSSI peers in a sample of 150 high school students (60% female) with a mean age of 15.56 (SD=2.00) years. Analyses showed that students with NSSI rated themselves lower on academic intelligence, physical attractiveness, social skills and emotional stability than their non-NSSI peers. The self-injurers also had more friends who engaged in NSSI, and having more NSSI acquaintances was negatively related to self-esteem. It could be that adolescents with lower self-esteem are more attracted to self-injuring peers, or that adolescents with low self-esteem are more vulnerable to copy NSSI to deal with their problems or to gain a certain identity in their peer group. Future studies must test these possible NSSI pathways.

Impulsive and compulsive traits in eating disordered patients compared with controls

Abstract The question whether bulimia nervosa (BN) patients show more impulsive and less compulsive traits than anorexia nervosa (AN) patients has been linked to the idea of eating disorders belonging to the so-called obsessive-compulsive spectrum disorders. In this study we have compared both impulsive and compulsive traits in three subgroups of eating disordered patients (total n =56) and a control group of 102 female students. Information about impulsive and obsessive-compulsive traits were gathered by means of standardised self-rating scales. BN and bingeing-purging AN patients reported more impulsive and obsessive traits than restrictive AN patients and controls without eating disorders, although these traits were also present in the latter groups. The data support the hypothesis that obsessive-compulsive and impulsive traits are not mutually exclusive but can be found in groups of individuals with the same diagnosis or even within the same individual.

Self-injurious behaviors in eating-disordered patients

High rates of self-injurious behaviors (SIBs) have been described in eating-disordered patients. The present study in 134 female inpatients suffering from an eating disorder (ED) confirmed this: 44% of the total group reported at least one form of SIB (mostly hair pulling, scratching, cutting, or bruising) with a mean age at onset of 17.5 years. No major differences have been found between the subgroups (anorexics, bulimics). The considerable number of patients who did not feel any pain during SIB showed more tendency towards dissociative experiences. Those who admitted SIB reported higher levels of psychological dysfunctioning, dissociative experiences, and impulsiveness.

Perceived parental psychological control and eating-disordered symptoms: maladaptive perfectionism as a possible intervening variable.

Recent developmental theorizing conceptualizes perfectionism as a mediator of the relation between intrusive parenting and psychopathology. Research addressing this hypothesis in relation to eating disorders (EDs), however, is lacking. This case-control study (a) examined mean-level differences between ED patients and normal controls in psychologically controlling parenting and perfectionism and (b) addressed the intervening role of perfectionism in associations between psychological control and ED symptoms, distinguishing between maladaptive and relatively more adaptive types of perfectionism. Hypotheses were examined in a sample of normal controls (N = 85) and a sample of ED patients (N = 60). Findings indicate that ED patients and bulimics in particular show elevated levels of paternal (but not maternal) psychological control and elevated levels of maladaptive perfectionism compared with normal controls. Mediation analyses show that maladaptive perfectionism is a significant intervening variable between parental psychological control and ED symptoms. Directions for future research on controlling parenting, perfectionism, and ED are outlined.